The Continuing Increase of Diabetes in the U.S.
- Ali H. Mokdad, PHD,
- Earl S. Ford, MD, MPH,
- Barbara A. Bowman, PHD,
- David E. Nelson, MD, MPH,
- Michael M. Engelgau, MD, MS,
- Frank Vinicor, MD, MPH and
- James S. Marks, MD, MPH
- Address correspondence to Ali H. Mokdad, PhD, Division of Nutrition and Physical Activity, 4770 Buford Highway, N.E., Mailstop K-26, Atlanta, GA 30341. E-mail: .
Diabetes is a major cause of morbidity and mortality in the U.S. (1). The health care direct and indirect costs associated with diabetes in 1997 were an estimated $98 billion (2). Evidence from several studies indicates that obesity and weight gain are associated with an increased risk of diabetes (3,4). Obesity continues to increase rapidly in the U.S. The prevalence of obesity (BMI ≥30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998 (5).
Recently, we reported that the prevalence of diagnosed diabetes in U.S. adults increased from 4.9% in 1990 to 6.5% in 1998 (6). To determine whether this increase is continuing, we used 1999 data from the Behavioral Risk Factor Surveillance System. The results were striking: the prevalence of diabetes increased to 6.9% in 1999, a 6% increase in 1 year (Table 1). Average weight increased from 76.2 kg in 1998 to 76.7 kg in 1999 (84.3-85.0 kg among men and 68.5-68.7 kg among women).
Diabetes is clearly a growing public health threat in the U.S. This update is consistent with our earlier prediction of the epidemic nature of diabetes. Specifically for diabetes, much of the impact of the continuing increase in obesity will be manifested in future years because of the substantial delay between the onset of obesity and the subsequent development of diabetes. Public health strategies to limit this increase and address its impact are urgently needed.