Monday, August 20, 2007

Diabetes: "epidemic" may be too strong a word

This morning's edition of The New York Times featured an article entitled "An Increase in Diagnoses May Not Mean a Higher Rate of the Disease, a Survey Shows," no doubt written to address the oversimplified media response to recent reports that the diagnosis of diabetes is at its highest levels in history.

To get a better idea of whether the disease is striking more people or whether more people who have the disease are receiving diagnoses, the article notes that statisticians have turned to another set of federal data. It is from the National Health and Nutrition Examination Survey (NHANES), which is a periodic survey of a representative group of Americans that not only asks whether people have been told they have diabetes but that also includes blood tests to find undiagnosed cases. (I would just personally add that NHANES does not capture what type of diabetes a person has, thus the counts do little to track the growth in type of diabetes, which is a major flaw that has yet to be corrected. More recent data, notably from the SEARCH for Diabetes in Youth, suggests that incidence both types of diabetes are growing, and that previous estimates of type 1 diabetes may have been under-counted).

Still, the article reports that in a paper published last year in Diabetes Care, federal scientists used those data to ask what was the total proportion of the population with diabetes — diagnosed and undiagnosed.

Their surprising conclusion, said Katherine M. Flegal, an author of the paper and an epidemiologist at the National Center for Health Statistics, was that the overall age-adjusted proportion of the population that has diabetes had not really changed from 1988 to 2002, the most recent year for which federal data are available.

No doubt, the incidence of both types of diabetes is rising, particularly among certain groups that had previously had lower levels of diagnoses, such as Blacks and Hispanics, and that probably reflects the fact that we have become better at diagnosing people. But some question whether the term "epidemic" is really appropriate in the case of diabetes. Regardless, talk is cheap, what we really need is to address the cause behind the increase in both type 2 AND type 1. So far, little has been done in that regard except a lot of finger-pointing.


Jenny said...


I was thrilled to see Gina Kolata cite two facts I've had on my web site for 3 years--that there's an 80% concordance for diabetes in identical twins and the only 10% of the obese develop diabetes, making it not so likely that obesity itself causes diabetes.

What was a shame, though, was she went on to report that attaining normal blood sugars was "impossible" which is simply not true, and to suggest that diabetes causes heart disease as if that was not related to the way doctors tell people that A1cs shown to quadruple heart disease risk are "good control."

The coverage then segueyed into an ad for statin drugs for all diabetics.

One day I'll pick up my paper and read a mainstream article suggesting that people with Type 2 can (and do) achieve normal blood sugars by cutting way down on carbs and that attaining normal blood sugars will prevent all diabetic complications.

I'll probably have MY heart attack thanks to the shock.

BetterCell said...

It's too bad Scott that most writers who report on Diabetes fail to specify for the most part, if they are writing about Type 1 Diabetes or IRD (aka Type 2).
When you "Lump" the two different Diseases into one word Diabetes, then an injustice is done for all of us with Type 1 Diabetes because the reference for the most part is always to Type 2.
It is time for everyone in Medicine to begin to refer to Type 2 as IRD or something else, but not Diabetes.