American Diabetes Month: How many people in US are living with the disease? 1 in 5 are not aware they have it
More than 88 million Americans adults or over a third have prediabetes
In the US, the number of people living with diagnosed diabetes and new cases of diabetes doubled in the 1990s and throughout the 2000s, becoming one of the country’s most troubling public health threats. Currently, the seventh leading cause of death in the US, more than 34 million Americans — about 1 in 10 — have diabetes. However, 1 in 5 of them do not know that they have the disease. This is according to the 2020 National Diabetes Statistics Report, a periodic publication of the Centers for Disease Control and Prevention (CDC).
The analysis reveals that 26.9 million people or 8.2% of the US population, including 26.8 million adults were diagnosed with the disease in 2018. The agency believes that 7.3 million people or 21.4% were undiagnosed in 2018 — implying that they were either not aware they had the disease or they did not report it.
While type 2 diabetes accounts for approximately 90% to 95% of all diagnosed cases of diabetes, type 1 diabetes accounts for approximately 5-10%. Health experts emphasize that in the last 20 years, the number of adults diagnosed with diabetes has more than doubled as the American population has aged and become more overweight or obese.
“Among the US population overall, 34.2 million people of all ages — or 10.5% of the US population — had diabetes in 2018. 34.1 million adults aged 18 years or older — or 13% of all US adults — had diabetes. The percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65 years or older,” says the report.
Overall, among the US population, 210,000 children and adolescents younger than age 20 years — or 25 per 10,000 US youths — had diagnosed diabetes in 2018. This includes 187,000 with type 1 diabetes. Another 1.4 million adults aged 20 years or older, or 5.2% of all US adults with diagnosed diabetes, reported both having type 1 diabetes and using insulin. An estimated 2.9 million adults aged 20 years or older, or 10.9% of all US adults with diagnosed diabetes, started using insulin within a year of their diagnosis, reveals analysis.
Incidence of newly diagnosed diabetes
About 1.5 million new cases of diabetes, which is 6.9 per 1,000 persons, were diagnosed in 2018. Compared to adults aged 18 to 44 years, incidence rates of diagnosed diabetes were higher among adults aged 45 to 64 years, and those aged 65 years and older.
“Among adults aged 18 years or older, the age-adjusted incidence of diagnosed diabetes was similar in 2000 (6.2 per 1,000 adults) and 2018 (6.7 per 1,000 adults). A significant decreasing trend in incidence was detected from 2008 (8.4 per 1,000 adults) through 2018,” write authors.
As far as county-level incidence among adults aged 20 years or older is concerned, researchers found that estimates of diagnosed diabetes incidence varied across US counties, ranging from 1.2 to 46.2 per 1,000 persons in 2016. The median county-level incidence of diagnosed diabetes was 10.1, 11.0, and 10.3 per 1,000 persons in 2004, 2008, and 2016, respectively.
Prevalence of prediabetes
Prediabetes is a health condition in which blood sugar levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. An emerging health threat, it can also lead to type 2 diabetes, besides increasing the risk of developing chronic kidney disease, heart disease, and stroke. According to CDC, an estimated 88 million adults aged 18 years or older — over a third — have prediabetes, and more than 84% of them do not know they have it.
“Among US adults aged 18 years or older, crude estimates for 2013-2016 indicate that 34.5% of all US adults had prediabetes, based on their fasting glucose or A1C level, while 10.5% of adults had prediabetes based on both elevated fasting plasma glucose and A1C levels. 15.3% of adults with prediabetes reported being told by a health professional that they had this condition,” the findings state.
Among US adults aged 18 years or older, a higher percentage of men (37.4%) than women (29.2%) had prediabetes, shows age-adjusted data for 2013-2016. There were no significant changes in the age-adjusted prevalence of prediabetes from 2005-2008 to 2013-2016. Among adults with prediabetes, the age-adjusted percentage aware that they had this condition doubled from 6.5% to 13.3% between 2005-2008 and 2013-2016.
A previous report had suggested that nearly 1 in 5 adolescents (18%) aged 12-18 years, and 1 in 4 young adults (24%) aged 19-34 years, are living with prediabetes in the US. The percentage of adolescents and young adults living with prediabetes was higher in males than in females (22.5% versus 13.4%) and participants with obesity (25.7% versus 16.4%).
Adolescents and young adults with prediabetes had significantly higher cholesterol levels, systolic blood pressure, abdominal fat, and lower insulin sensitivity than those with normal glucose tolerance, which increased their risk of type 2 diabetes and other cardiovascular diseases.
“The prevalence of prediabetes in adolescents and young adults reinforces the critical need for effective public health strategies that promote healthy eating habits, physical activity, and stress management. These lifestyle behaviors can begin early in a child’s life and should continue through adolescence and adulthood to reduce the onset of type 2 diabetes,” says CDC Director Robert R Redfield.
The medical costs for people with diabetes are twice as high as for people who do not have the disease. The total direct and indirect estimated costs of diagnosed diabetes in the US in 2017 was $327 billion. Between 2012 and 2017, excess medical costs per person associated with diabetes increased from $8,417 to $9,601.
“Total direct estimated costs of diagnosed diabetes increased from $188 billion in 2012 to $237 billion in 2017 (2017 dollars), while total indirect costs increased from $73 billion to $90 billion in the same period (2017 dollars),” write authors.