Diabetes is poised to explode. As many as 1 in 3 adults will develop the chronic, life-threatening disease by 2050, a stark increase from the 1 in 10 presently affected, according to estimates released today by the Centers for Disease Control and Prevention. If current trends continue, the number of new cases could jump from 8 per every 1,000 people in 2008 to 15 per every 1,000 within the next 40 years.
"It's alarming," says Ann Albright, director of the CDC's Division of Diabetes Translation. "People have to remember that once you have diabetes, you can't give it back."
The rising rate of type 2 diabetes—much more prevalent than type 1—is fueling the trend, researchers say. Type 2 occurs when the body does not respond to or produce enough insulin, and though genetics play a role, excess weight and inactivity both increase the risk. Complications include heart attacks, strokes, blindness, kidney failure, and nerve damage.
Here are three other factors that researchers believe will propel the numbers:
1. The "age wave." The number of adults ages 65 and older is expected to climb from 38.7 million in 2008 to 88.5 million by 2050, and older adults are more likely to develop diabetes than are younger adults. The body's ability to use and produce insulin gradually declines around age 45, Albright says. But type 2 diabetes is also on the rise in younger people, particularly among adolescents, a group rarely affected in the past. Lifestyle factors, like obesity and a lack of exercise, are likely to blame.
2. U.S. minority populations are growing. African-Americans, Hispanics, American Indians, and Asian-Americans have the highest risk of developing type 2 diabetes. African-Americans, for example, are twice as likely to be diagnosed as non-Hispanic whites, according to the Office of Minority Health, an arm of the U.S. Department of Health and Human Services. They're also more likely to suffer complications. "You have to look at the communities and environments many members of these populations live in," Albright says. "Maybe they're in lower socioeconomic groups, and they don't have access to healthy food options. Maybe they don't have safe areas to be physically active."
3. People with diabetes are living longer. Obviously this is a positive trend, Albright says, and is largely due to better medical care, which has cut the rate of amputations and kidney failure—often fatal complications. Public health campaigns and greater emphasis on diabetes education have also likely contributed. Similarly, the number of undiagnosed cases has fallen. "That's what we want to see. We want people to be living longer, and we want to diagnose them earlier," Albright says. "We don't want to see the overall prevalence go down because people are dying prematurely or walking around not knowing they have diabetes."
Of course, there's still time to curtail the trend, researchers say. "There's an old analogy that says your genetics load the cannon, and your lifestyle lights the fuse," says Albright. Diet makes a huge difference in type 2 diabetes prevention. The best preventative diet is one that gets 40 percent of its calories from carbohydrates (including fruits and vegetables), 30 percent from protein, and 30 percent from healthy fats, says Martin Abrahamson, medical director of the Joslin Diabetes Center in Boston. Opt for carbs like whole grains and whole wheat: They have a low glycemic index, meaning they'll produce only small fluctuations in blood glucose and insulin levels, which can ward off diabetes. And it's smart to choose vegetable protein over animal protein, and monounsaturated and polyunsaturated fat over saturated fat, he says.
Exercise is also important. In 2002, a clinical trial called the Diabetes Prevention Program found that people could cut their risk of developing the disease by more than 50 percent if they spent 30 minutes walking briskly six times a week. "This is not a matter of running marathons or climbing mountains," says Robert Rizza, director of research at the Mayo Clinic College of Medicine. "There are all kinds of small things we can do that will make a difference."