Epidemiology and Pathophysiology

Epidemiology 

 

  • 30.3 million Americans, or 9.4% of the US population, have diabetes.1
  • 7.3million people with diabetes have not had a diagnosis.1

Source: CDC. Diabetes Info Cards. https://www.cdc.gov/diabetes/library/socialmedia/infocards.html.

Diabetes affects people of all races and ethnicities, but disparities exist.3

  • American Indians/Alaskan Natives comprise the largest age-adjusted racial/ethnic group of people diagnosed with diabetes.
  • The proportion of African American, Hispanic, and Asian American populations who have diabetes is higher than in the non-Hispanic white population.

Source: CDC. Addressing Health Disparities in Diabetes. https://www.cdc.gov/diabetes/disparities.html

1.5 million new cases of diabetes were diagnosed in adults in the United States in 2018. An estimated 452,000 new cases of diabetes occurred in patients age 18-44 years, 706,000 new cases in patients age 45-64 years, and 326,000 new cases in patients 65 years or older.1

Source: Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020.https://www.cdc.gov/diabetes/data/statistics/statistics-report.html

Annually, 5,758 people younger than 20 years had diagnoses of type 2 diabetes annually during 2014-2015.1

  • The proportion of newly diagnosed cases in people under 20 years of age was higher among US minority populations than in non-Hispanic whites.1
  • Between 2001 and 2009, the overall prevalence of type 2 diabetes among children and adolescents increased by 30.5% when adjusted for differences in completeness of ascertainment.4

 

Trends in type 2 diabetes prevalence among children and adolescents, 2001-2009, by sex and age and race/ethnicity 4

NHW=non-Hispanic white; AA=African American; HISP=Hispanic; API=Asian Pacific Islander; AI=American Indian.

  • In 2018, 88 million Americans age 20 and older had prediabetes.1
  • From 2013-2016, based on fasting glucose or A1C levels, 34.5% of U.S. adults aged 18 years or older had prediabetes.1
    • 6% of those adults 65 years or older had prediabetes.
  • On the basis of fasting glucose or A1C levels, and after adjusting for population age differences, the percentage ofUS adults aged 20 years or older with prediabetes 2013−2016 was similar for non-Hispanic whites (33.9%), non-Hispanic blacks (36.9%), non-Hispanic Asians (32.8%), and Hispanics (35.4%).1
  • Diabetes was the seventh leading cause of death in the United States in 2018.5
    • The death rate from diabetes may be underreported.6
    • Studies have reported that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on the death certificate.6
    • Approximately 10% to 15% of death certificates had diabetes listed as the underlying cause of death.6

 

Pathophysiology

 

Diabetes is characterized by the dysfunction of insulin-producing pancreatic beta cells, insulin hormone resistance in cells of the body, or a combination of both.8,9

  • Genetic predispositions and environmental factors that affect beta-cell function and insulin sensitivity have both been implicated in the development of type 2 diabetes.8,9
  • Type 2 diabetes begins with a resistance to insulin that worsens over time.7
  • When the pancreatic beta cell can no longer produce enough insulin to compensate for a diminished insulin response, glucose concentrations rise and ß cell functions are impaired.8
  • The progressive failure of beta cells is responsible for the transition from impaired glucose tolerance to type 2 diabetes.9

Source: DeFronzo RA, et al. Pathogenesis of NIDDM. A balanced overview. Diabetes Care. 1992;15:318-368.

 

References

  1. Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html.
  2. CDC. Diabetes Info Cards. https://www.cdc.gov/diabetes/library/socialmedia/infocards.html.
  3. . CDC. Addressing Health Disparities in Diabetes. https://www.cdc.gov/diabetes/disparities.html.
  4. . Dabelea D, SEARCH for Diabetes in Youth Study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009.. JAMA. 2014;311:1778-1786.
  5. Xu JQ, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2018. NCHS Data Brief, 355. Hyattsville, MD: National Center for Health Statistics.2020. https://www.cdc.gov/nchs/products/databriefs/db355.htm#section_2.
  6. . American Diabetes Association. Statistics about diabetes.https://www.diabetes.org/resources/statistics/statistics-about-diabetes?loc=db-slabnav
  7. Levin PA. Practical combination therapy based on pathophysiology of type 2 diabetes. Diabetes Metab Syndr Obes. 2016;9:355-369.
  8. Kahn SE. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet. 2014;383:1068-1083.
  9. DeFronzo RA. Pathogenesis of NIDDM. A balanced overview. Diabetes Care. 1992;15:318-368.