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. 2017 Sep;40(9):1139-1143.
doi: 10.2337/dc16-2442.

Declines in the Incidence of Diabetes in the U.S.-Real Progress or Artifact?

Free PMC article

Declines in the Incidence of Diabetes in the U.S.-Real Progress or Artifact?

Elizabeth Selvin et al. Diabetes Care. .
Free PMC article


National surveillance data show a sustained decline in the incidence rate of diagnosed diabetes, which has been heralded as a success in the battle against diabetes in the U.S. In this Perspective, we take a closer look at these data and provide additional insights to help interpret these trends. We examine multiple sources of data on the prevalence and incidence of diabetes in the U.S. as well as data on trends in diabetes risk factors to provide context for these national surveillance findings. Although some of the incidence decline may represent real progress against diabetes, it is likely that there are also nonbiological factors at play, especially changes in diagnostic criteria for diabetes. We present and discuss data that suggest improved detection and changes in screening and diagnostic practices may have resulted in the depletion of the "susceptible population." Providing this context for the recent declines in new diabetes diagnoses observed in national data is critical to help avoid misinterpretation. We argue that it is premature to declare victory against the epidemic of diabetes in the U.S. and discuss how we might better focus current public health efforts, including a specific emphasis to address prediabetes.


Figure 1
Figure 1
Age-adjusted diabetes incidence rate and 95% CIs, 1980–2014, NHIS. FG, fasting glucose. Source data:
Figure 2
Figure 2
Conceptual model depicting factors associated with likelihood of self-reporting diabetes in national surveys. DM, diabetes mellitus; Dx, diagnosis; SES, socioeconomic status.

Comment in

  • The War Is Not Yet Won.
    Young LA, Buse JB. Young LA, et al. Diabetes Care. 2017 Sep;40(9):1152-1153. doi: 10.2337/dci17-0008. Diabetes Care. 2017. PMID: 28830956 No abstract available.

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