Diabetes declines but reason remains unclear

Between 1980 and 2014, the number of adults in the United States with newly diagnosed diabetes more than tripled. From 1991 to 2009, the number of new cases swelled from 573,000 to more than 1.7 million. But figures released Tuesday by the Centers for Disease Control and Prevention (CDC) show the number of new diabetes cases fell from 1.7 million in 2009 to 1.4 million in 2014, the fifth straight year of decline.

“It seems pretty clear that incidence rates have now actually started to drop,” said Edward Gregg, one of the CDC’s diabetes researchers. “Initially it was a little surprising because I had become so used to seeing increases everywhere we looked.”

Affecting one in every 10 American adults, diabetes is the country’s leading cause of heart disease, stroke, blindness, limb amputations, and kidney disease. It adds $176 billion to national healthcare costs. Diabetes also costs the economy another $69 billion due to disability, lost productivity, and premature death, according to a study by the American Diabetes Association.

The CDC numbers did not differentiate between new cases of Type 1 diabetes, which is generally not associated with poor lifestyle habits, versus Type 2, which is typically linked to obesity and a sedentary lifestyle. That makes understanding the reason for the decline in new diabetes cases somewhat problematic. Whether efforts to prevent diabetes have finally started to work or the disease has simply peaked in the population remains unclear.

And while these latest numbers are encouraging, health advocates remain concerned. The number of new diabetes cases each year is still triple what it was in 1980 and two high-risk populations—African Americans and Hispanics—didn’t show a significant decrease in new cases.

“It’s not yet time to have a parade,” David M. Nathan, director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital, told NPR. But “it has finally entered into the consciousness of our population that the sedentary lifestyle is a real problem, that increased body weight is a real problem.”

The federal government has launched a myriad of weight-loss and exercise programs all with mixed results. In 2002, researchers at the National Institute of Health published the results of its Diabetes Prevention Program. The study demonstrated losing a modest amount of weight and getting more exercise sharply reduced the risk of developing Type 2 diabetes in people considered high risk. In 2010, the Affordable Care Act required chain restaurants to publish the ingredients and calorie content of their meals. First lady Michelle Obama’s “Let’s Move” campaign required, among other things, for school lunches to be “healthier.” Berkeley, Calif., responding to the campaign against sodas, became the first city in the United States to tax sugary drinks.

But outside of a sharp decrease in the consumption of sugary sodas, there are few clear trends directly linked to a decline in new diabetic cases. Although the American public has “cut back some” in its overall calorie intake, consumption of fruits and vegetables remains low, and desert remains on the dinner menu.

Barry Popkin, a University of North Carolina professor who has studied food data extensively, is underwhelmed by modest dietary changes he’s seen so far.

“The food part of our diet is horrendous and remains horrendous,” he told The New York Times.

Do patients, particularly those at high risk for developing diabetes, lack information or will power? Perhaps it’s a combination of both.

“It’s so hard for patients to change their eating habits. They can know what to do, yet lack the will to do it,” said Debbie Hawkins, a registered nurse and a certified diabetes educator who volunteers at Christ Community Health Services Augusta, in Augusta, Ga. Hawkins also noted low-income patients face additional challenges. “Ever notice what’s on the menu at a local soup kitchen? Carbs, which are high in sugar.”

Still, many patients are surprised to learn that small changes can make a big difference. Alabama has the highest incidence of diabetes in the country. Robin Williams, a music teacher in Birmingham, lost 33 pounds by cutting out candy, packing her lunch, and avoiding fast food.

“I want to see my child grow up,” she told The Times.

Watching friends and family suffer from the ravages of the disease is also motivating. Eleanor Randolph, a retired schoolteacher in Livingston, said her cousin last year lost a toe and then a few months later, a leg, and finally his other leg.

“It kind of shakes you up,” she told The Times. “It makes you think. It makes you want to do right.”