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Category: Diabetes

Latest Statistics: 34 Million Americans Have Diabetes

Previous data indicates that diabetes is the leading risk factor for hospitalizations across the United States, with a total of 7.8 million hospital discharges reporting the condition as any of the listed diagnoses among adult patients aged 18 or older. Although incidence rates have slowed in recent years, approximately 34 million adults in the United States have type 1 or type 2 diabetes today. Of those, about 7.3 million meet laboratory criteria for diagnosed diabetes, however, are unaware or do not report having the disease. 

In a recent attempt to calculate the national estimated disease burden and prevalence of diabetes, the Centers for Disease Control and Prevention released the 2020 National Diabetes Statistics Report, which can be accessed in full here. Their findings indicate a decrease in the number of newly diagnosed diabetes cases in recent years among most – but not all – demographics and highlight the importance of more targeted prevention methods focused on adolescents specifically. 

Data for the report were derived from the National Health and Nutrition Examination Survey, the National Health Interview Survey, the Indian Health Service (IHS), National Data Warehouse, the Behavioral Risk Factor Surveillance System, the U.S. Diabetes Surveillance System, and the U.S. resident population estimates. Researchers established diagnosed diabetes status based on self-reported patient information; undiagnosed diabetes was determined by fasting plasma glucose measures or HbA1c levels.

Current Estimates

In 2018, new cases of diagnosed diabetes grew by 1.5 million, equivalent to about 6.9 diagnosed patients per 1,000 persons, similar to 2006 incidence rates. That year an estimated 88 million adults had prediabetes, although many of them may have been unaware of their condition.

Currently, adults aged. between 18 to 44 years experience lower diabetes rates than those aged between 45 and 65 as well as those aged above 65 years. However, younger demographics are increasingly at risk for developing the condition.

Incidence of New Cases in Youth

Per the latest statistics, the number of new diabetes cases decreased throughout the past decade in the United States with one exception – the overall incidence of type 1 diabetes significantly increased among children and adolescents between 2002 and 2015. The largest change was observed among children of Hispanic descent. In addition, the prevalence of type 2 diabetes also increased in this age demographic with changes consistent across all racial groups.

Prevalence and Risk Factors

Despite the decreased incidence of new cases in adults, the latest data from the Centers for Disease Control and Prevention reveal that the age-adjusted prevalence of total diabetes increased among adults between 1999 and 2016 – up from 9.5% in 1999-2002 to 12% in 2013-2016. These results held steady in 2018 at 6.7 per 1,000 adults compared with 2000 data, which reported a rate of 6.2 per 1,000 persons. 

Meanwhile, the age-adjusted results for 2017-2018 found the prevalence of diagnosed diabetes was highest among Native Americans and Alaskan Natives, Hispanic adults, and African Americans.

“Among adults, prevalence varied significantly by education level, which is an indicator of socioeconomic status,” the report explains. “Specifically, 13.3% of adults with less than a high school education had diagnosed diabetes vs. 9.7% of those with a high school education and 7.5% of those with more than a high school education.”

Common risk factors for diabetes-related complications showed that about 22% of diagnosed adults were tobacco users, 15% reported current smoking, and 36.4% had quit smoking. Furthermore, 89% of those with diagnosed diabetes were overweight or had obesity while 38% were physically inactive. 

Implications

As current literature proves, diabetes has a significant burden on population health and outcomes, contributing to increased risks of comorbid cardiometabolic conditions as well as adverse complications. The growing number of newly diagnosed cases in children and adolescents indicates an urgent need for age-specific prevention and management protocols as well as increased efforts to combat the disease in younger populations as early onset diabetes tends to predispose patients to poorer outcomes. 

The CDC’s latest report outlining trends in prevalence and estimates of diabetes burden can be accessed here.

New Technology Reduce Burden and Improves Type 1 Diabetes Management

Although significantly less prevalent than type 2 diabetes, type 1 affects over 1 million children and adults in the United States – or about 5% of the diabetes population. Individuals with type 1 diabetes must monitor their blood sugar levels continuously to ensure they do not drop or grow to dangerous measures. Conventional monitoring methods require patients to prick their fingers several times daily or wear a glucose monitor, however, a new form of technology may help replace traditional strategies while improving glycemic outcomes.

 A recent study published in the New England Journal of Medicine evaluated the efficacy of closed-loop systems that automate insulin delivery and their effects on glucose control in patients with type 1 diabetes. The authors of the paper investigated the use of a novel artificial pancreas that continuously monitors and regulates blood glucose levels by releasing the hormone into the body when insulin levels are low. The closed-loop control, called the Control-IQ system, utilizes algorithms to automatically adjust insulin doses throughout the day without the need for blood drawing or patient involvement.

Closed-Loop Control for Type 1 Diabetes

Researchers conducted a 6-month randomized, multi-center trial of 168 individuals with type 1 diabetes. Participants were assigned to receive treatment either with the closed-loop system or a sensor-augmented pump (as part of the control group). Over 100 subjects were assigned to the Control-IQ system to measure the primary outcome – the percentage of time that blood glucose levels were within the target range of 70 to 180 mg per deciliter. Participants were between 14 and 71 years old with a glycated hemoglobin level between 5.4 and 10.6%. The researchers did not monitor the glucose systems remotely as they wanted to replicate real-life conditions.

Continuous Blood Glucose Control

At the end of the trial, the team found that the mean percentage of time that glucose levels were within the target range had increased within the closed-loop cohort. Participants in this group were in the target range for an average of 2.6 hours longer per day, meanwhile, those who used the sensor-augmented pump experienced no change during the trial. Furthermore, the percentage of time that glucose levels were under 180 mg per deciliter, mean glucose level, and other secondary outcomes all favored the closed-loop system.

The median percentage of time that the system was in closed-loop mode was 90% over the course of 6 months. No serious hypoglycemic events were reported in either cohort although, one episode of diabetic ketoacidosis occurred in the closed-loop group due to an equipment issue. None of the cohorts experienced severe hypoglycemia during the study.

 Most notably, the closed-loop system not only improved participants’ blood glucose control throughout the day, but it also controlled levels overnight – a vital development for patients who experience glycemic drops throughout the night.

As the study’s findings reveal, the use of a closed-loop system can significantly improve the number of time patients remain in the target glycemic range  compared with the use of a sensor-augmented insulin pump. By automating the insulin delivery process, the new technology has the potential to both improve the health of type 1 diabetes patients and alleviate some of the burdens of managing the condition. According to experts, this could result in a reduction in diabetes complications, including eye, nerve, and kidney diseases. Director of the UVA Center for Diabetes Technology, Boris Kovatchev, PhD, told Medical News Today that the technology’s glucose control abilities go “beyond what is achievable using traditional methods,” indicating a tremendous potential to improve diabetes management.

 

The study is part of a larger research initiative – the International Diabetes Closed-Loop (iDCL) Study  – which focuses on testing various artificial pancreas systems to assess their safety, efficacy, and user-friendliness, among other factors. Meanwhile, the research team has submitted the results of the trial to the FDA and is awaiting a final decision on market approval of the novel technology.