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    Type 2 Diabetes Prevalence and Chemical Production, U.S.


    While excess calories, junk food, and lack of exercise certainly play a major role in the increasing prevalence of type 2 diabetes, prevalence the 1 last update 11 Jul 2020 has also increased along with chemical production. While correlation does not prove causation, these trends could be related. While excess calories, junk food, and lack of exercise certainly play a major role in the increasing prevalence of type 2 diabetes, prevalence has also increased along with chemical production. While correlation does not prove causation, these trends could be related. 

    Source: Neel and Sargis (2011), published by the American Diabetes Association. 

    The Details



    Summary

    Diabetes Incidence and Historical Trends

    Both the incidence  and prevalence of type 1, type 2, and gestational diabetes has increased over the past decades, worldwide. There is some evidence of recent plateaus in some countries.

    This page looks at these trends in more detail, focusing on type 1 diabetes, and includes information on ethnicity, age, gender, seasonality, and geography, as well as type 1 diabetes clusters-- yes, clusters do exist.

    None of the environmental factors linked to type 1 diabetes so far appear to be able to explain the increasing incidence trends (Norris et al. 2020), except, I would argue, environmental chemical exposures.


    The Details

    About Incidence and Prevalence

    Incidence is the number of people who get a disease in a given location and time period, and prevalence is the number of people who have a disease in a given location and time period. Essentially, incidence is a measure of how many people are newly diagnosed with a disease.

    Type 2 Diabetes Incidence and Prevalence

    For the most current information on the number of people with type 2 diabetes around the world, see the International Diabetes Federation Diabetes Atlas. Here are some numbers:
    In China, nearly 50% of adults had diabetes or prediabetes in 2013 (Wang et al. 2017).

    Of U.S. adults, 12-14% have type 2 diabetes (in 2011-12). The numbers are higher for blacks, Hispanics, and Asians than for whites. The prevalence of diabetes in the U.S. has increased over the past few decades (it was 9.8% in 1988-1994) (Menke et al. 2015). The good news, however, is that in U.S. adults since 2009, diabetes prevalence has flattened out, and incidence has actually decreased (especially in non-Hispanic whites). However, rates are still high, and obesity continues to increase (Benoit et al. 2019). In fact, in many developed countries, the increasing type 2 diabetes incidence may be leveling out. From 2006-14, increasing trends were found in only 33% of populations, whereas 30% and 36% had stable or declining incidence (these data are mostly from higher income countries) (Magliano et al. 2019). For more on this study, see article in Medpage Today, Is Diabetes Becoming Mainly a Third World Problem?— Incidence declines seen predominantly in high-income countries.

    In U.S. youth, the latest data show that the prevalence of type 2 diabetes increased by over 30% between 2001 and 2009 (Dabelea et al. 2014). In addition, nearly 1 in every 5 U.S. teenagers has abnormally high blood glucose levels (Menke et al. 2016). In fact, in the U.S., the rates of type 2 diabetes in children are now increasing faster than type 1 diabetes: between 2002 and 2012, the incidence of type 2 diabetes in children increased by 4.8% per year, and was especially high in minority groups (Mayer-Davis et al. 2017). As of 2016, about 1 of 5 adolescents and 1 of 4 young adults had prediabetes (Andes et al. 2019).

    In the U.S., racial minority groups tend to have the highest incidence of type 2 diabetes. The cause of these differences is not known; certainly diet, an unsafe environment, poverty, and lifestyle could play a role, as could exposure to environmental chemicals (Golden et al. 2019; Sargis and Simmons, 2019). In the U.S., racial minority groups tend to develop type 2 diabetes at a lower body weight (BMI) than whites (Zhu et al. 2019).

    In the U.S., subgroups within various racial groups also have a differing prevalence of type 2 diabetes. In a sample of U.S. adults, the prevalence of total diabetes was 12% for non-Hispanic whites, 20% for non-Hispanic blacks, 22% for Hispanics, and 19% for non-Hispanic Asians. Among Hispanic adults, the prevalence of total diabetes was 25% for Mexicans, 22% for Puerto Ricans, 21% for Cuban/Dominicans, 19% for Central Americans, and 12% for South American subgroups. Among Asians, the prevalence of total diabetes was 14% for East Asians, 23% for South Asian, and 22% for Southeast Asian subgroups. The prevalence of undiagnosed diabetes was 4% for non-Hispanic whites, 5% for non-Hispanic blacks, 8% for Hispanics, and 8% for Asians (Cheng et al. 2019).

    Preschoolers with Type 2? Really?

    Really. In Texas, perhaps the youngest person ever to develop type 2 diabetes was 3 1/2 years old. It was caught early and reversed with dietary changes and metformin (Yafi et al. 2015). Also in Texas, a 5 year old was also diagnosed with type 2 diabetes (Hutchins et al. 2017). While these cases are rare enough to merit publication as case studies, the trend is alarming!

    Type 1 Diabetes Incidence and Prevalence

    There are approximately 500,000 children aged under 15 with type 1 diabetes in the world (Patterson et al. 2014). No wait, that was in 2013. In 2017, it''s 600,900 children and 1,110,100 with adolescents in 2019. numbers have increased in most regions (Patterson et al. 2019). (Check the current IDF Diabetes Atlas for the most recent numbers.) The most recent numbers as of 2019 show that 600,900 children have type 1 diabetes in the world, and that 98,200 more are diagnosed each year. Incidence remains highest in Finland, Sardinia and Sweden, followed by Kuwait, some other northern European countries, Saudi Arabia, Algeria, Australia, New Zealand, USA and Canada. The lowest incidence is seen across East and South-East Asia. Globally, the average increase in incidence has been 3-4%/year over past decades, being steeper in low-incidence countries (Tuomilehto et al. 2020). 

    In the U.S., the CDC collects nation-wide data on diabetes, but does not differentiate between type 1 and type 2 diabetes. In 2016, supplemental questions to help distinguish diabetes type were added to the National Health Interview Survey (NHIS). Based on self-reported type and current insulin use, 0.55% of U.S. adults had diagnosed type 1 diabetes, representing 1.3 million adults; 8.6% had diagnosed type 2 diabetes, representing 21.0 million adults. Of all diagnosed cases, 5.8% were type 1 diabetes, and 90.9% were type 2 diabetes; the remaining 3.3% of cases were other types of diabetes (Bullard et al. 2018).

    In the U.S., as elsewhere, type 1 diabetes prevalence varies by race or ethnicity. For example, the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), of four U.S. locations, found that the overall prevalence of type 1 diabetes in Hispanics/Latinos was 1.8/1000 persons. This is similar to the estimates obtained through other studies, such as NHANES (2.6/1000) and the SEARCH for Diabetes in Youth Study (1.5/1000). The prevalence varying by specific Hispanic/Latino background, and is highest in people of Dominican ancestry (Kinney et al. 2019). Note that each of these studies uses different definitions of type 1 diabetes, based on criteria such as age of onset or insulin use, and are not necessarily based on a doctor''s Hospital of Alabama show that there was an increase in type 1 incidence between 2000-2017, with an annual percent change of 10% from 2000-2007 and a 1.7% decrease from 2007-2017. The incidence for Whites and Blacks both increased, with an average annual percentage change of 4.4% and 2.8%, respectively. The increase plateaued in 2006 for Whites and 2010 for Blacks (Correya et al. 2019).

    Can Genes Alone Explain the Increasing Incidence?

    Type 1 Diabetes Incidence and Chemical Production, U.S.


    Type 1 diabetes incidence has increased in conjunction with chemical production in the U.S. over the past decades. Incidence rates were low before World War 2 (the range is shown in the bars above 1920), when the widespread use of chemicals began. While "" these trends could be related.

    Sources: Chemical production data taken from Neel and Sargis (2011). Diabetes incidence data taken from various studies on type 1 diabetes incidence, included in this PubMed collection.

    No.

    Essentially all researchers agree that changes of this magnitude cannot be explained by genetic changes alone. In fact, studies are finding that high risk susceptibility genes for type 1 diabetes are becoming less frequent over time in children, while more children with low to moderate risk genes are developing the disease more now than in years past (Fourlanos et al. 2008; Gillespie et al. 2004; Hermann et al. 2003; Resic-Lindehammer et al. 2008; Steck et al. 2011; Vehik et al. 2008). An interesting study from Poland analyzed susceptibility genes from exhumed skeletons from the Middle Ages, and found that genetic predisposition to type 1 diabetes is lower today than it was 700 years ago (Witas et al. 2010).

    It is also clear that the trend varies by year and by location, implying environmental factors are critical. The rates of increase are not uniform within Europe or within countries, suggesting that different risk factors vary over time in different countries (Patterson et al. 2012).

    Genes probably do play a role in the geographical variations in type 1 diabetes incidence around the world. Yet even some studies find that genetics do not necessarily play a large role in some of these variations (e.g., Santana Del Pino et al. 2017).

    One Israeli study found that the average annual percent change in type 1 diabetes incidence increased by 1.9% in people with a first-degree relative with type 1, and decreased by 0.2% in people without a first-degree relative with type 1, suggesting that environmental factors impose higher diabetogenic pressure in people with genetic susceptibility (Zung et al. 2018). I haven''s children. At that rate, the incidence of type 1 will double in just four years (between 2016 and 2020), and prevalence will sextuple by 2025 (Zhao et al. 2014). In Zhejiang, China (just south of Shanghai), incidence increased 12% per year between 2007 and 2013. Even worse, incidence increased by over 33% per year in children under 5 years old! (Wu et al. 2016). Poland has an increasing incidence by 12.7% per year from 2010 to 2014, especially in urban areas (Szalecki et al. 2018). Algeria also shows a steep rise of 12.8% from 1973-2017 (Touhami et al. 2019).

    Geographic Variations

    Of the 500,000 children with type 1 diabetes in the world, the most live in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually (highest incidence) were the United States (13,000), India (10,900) and Brazil (5000) (Patterson et al. 2014). In the U.S., an estimated 191,986 U.S. youth under age 20 have diabetes; 166,984 have type 1 diabetes; 20,262 have type 2 diabetes; and 4,740 have "" (Pettitt et al. 2014).

    Type 1 diabetes incidence ranges from very low in South America and Asia, to very high in Europe, especially northern Europe (Onkamo et al. 1999). Finland, Sardinia (Italy), and Sweden have the highest incidence of type 1 diabetes in the world (Diamond Project Group 2006, Patterson et al. 2014, Tuomilehto 2013). In fact, the longer you live in Sweden, the higher your risk of type 1 diabetes-- offspring of immigrant women living in Sweden for 11 years or more have a 22% higher risk than offspring of women living in Sweden for 5 years or less (Hussen et al. 2015). Other countries show changes in incidence when after immigration, for example, immigrants to Israel from lower incidence countries lose their protection against diabetes around adolescence; the younger they are when the immigrate, the more likely they are to get type 1 (Peled et al. 2017). 

    As an example of a country with low incidence, black children in Dar es Salaam in Tanzania have very low incidence of type 1 diabetes, at 1.5 people diagnosed per 100,000 people, which is much lower than rates for black children in the U.S., Virgin Islands, or Cuba. In Tanzania, only one child under age 5 was diagnosed during one 10 year study period (Swai et al. 1993). In Ghana, rates remain low, although there have been some changes over time, with increasing rates in adolescents but decreasing rates overall (from 1992-2018) (Sarfo-Kantanka et al. 2020). The Raikas, a tribal group in India, have a far higher genetic risk of type 1 diabetes than other North Indians, yet the incidence of type 1 is almost nil (Bhat et al. 2014)-- implying that genetics do not tell the whole story.

    Age

    Type 1 Incidence Is Increasing Fastest in the Youngest Children


    Eric was diagnosed with type 1 diabetes just two days after this photo was taken, at age 18 months. Type 1 incidence is increasing fastest in children under 5. His mother wrote a book, 100 questions and answers about your child''s high incidence of type 1 diabetes does not fit the rule. Variations within countries also do not always correspond to latitude (Soltesz et al. 2007).

    A study using data from 72 countries found that those at higher latitudes and with less sunshine had higher rates of type 1 diabetes. They also found that incidence was higher in countries with "" climates (Chen et al. 2017).
     
    Vitamin D, which is produced by the skin when exposed to sunlight, is a possible explanation for this pattern. In a study of 51 regions around the world, Mohr et al. (2008) found that areas with lower levels of ultraviolet B radiation (the main source of vitamin D in humans) had a higher incidence of type 1 diabetes. Vitamin D deficiency appears to be a risk factor for type 1 diabetes, and vitamin D cannot be produced adequately by the skin during the winter in areas closer to the polar regions. In Sweden, a study has found that temperature is more important than sunshine in explaining the higher incidence in the northern parts of that country. Cold weather may increase insulin resistance and exacerbate the disease process (Waernbaum and Dahlquist, 2016). Another possibility is that persistent organic pollutants (POPs) play a role. POPs evaporate and migrate to the polar regions of the earth; some POPs (as well as other chemicals) can even interfere with vitamin D synthesis (see the vitamin D deficiency page).

    Wealth

    Most countries with high type 1 diabetes incidence are Westernized, developed countries, and the highest incidence countries tend to be the wealthiest countries (Diamond Project Group 2006Gomez-Lopera et al. 2019). Even within regions such as Europe, incidence is correlated to gross national product (GNP) and other indicators of national prosperity (Patterson et al. 2001). Some studies have found higher incidence of type 1 in wealthier areas or in people with higher socioeconomic status within countries as well, such as Chile (Torres-Aviles et al. 2010) and the U.S. (D''s disease for example, which is more common in people with type 1 diabetes (Chantzichristos et al. 2018).

    reverses diabetes type 2 can drink alcohol (🔴 natural treatment) | reverses diabetes type 2 meal planhow to reverses diabetes type 2 for These seasonal variations are often attributed to viruses, cold weather, or vitamin D levels. In fact, one study from Denmark found that the association between type 1 diabetes and season of birth disappeared (in males) during the years when margarine was fortified with the 1 last update 11 Jul 2020 vitamin D (Jacobsen et al. 2016). A number of environmental chemical exposures can also vary seasonally, such as air pollutant levels (Hathout et al. 2002), nitrate levels in drinking water (Parslow et al. 1997), flame retardant levels in the body (Hoffman et al. 2017), and agricultural pesticide use. There may be other explanations as well (e.g., children may get less exercise in cold climates in the winter, leading to increased insulin resistance, or their parents eat Icelandic smoked mutton at Christmas... but you'll have to read about that story on the nitrate and nitrite page).These seasonal variations are often attributed to viruses, cold weather, or vitamin D levels. In fact, one study from Denmark found that the association between type 1 diabetes and season of birth disappeared (in males) during the years when margarine was fortified with vitamin D (Jacobsen et al. 2016). A number of environmental chemical exposures can also vary seasonally, such as air pollutant levels (Hathout et al. 2002), nitrate levels in drinking water (Parslow et al. 1997), flame retardant levels in the body (Hoffman et al. 2017), and agricultural pesticide use. There may be other explanations as well (e.g., children may get less exercise in cold climates in the winter, leading to increased insulin resistance, or their parents eat Icelandic smoked mutton at Christmas... but you'll have to read about that story on the nitrate and nitrite page).

    Interestingly, seasonal variations have also been found in other types of diabetes. For example, in gestational diabetes incidence/prevalence (see below), and in season of birth for type 2 diabetes (Si et al. 2017). Seasonal variations are also present in other autoimmune diseases (Watad et al. 2017).

    Other Variations

    In Australia, researchers have found that there is a regular 5 year pattern of type 1 diabetes incidence in children. That is, every 5 years there is a peak or trough in the overall incidence rates. Why this is I have no idea (Haynes et al. 2015Haynes et al. 2012). A Polish study also found a 5 year fluctuation pattern (Chobot et al. 2017). Huh.

    What about diabetes complications? South Asians with type 1 diabetes living in India had significantly greater risk of diabetic kidney disease and retinopathy, but a lower risk of neuropathy than white Europeans living in the UK. South Asians in India also had a significantly greater risk of diabetic kidney disease than South Asians living in the UK, but there was no significant difference in the risk of other complications. These finding are the same as are seen in type 2 diabetes (Chetan et al. 2019). This implies that geography may also play a role in the risk of complications from diabetes (although how much is due to different treatment in different areas is a major question for me).

    Other Autoimmune Diseases

    The incidence of many immune disorders, including many other autoimmune diseases, is rising (Bach 2002). Worldwide, the incidence of celiac disease is rising, and like type 1, this rise is occurring in industrialized countries, and beginning in the latter half of the 20th century (King et al. 2020). In Finland, the increasing incidence of the autoimmune disease multiple sclerosis follows the same pattern as type 1 diabetes as well (Holmberg et al. 2013).

    Gestational Diabetes Incidence and Prevalence

    The incidence of gestational diabetes also appears to be increasing, in many countries around the world. For example, throughout the U.S., the prevalence of gestational diabetes increased dramatically between 1989 and 2004 (Getahun et al. 2008). A different study also finds an increase in gestational diabetes prevalence in the U.S., between 1979 and 2010 (Lavery et al. 2017). Between 2012 and 2016, gestational diabetes prevalence has continued to increase in the U.S. (Deputy et al. 2018). In Pennsylvania, gestational diabetes incidence rose for 1 last update 11 Jul 2020 between 1999 and 2008 (Khalifeh et al. 2014 ).The incidence of gestational diabetes also appears to be increasing, in many countries around the world. For example, throughout the U.S., the prevalence of gestational diabetes increased dramatically between 1989 and 2004 (Getahun et al. 2008). A different study also finds an increase in gestational diabetes prevalence in the U.S., between 1979 and 2010 (Lavery et al. 2017). Between 2012 and 2016, gestational diabetes prevalence has continued to increase in the U.S. (Deputy et al. 2018). In Pennsylvania, gestational diabetes incidence rose between 1999 and 2008 (Khalifeh et al. 2014 ).

    In Korea, the incidence increased dramatically between 2006 and 2010 (Cho et al. 2015). In Canada, the incidence of gestational diabetes has doubled over the past 14 years (Feig et al. 2014). In Denmark, gestational diabetes increased in all age groups between 2004 and 2012 (Jeppesen et al. 2017). In Catalonia, Spain, gestational diabetes prevalence almost doubled between 2006 and 2015 (Gortazar et al. 2019); another Spanish study also find increasing incidence (López-de-Andrés et al. 2020). In Israel, glucose levels become higher in pregnant women between 2005 and 2016 after a glucose tolerance test (Yoles et al. 2019).

    In parts of China, gestational diabetes prevalence has remained somewhat stable (with annual variations) between 2011 and 2018, but the prevalence is quite high, affecting an average 17.6% of pregnant women (Yan et al. 2019).

    An interesting study from Denmark found that gestational diabetes incidence rates are different in women who immigrated as compared to those who grew up in Denmark. The risk varied a lot based on country of origin, and varied depending on the number of years spent in Denmark (Kragelund Nielsen et al. 2020).

    reverses diabetes type 2 journal (☑ ketosis) | reverses diabetes type 2 good foodhow to reverses diabetes type 2 for Gestational diabetes also shows seasonal variations. In Australia, the prevalence and incidence of gestational diabetes can vary by season, although one study found it peaked in the summer (Moses et al. 2016), and one in the winter (Verburg et al. 2016). In Sweden (Katsarou et al. 2016), Canada (Booth et al. 2017), Greece (Vasileiou et al. 2018) and Italy (Chiefari et al. 2017), peak gestational diabetes incidence is in the summer. In Israel, glucose levels are lowest in pregnant women in the winter and highest in summer (Wainstock and Yoles, 2019).

    References

    To download or see a list of all the references cited on this page (and many additional references, for example from all of the countries/regions listed above), see the collection Diabetes incidence and prevalence in PubMed. The collection includes over 700 studies from around the world-- almost all of which have found an increasing trend.

    And, see the collection Clusters of type 1 diabetes in PubMed for studies on seasonal variations and geographical diabetes clusters.

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