The Lancet Diabetes & Endocrinology:
Close to half (40%) of the adult population of the USA is expected to develop type 2 diabetes at some point during their lifetime, suggests a major study published in The Lancet Diabetes & Endocrinology. The future looks even worse for some ethnic minority groups, with one in two (> 50%) Hispanic men and women and non-Hispanic black women predicted to develop the disease.
A team of US researchers combined data from nationally representative US population interviews and death certificates for about 600 000 adults to estimate trends in the lifetime risk of diabetes and years of life lost to diabetes in the USA between 1985 and 2011.
Over the 26 years of study, the lifetime risk of developing type 2 diabetes for the average American 20-year-old rose from 20% for men and 27% for women in 1985–1989, to 40% for men and 39% for women in 2000–2011. The largest increases were in Hispanic men and women, and non-Hispanic black women, for whom lifetime risk now exceeds 50%.
Dr Edward Gregg, study leader and Chief of the Epidemiology and Statistics Branch, Division of Diabetes Translation at the Centers for Disease Control and Prevention said, “Soaring rates of diabetes since the late 1980s and longer overall life expectancy in the general population have been the main drivers of the striking increase in the lifetime risk of diabetes over the last 26 years. At the same time, a large reduction in death rates in the US population with diabetes has reduced the average number of years lost to the disease. However, the overwhelming increase in diabetes prevalence has resulted in an almost 50% increase in the cumulative number of years of life lost to diabetes for the population as a whole: years spent living with diabetes have increased by 156% in men and 70% in women.”*
He concludes, “As the number of diabetes cases continue to increase and patients live longer there will be a growing demand for health services and extensive costs. More effective lifestyle interventions are urgently needed to reduce the number of new cases in the USA and other developed nations.”*
Writing in a linked Comment, Dr Lorraine Lipscombe from Women’s College Hospital and the University of Toronto, Toronto, Canada says, “The trends reported by Gregg and colleagues are probably similar across the developed world, where large increases in diabetes prevalence in the past two decades have been reported…Primary prevention strategies are urgently needed. Excellent evidence has shown that diabetes can be prevented with lifestyle changes. However, provision of these interventions on an individual basis might not be sustainable. Only a population-based approach to prevention can address a problem of this magnitude. Prevention strategies should include optimisation of urban planning, food-marketing policies, and work and school environments that enable individuals to make healthier lifestyle choices. With an increased focus on interventions aimed at children and their families, there might still be time to change the fate of our future generations by lowering their risk of type 2 diabetes.”
*Quotes direct from author and cannot be found in text of Article.
In a study published July 30, 2014 DOI: 10.1371/journal.pone.0103376 indicates the wisdom of eating more nuts. In fact, eating more nuts is just the ticket. You don’t even have to take me out the ballpark. The jury is in so go nuts.
The ability of tree nuts to improve glycemic control may relate to a carbohydrate displacement mechanism by which tree nuts reduce the glycemic load of the diet by displacing high glycemic-index carbohydrates. And they taste better than hi fructose carb snacks. read more: Effect of Tree Nuts on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Dietary Trials
Tree nuts are the perfect workplace snack. Not only do they taste good, they also help reduce work-related stress, a risk factor for type 2 diabetes.
Workplace stress can have a range of adverse effects on health with an increased risk of cardio-vascular diseases in the first line.
Risk of diabetes about 45 percent higher.
Individuals who are under a high level of pressure at work and at the same time perceive little control over the activities they perform face an about 45 percent higher risk of developing type 2 diabetes than those who are subjected to less stress at their workplace.
Diabetes is strongly associated with socioeconomic status (SES): low income, low education, and low occupational status are all linked to a higher risk for diabetes. Trying to understand the mechanisms underlying the association, Silvia Stringhini from the Institute for Social and Preventive Medicine in Lausanne, Switzerland and colleagues report in this week’s PLOS Medicine that a substantial part of it appears to be attributable to chronic inflammation.
“Taking together the evidence linking socioeconomic adversity to inflammation and inflammation to type 2 diabetes” the authors write, “it seems reasonable to postulate that chronically increased inflammatory activity in individuals exposed to socioeconomic adversity over the entire lifecourse may, at least partially, mediate the association between socioeconomic status over the lifecourse and future type 2 diabetes risk.”
To test their hypothesis, they analyzed data from the Whitehall II study. Following the famous original Whitehall study that pioneered the study of social determinants of health, Whitehall II has followed over 10,000 participants, all British civil servants working in London, since the mid 1980s. The study is ongoing, and participants undergo regular health check-ups and also provide extensive information about their social situation every few years.
For their study, the researchers focused on 6387 participants who had provided information on their education level and current occupation (reflective of early adulthood and present socio-economic status, respectively) as well as their father’s occupation (a proxy for childhood socio-economic status). In addition, it was known which of the participants had developed diabetes and when, and whether and when their blood work had shown signs of chronic inflammation.
They found that cumulative exposure to low SES over the lifecourse and a downward trajectory from high SES in childhood to low SES in adulthood were associated with an increased risk of developing type 2 diabetes over the study period. In addition, inflammatory processes, measured repeatedly through biomarkers in the blood, explained as much as one third of this association.
“Assuming that our findings reflect a causal association”, the authors say, “our results suggest that tackling socioeconomic differences in inflammation, especially among the most disadvantaged groups, might reduce social inequalities in type 2 diabetes.”
They suggest that future studies should test interventions that reduce chronic inflammation, as “(such studies) will be necessary to determine the extent to which social inequalities attributable to chronic inflammation are reversible.”
Funding: SS is supported by a post-doctoral fellowship awarded by the Swiss School of Public Health (SSPH+). MK is supported by the Medical Research Council (K013351), UK, the US National Institutes of Health (R01HL036310; R01AG034454), the EU New OSH ERA Research Programme and an ESRC professorship. MS is supported by the British Heart Foundation. MK is partially supported by MRC, Economic and Social Research Council Grant RES 596-28-0001 and National Heart Lung and Blood Institute Grant HL36310. DB was a Wellcome Trust fellow during the preparation of this manuscript. The Whitehall II study has been supported by grants from the British Medical Research Council (MRC); the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute (R01HL036310); the National Institute on Aging, NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Stringhini S, Batty GD, Bovet P, Shipley MJ, Marmot MG, et al. (2013) Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study. PLoS Med 10(7): e1001479. doi:10.1371/journal.pmed.1001479
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