Rapid rise in the incidence of type 2 diabetes from 1987 to 1996: results from the San Antonio Heart Study.

BACKGROUND The prevalence of type 2 diabetes has increased in the early part of the 20th century, particularly in developing countries. There is now evidence that the prevalence also continues to increase in developed countries, including the United States. However, it is unknown whether this increase is due to a rise in the incidence of diabetes or to decreasing diabetic mortality or both. METHODS Participants in the San Antonio Heart Study, who were nondiabetic at baseline and who returned for a 7- to 8-year follow-up examination, were examined for secular trends in the incidence of type 2 diabetes. Risk factors for diabetes, such as obesity, were also examined. Patients were enrolled in the San Antonio Heart Study from 1979 to 1988 and 7- to 8-year incidence of diabetes was determined from 1987 to 1996. RESULTS A significant secular trend in the 7- to 8-year incidence of type 2 diabetes was observed in Mexican Americans (5.7% for participants enrolled in 1979 to 15.7% for participants enrolled in 1988). In non-Hispanic whites, the incidence increased from 2.6% for participants enrolled in 1980 to 9.4% for participants enrolled in 1988 (P = .07) . After adjusting for age and sex, the secular trend remained significant in Mexican Americans and borderline significant in non-Hispanic whites. This indicates that between 1987 and 1996 the 7- to 8-year incidence of type 2 diabetes approximately tripled in both ethnic groups. The overall secular trend also remained significant after adjusting for additional risk factors for diabetes, such as obesity. A rising secular trend in obesity was also observed. CONCLUSIONS There has been a significant increasing secular trend in the incidence of type 2 diabetes in Mexican Americans and a borderline significant trend in non-Hispanic whites participating in the San Antonio Heart Study. Unlike other cardiovascular risk factors such as lipid levels, cigarette smoking, and blood pressure, which are either declining or under progressively better medical management and control, and unlike cardiovascular mortality, which is also declining, obesity and type 2 diabetes are exhibiting increasing trends. Thus, obesity and diabetes could easily become the preeminent US public health problem.

[1]  Teven,et al.  MORTALITY FROM CORONARY HEART DISEASE IN SUBJECTS WITH TYPE 2 DIABETES AND IN NONDIABETIC SUBJECTS WITH AND WITHOUT PRIOR MYOCARDIAL INFARCTION , 2000 .

[2]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.

[3]  J. Widimský,et al.  Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus , 1998, Diabetes Care.

[4]  C. Sempos,et al.  Consistency between US dietary fat intake and serum total cholesterol concentrations: the National Health and Nutrition Examination Surveys. , 1997, The American journal of clinical nutrition.

[5]  E. Dasbach,et al.  The cost-effectiveness of intensive therapy for diabetes mellitus. , 1997, Endocrinology and metabolism clinics of North America.

[6]  J. Feldman,et al.  Health, United States, 1996-97 and Injury chartbook , 1997 .

[7]  D. Mccarty,et al.  The Epidemic of NIDDM in Asian and Pacific Island Populations: Prevalence and Risk Factors , 1997, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[8]  P C O'Brien,et al.  Relative contributions of incidence and survival to increasing prevalence of adult-onset diabetes mellitus: a population-based study. , 1997, American journal of epidemiology.

[9]  M. Worsham,et al.  Trends in the prevalence and incidence of self-reported diabetes mellitus -- United States, 1980-1994. , 1997, MMWR. Morbidity and mortality weekly report.

[10]  T. Byers,et al.  Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey. , 1996, American journal of public health.

[11]  G. Schernthaner.  Cardiovascular mortality and morbidity in type-2 diabetes mellitus. , 1996, Diabetes research and clinical practice.

[12]  S. Daniels,et al.  Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. , 1996, The Journal of pediatrics.

[13]  Otis Dudley Duncan,et al.  A socioeconomic index for all occupations. , 1996 .

[14]  P Whelton,et al.  Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. , 1995, Hypertension.

[15]  B. Bradshaw,et al.  Emergence of diabetes mellitus in a Mexican-origin population: a multiple cause-of-death analysis. , 1995, Social biology.

[16]  K. Flegal,et al.  Increasing Prevalence of Overweight Among US Adults: The National Health and Nutrition Examination Surveys, 1960 to 1991 , 1994 .

[17]  D. Gordon,et al.  Declining serum total cholesterol levels among US adults. The National Health and Nutrition Examination Surveys. , 1993, JAMA.

[18]  D. Labarthe,et al.  Acute myocardial infarction and coronary heart disease mortality among Mexican Americans and non-Hispanic whites in Texas, 1980 through 1989. , 1993, Ethnicity & disease.

[19]  S. Haffner,et al.  Increased Incidence of Type II Diabetes Mellitus in Mexican Americans , 1991, Diabetes Care.

[20]  P. Bennett,et al.  Diabetes mellitus in the Pima Indians: incidence, risk factors and pathogenesis. , 1990, Diabetes/metabolism reviews.

[21]  S. Haffner,et al.  Lack of awareness and treatment of hyperlipidemia in type II diabetes in a community survey. , 1989, JAMA.

[22]  P. Bennett,et al.  Incidence, prevalence and risk factors for non-insulin-dependent diabetes mellitus. , 1988, Primary care.

[23]  J L Kelsey,et al.  The measurement of social class in epidemiology. , 1988, Epidemiologic reviews.

[24]  M. Stern,et al.  Secular decline in death rates due to ischemic heart disease in Mexican Americans and non-Hispanic whites in Texas, 1970-1980. , 1987, Circulation.

[25]  S. Haffner,et al.  Do Upper-Body and Centralized Adiposity Measure Different Aspects of Regional Body-Fat Distribution? Relationship to Non-Insulin-Dependent Diabetes Mellitus, Lipids, and Lipoproteins , 1987, Diabetes.

[26]  S. Haffner,et al.  Hyperinsulinemia in a population at high risk for non-insulin-dependent diabetes mellitus. , 1986, The New England journal of medicine.

[27]  S. Haffner,et al.  A comparison of three indicators for identifying Mexican Americans in epidemiologic research. Methodological findings from the San Antonio Heart Study. , 1986, American journal of epidemiology.

[28]  D. Rao,et al.  Relationship of prevalence of non‐insulin‐dependent diabetes mellitus to Amerindian admixture in the Mexican Americans of San Antonio, Texas , 1986, Genetic epidemiology.

[29]  M Rosenthal,et al.  Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans. The San Antonio Heart Study. , 1984, American journal of epidemiology.