Man exercising in a gym.

New cases of diabetes may be down but more work is needed

									Charlie Plain |
																			December 9, 2015

Man exercising in a gym.A recent report by the Centers for Disease Control and Prevention (CDC) found new cases of diabetes dropped by roughly one-fifth from 2008-2014, from 1.7 million to 1.4 million. And while the investigators are unsure whether prevention efforts are working or if the disease peaked in the U.S., the findings were good news after decades of seeing numbers skyrocket.

According to a recent New York Times article, “there is growing evidence that eating habits, after decades of deterioration, have finally begun to improve. The amount of soda Americans drink has declined by about a quarter since the late 1990s, and the average number of daily calories children and adults consume also has fallen. Physical activity has started to rise, and once-surging rates of obesity, a major driver of type 2 diabetes, the most common form of the disease, have flattened.”

Health Talk spoke with Mark Pereira, associate professor of epidemiology and community health in the School of Public Health and Elizabeth Seaquist, professor of medicine in the Medical School to help understand the numbers.

Health Talk (HT): How does prevention play a role in lowered number of diabetes cases?

Mark Pereira (MP): Type 2 diabetes is highly preventable through regular physical activity, which does not have to be intense or vigorous. Thirty-plus minutes of daily walking is effective at reducing the risk of diabetes.  Also, following the dietary guidelines in terms of fresh fruits, vegetables, whole grains, and avoiding fast food, highly process foods, refined starches and sugars, goes a long way towards preventing diabetes.

There is some evidence that diabetes awareness has increased over the past decade, and obesity prevalence has levelled off or may have declined in some groups in the U.S. It’s starting to look like we are achieving some real population level public health goals in terms of awareness, education, changing policies towards promotion of physical activity and healthful eating patterns. We still have a long way to go but this news is very encouraging.

HT: What is being done in a clinical sense to help prevent new diabetes cases?

Elizabeth Seaquist (ES): There is more emphasis on encouraging patients to exercise regularly and eat a well-balanced and healthy diet. In addition, lean patients are encouraged to remain lean and overweight and obese patients are encouraged to lose weight. The National Diabetes Prevention Program demonstrated that those focusing on these variables will reduce the incidence of diabetes in those at risk.

HT: How do we keep diabetes rates down?

MP: We must continue to make progress in all areas of education, environment, and policies. One local example includes the removal of fast food restaurants in hospitals. Breakfast and lunch programs in public schools have improved. We need to focus on our youth to improve their education and life course trajectory for healthful living habits and work together on these issues across academia, government, industry and community groups.

A great local example is how much our Twin Cities communities and governments continue to invest more in an environment that promotes physical activity through our park systems, transportation systems, nation-leading bicycling and active commuting infrastructure.​ Our local food environment and culture is also at the top of the nation as a model that is important for local economy, environment, culture and health.

HT: Do you trust the numbers or is this a fluke?

MP: I’m comfortable with the decrease in self-reported diabetes as a real trend, but there are some limitations with the data from the CDC. The data are based on self-report, rather than on measured blood sugar. Nonetheless, the survey methods have been consistent over time, so you would expect the steady downward trend in diabetes incidence, which is now statistically significant, to be real rather than artifact. However, we cannot use the self-report data to precisely estimate diabetes prevalence in the U.S. because many people have diabetes but do not realize they have the disease until they develop symptoms and then are eventually diagnosed. We need to look to other large studies of the population that have measured blood sugar. Those studies are more difficult to conduct, but they do exist, although on a smaller scale.

ES: I also trust the numbers and think this shows that diabetes prevention is beginning to get the attention it needs, but that more attention is needed. Everyone in the U.S. should understand the importance of diet, exercise and weight management in health.

~ This post originally appeared on the Academic Health Center’s “Health Talk” blog.

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