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Towards a subsiding diabetes epidemic: trends from a large population-based study in Israel.

Karpati T, Cohen-Stavi CJ, Leibowitz M, Hoshen M, Feldman BS, Balicer RD - Popul Health Metr (2014)

Bottom Line: Annual mortality rates among diabetics decreased from 13.8/1000 to 10.7/1000 (p = 0.0002).Total population incidence rates declined from 13.3/1000 in 2006 to 10.8/1000 in 2012 (p < 0.0001), with similar incidence trends (13.2/1000 to 10.2/1000; p = 0.0007) among previously-screened at-risk members, and a rise in testing rates from 53.0% to 66.7% (p = 0.0004).The previously-unscreened group decreased 28.6%, and the incidence rates within this group remained stable.

View Article: PubMed Central - PubMed

Affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel.

ABSTRACT

Background: With increasing diabetes prevalence worldwide, an impending diabetes "pandemic" has been reported. However, definitions of incident cases and the population at risk remain varied and ambiguous. This study analyzed trends in mortality and screening that contribute to diabetes prevalence and incidence, distinguishing between new incident cases and newly detected cases.

Methods: In an integrated provider-and-payer-system covering 53% of Israel's population, a composite diabetes case-finding algorithm was built using diagnoses, lab tests, and antidiabetic medication purchases from the organization's electronic medical record database. Data were extracted on adult members aged 26+ each year from January 1, 2004 through December 31, 2012. Rates of diabetes prevalence, incidence, screening, and mortality were reported, with incidence rates evaluated among the total, "previously-screened," and "previously-unscreened" at-risk populations.

Results: There were 343,554 diabetes cases in 2012 (14.4%) out of 2,379,712 members aged 26+. A consistent but decelerating upward trend in diabetes prevalence was observed from 2004-2012. Annual mortality rates among diabetics decreased from 13.8/1000 to 10.7/1000 (p = 0.0002). Total population incidence rates declined from 13.3/1000 in 2006 to 10.8/1000 in 2012 (p < 0.0001), with similar incidence trends (13.2/1000 to 10.2/1000; p = 0.0007) among previously-screened at-risk members, and a rise in testing rates from 53.0% to 66.7% (p = 0.0004). The previously-unscreened group decreased 28.6%, and the incidence rates within this group remained stable.

Conclusions: The increase in diabetes prevalence is decelerating despite declining mortality and increasing testing rates. A decline in previously-screened incident cases and a shrinking pool of previously-unscreened members suggests that diabetes trends in Israel are moving toward equilibrium, rather than a growing epidemic.

No MeSH data available.


Related in: MedlinePlus

Trends in age-standardized prevalence of diabetes from 2004 to 2012.
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Fig1: Trends in age-standardized prevalence of diabetes from 2004 to 2012.

Mentions: Trends in diabetes prevalence and mortality of the diabetes population are presented in Table 1 and Figures 1 and 2. The age-standardized prevalence of diabetes in the study population increased 18.0% between 2006 and 2012 from 105.2/1000 to 124.1/1000. This trend was statistically significant with p < 0.0001. The increase in prevalence was more marked in the older age groups, with the greatest rise in prevalence in those aged 85 and older, nearly doubling over the study period. While prevalence rose overall, the annual rate of increase continuously slowed over the study period (Figure 1). This leveling in prevalence rates is seen among all age groups, particularly in those under age 65 for whom a plateauing rate is observed from 2009 to 2012 (Table 1). Simultaneously, during the seven-year period from 2006–2012, the age-adjusted mortality rates among the diabetes population fell from 12.2/1000 to 10.7/1000, a relative decline of 12.3% (p = 0.0002). The age-stratified trends reveal that there was a gradual and consistent decline in mortality among adults aged 45 and older. The decline in mortality in diabetics is highly correlated to the mortality in the general Clalit population (−11.8% over the same period, p <0.001) (results not shown).Figure 1


Towards a subsiding diabetes epidemic: trends from a large population-based study in Israel.

Karpati T, Cohen-Stavi CJ, Leibowitz M, Hoshen M, Feldman BS, Balicer RD - Popul Health Metr (2014)

Trends in age-standardized prevalence of diabetes from 2004 to 2012.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233034&req=5

Fig1: Trends in age-standardized prevalence of diabetes from 2004 to 2012.
Mentions: Trends in diabetes prevalence and mortality of the diabetes population are presented in Table 1 and Figures 1 and 2. The age-standardized prevalence of diabetes in the study population increased 18.0% between 2006 and 2012 from 105.2/1000 to 124.1/1000. This trend was statistically significant with p < 0.0001. The increase in prevalence was more marked in the older age groups, with the greatest rise in prevalence in those aged 85 and older, nearly doubling over the study period. While prevalence rose overall, the annual rate of increase continuously slowed over the study period (Figure 1). This leveling in prevalence rates is seen among all age groups, particularly in those under age 65 for whom a plateauing rate is observed from 2009 to 2012 (Table 1). Simultaneously, during the seven-year period from 2006–2012, the age-adjusted mortality rates among the diabetes population fell from 12.2/1000 to 10.7/1000, a relative decline of 12.3% (p = 0.0002). The age-stratified trends reveal that there was a gradual and consistent decline in mortality among adults aged 45 and older. The decline in mortality in diabetics is highly correlated to the mortality in the general Clalit population (−11.8% over the same period, p <0.001) (results not shown).Figure 1

Bottom Line: Annual mortality rates among diabetics decreased from 13.8/1000 to 10.7/1000 (p = 0.0002).Total population incidence rates declined from 13.3/1000 in 2006 to 10.8/1000 in 2012 (p < 0.0001), with similar incidence trends (13.2/1000 to 10.2/1000; p = 0.0007) among previously-screened at-risk members, and a rise in testing rates from 53.0% to 66.7% (p = 0.0004).The previously-unscreened group decreased 28.6%, and the incidence rates within this group remained stable.

View Article: PubMed Central - PubMed

Affiliation: Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel.

ABSTRACT

Background: With increasing diabetes prevalence worldwide, an impending diabetes "pandemic" has been reported. However, definitions of incident cases and the population at risk remain varied and ambiguous. This study analyzed trends in mortality and screening that contribute to diabetes prevalence and incidence, distinguishing between new incident cases and newly detected cases.

Methods: In an integrated provider-and-payer-system covering 53% of Israel's population, a composite diabetes case-finding algorithm was built using diagnoses, lab tests, and antidiabetic medication purchases from the organization's electronic medical record database. Data were extracted on adult members aged 26+ each year from January 1, 2004 through December 31, 2012. Rates of diabetes prevalence, incidence, screening, and mortality were reported, with incidence rates evaluated among the total, "previously-screened," and "previously-unscreened" at-risk populations.

Results: There were 343,554 diabetes cases in 2012 (14.4%) out of 2,379,712 members aged 26+. A consistent but decelerating upward trend in diabetes prevalence was observed from 2004-2012. Annual mortality rates among diabetics decreased from 13.8/1000 to 10.7/1000 (p = 0.0002). Total population incidence rates declined from 13.3/1000 in 2006 to 10.8/1000 in 2012 (p < 0.0001), with similar incidence trends (13.2/1000 to 10.2/1000; p = 0.0007) among previously-screened at-risk members, and a rise in testing rates from 53.0% to 66.7% (p = 0.0004). The previously-unscreened group decreased 28.6%, and the incidence rates within this group remained stable.

Conclusions: The increase in diabetes prevalence is decelerating despite declining mortality and increasing testing rates. A decline in previously-screened incident cases and a shrinking pool of previously-unscreened members suggests that diabetes trends in Israel are moving toward equilibrium, rather than a growing epidemic.

No MeSH data available.


Related in: MedlinePlus