Recent studies in the U.S. have shown that incidence of diagnosed diabetes decreased and prevalence plateaued after 2010 despite a modest increase in obesity prevalence. If the reduction in diabetes incidence is driven by changing obesity levels, prevalence may be an inadequate metric. Therefore, we investigated changes in prevalence and incidence of obesity and diabetes in adults in the United States during a 17 year period, 2001-2017.

We analyzed adult (≥20years) anthropometric records and diabetes status (prediabetes and diabetes combined) from the U.S. national representative Panel Study of Income Dynamics, 2001-2017. We used Poisson models to estimate the prevalence biannually from 2001-2017 and incidence of obesity (cases/1000 person years, PY) over 4 periods (2001-2005; 2005-2009; 2009-2013; 2013-2017). All rates were age- and sex-adjusted; survey weights were applied.

Prevalence of obesity increased from 20.9% (95% CI, 19.4-22.5) in 2001 to 26.4 (95% CI, 25.0-27.8) in 2009 to 29.5% (95% CI, 28.1-31.0) in 2017 (p<0.001), while prevalence of diabetes over the same period increased from 7.5% (95% CI, 6.6-8.4) to 10.0 (95% CI, 9.0-11.0) to 11.8% (95% CI, 10.8-12.7) (p<0.001).

The incidence of obesity changed over time: Compared to an obesity incidence of 29.3/1000 PY (95% CI, 26.0-35.5) in 2001-2005, the incidence increased to 31.7/1000 PY (95% CI,29.7-33.7) in 2005-2009, decreased to 28.8/1000 PY (26.3-31.4) in 2009-2013, and increased to 34.0/1000 PY (95% CI, 31.1-36.7) in 2013-2017 (p<0.001). There was an overall linear increase in diabetes incidence across periods from 2001-2005 to 2013-2017 (p<0.001): In 2001-2005, incidence was 11.9 per 1000 PY (95% CI, 10.6-13.1); in 2005-2009, 12.4/1000 PY (10.7-14.2); in 2009-2013, 13.3/1000 PY (11.5-15.2); and in 2013-2017 14.0/1000 PY (95% CI, 12.2-15.8).

In contrast to other U.S. studies of diabetes incidence, our results show no decline during the 2010s. This may be explained by our findings of an increasing incidence of obesity in the same population.


J. NIelsen: None. E. Gregg: None. K. Narayan: None. S.A. Cunningham: None.


Independent Research Fund Denmark (DFF-7025-00053B); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024, 1R01DK115937)

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