Context Although diabetes mellitus is one of the most prevalent and costly chronic diseases in the United States, no estimates have been published of individuals' average lifetime risk of developing diabetes.Objective To estimate age-, sex-, and race/ethnicity-specific lifetime risk of diabetes in the cohort born in 2000 in the United States.Design, Setting, and Participants Data from the National Health Interview Survey (1984Survey ( -2000 were used to estimate age-, sex-, and race/ethnicity-specific prevalence and incidence in 2000. US Census Bureau data and data from a previous study of diabetes as a cause of death were used to estimate age-, sex-, and race/ethnicityspecific mortality rates for diabetic and nondiabetic populations. Main Outcome MeasuresResidual (remaining) lifetime risk of diabetes (from birth to 80 years in 1-year intervals), duration with diabetes, and life-years and qualityadjusted life-years lost from diabetes. ResultsThe estimated lifetime risk of developing diabetes for individuals born in 2000 is 32.8% for males and 38.5% for females. Females have higher residual lifetime risks at all ages. The highest estimated lifetime risk for diabetes is among Hispanics (males, 45.4% and females, 52.5%). Individuals diagnosed as having diabetes have large reductions in life expectancy. For example, we estimate that if an individual is diagnosed at age 40 years, men will lose 11.6 life-years and 18.6 quality-adjusted lifeyears and women will lose 14.3 life-years and 22.0 quality-adjusted life-years.

BackgroundPeople with diabetes can suffer from diverse complications that seriously erode quality of life. Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years. Accurate projections of diabetes burden are essential to policymakers planning for future health care needs and costs.MethodsUsing data on prediabetes and diabetes prevalence in the United States, forecasted incidence, and current US Census projections of mortality and migration, the authors constructed a series of dynamic models employing systems of difference equations to project the future burden of diabetes among US adults. A three-state model partitions the US population into no diabetes, undiagnosed diabetes, and diagnosed diabetes. A four-state model divides the state of "no diabetes" into high-risk (prediabetes) and low-risk (normal glucose) states. A five-state model incorporates an intervention designed to prevent or delay diabetes in adults at high risk.ResultsThe authors project that annual diagnosed diabetes incidence (new cases) will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050. Assuming low incidence and relatively high diabetes mortality, total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. However, if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by 2050. Intervention can reduce, but not eliminate, increases in diabetes prevalence.ConclusionsThese projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Effective strategies will need to be undertaken to moderate the impact of these factors on national diabetes burden. Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population can considerably reduce, but not eliminate, future increases in diabetes prevalence.

OBJECTIVE -To project the number of people with diagnosed diabetes in the U.S. through 2050, accounting for changing demography and diabetes prevalence rates.RESEARCH DESIGN AND METHODS -We combined age-, sex-, and race-specific diagnosed diabetes prevalence rates-predicted from 1980 -1998 trends in prevalence data from the National Health Interview Survey-with Bureau of Census population demographic projections. Sensitivity analyses were performed by varying both prevalence rate and population projections.RESULTS -The number of Americans with diagnosed diabetes is projected to increase 165%, from 11 million in 2000 (prevalence of 4.0%) to 29 million in 2050 (prevalence of 7.2%). The largest percent increase in diagnosed diabetes will be among those aged Ն75 years (ϩ271% in women and ϩ437% in men). The fastest growing ethnic group with diagnosed diabetes is expected to be black males (ϩ363% from 2000 -2050), with black females (ϩ217%), white males (ϩ148%), and white females (ϩ107%) following. Of the projected 18 million increase in the number of cases of diabetes in 2050, 37% are due to changes in demographic composition, 27% are due to population growth, and 36% are due to increasing prevalence rates.CONCLUSIONS -If recent trends in diabetes prevalence rates continue linearly over the next 50 years, future changes in the size and demographic characteristics of the U.S. population will lead to dramatic increases in the number of Americans with diagnosed diabetes.

A diabetes epidemic emerged during the 20th century and continues unchecked into the 21st century. It has already taken an extraordinary toll on the U.S. population through its acute and chronic complications, disability, and premature death. Trend data suggest that the burden will continue to increase. Efforts to pre- vent or delay the complications of diabetes or, better yet, to prevent or delay the development of diabetes itself are urgently needed.

In an earlier study, we had forecasted 39 million with diagnosed diabetes in 2050 in the U.S. (1,2). However, since then, national diabetes incidence increased (3) and the relative risk of death among people with diabetes declined (4,5). These changes will impact future forecasts.Incorporating these changes, we now project 48.3 million people with diagnosed diabetes in the U.S. in 2050. We also present age-, sex-, and race/ethnicityspecific forecasts, with Bayesian CIs, of the number of people with diagnosed diabetes through 2050. RESEARCH DESIGN ANDMETHODS -We used a discretetime (1-year intervals), incidence-based Markov model with three states (no diagnosed diabetes, diagnosed diabetes, and death) (1). In each cycle of the model, projections are developed for 808 population subgroups defined by age, sex, and race/ethnicity.We estimated the age-, sex-, and race/ ethnicity-specific prevalence and incidence of diabetes from the U.S. National Health Interview Survey (6 -9) and modeled data for 1984 -2004 to improve the precision of 2004 estimates.Models were fit using Bayesian methods with improper flat priors applied to logistic regression. We assessed adequacy of model fit using posterior predictive P values (10). Estimated prevalence of diagnosed diabetes for 2000 and 2004 were 4.35 and 5.37%, respectively, and estimated incidence were 0.42 and 0.53% per year, respectively. The age-, sex-, and race/ethnicity-specific 2004 prevalence estimates were combined with U.S. population data for 2004 (11) to determine the initial distribution of individuals across disease states. Additionally, census projections of U.S. live births, mortality rates, and net migration were required (11).Estimates of the relative risk of mortality for people with diabetes were drawn from updates of a published study using Bayesian methods applied to logistic regression models (5). These estimates were sex-and age-group-specific for adults (aged Ն18 years) in four age categories.Probabilities of remaining in the nodiabetes and diabetes states vary over time, since mortality rates are time varying. The 1-year probability of remaining with no diabetes equals (1 Ϫ P ND-D Ϫ P t ND-Death ), where P ND-D is the timeindependent incidence rate to diagnosed diabetes and P t ND-Death equals the timevarying no-diabetes mortality rate.We derived posterior distributions of all unknown parameters (age-, sex-, race/ ethnicity-specific prevalence and incidence and age-and sex-specific relative risk) and propagated the uncertainty in these distributions through the Markov projection model. In fitting the models, we obtain 5,000 samples from the posterior distributions. The projection model is then run and results saved using each of these 5,000 samples. This gives a sample from the posterior distribution of the projection results. Means of these posterior distributions are our estimates, and quantiles (0.025, 0.975) of these posterior distributions are our CIs.RESULTS -Total prevalence more than doubles from 2005 to 2050 (from 5.62 to 12.00%), and all age-...

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OBJECTIVE -At birth, the lifetime risk of developing diabetes is one in three, but lifetime risks across BMI categories are unknown. We estimated BMI-specific lifetime diabetes risk in the U.S. for age-, sex-, and ethnicity-specific subgroups.RESEARCH DESIGN AND METHODS -National Health Interview Survey data (n ϭ 780, 694,[1997][1998][1999][2000][2001][2002][2003][2004] were used to estimate age-, race-, sex-, and BMI-specific prevalence and incidence of diabetes in 2004. U.S. Census Bureau age-, race-, and sex-specific population and mortality rate estimates for 2004 were combined with two previous studies of mortality to estimate diabetes-and BMI-specific mortality rates. These estimates were used in a Markov model to project lifetime risk of diagnosed diabetes by baseline age, race, sex, and BMI.RESULTS -Lifetime diabetes risk at 18 years of age increased from 7.6 to 70.3% between underweight and very obese men and from 12.2 to 74.4% for women. The lifetime risk difference was lower at older ages. At 65 years of age, compared with normal-weight male subjects, lifetime risk differences (percent) increased from 3.7 to 23.9 percentage points between overweight and very obese men and from 8.7 to 26.7 percentage points for women. The impact of BMI on diabetes duration also decreased with age.CONCLUSIONS -Overweight and especially obesity, particularly at younger ages, substantially increases lifetime risk of diagnosed diabetes, while their impact on diabetes risk, life expectancy, and diabetes duration diminishes with age.

OBJECTIVETo forecast the number of U.S. individuals aged <20 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) through 2050, accounting for changing demography and diabetes incidence.RESEARCH DESIGN AND METHODSWe used Markov modeling framework to generate yearly forecasts of the number of individuals in each of three states (diabetes, no diabetes, and death). We used 2001 prevalence and 2002 incidence of T1DM and T2DM from the SEARCH for Diabetes in Youth study and U.S. Census Bureau population demographic projections. Two scenarios were considered for T1DM and T2DM incidence: 1) constant incidence over time; 2) for T1DM yearly percentage increases of 3.5, 2.2, 1.8, and 2.1% by age-groups 0–4 years, 5–9 years, 10–14 years, and 15–19 years, respectively, and for T2DM a yearly 2.3% increase across all ages.RESULTSUnder scenario 1, the projected number of youth with T1DM rises from 166,018 to 203,382 and with T2DM from 20,203 to 30,111, respectively, in 2010 and 2050. Under scenario 2, the number of youth with T1DM nearly triples from 179,388 in 2010 to 587,488 in 2050 (prevalence 2.13/1,000 and 5.20/1,000 [+144% increase]), with the greatest increase in youth of minority racial/ethnic groups. The number of youth with T2DM almost quadruples from 22,820 in 2010 to 84,131 in 2050; prevalence increases from 0.27/1,000 to 0.75/1,000 (+178% increase).CONCLUSIONSA linear increase in diabetes incidence could result in a substantial increase in the number of youth with T1DM and T2DM over the next 40 years, especially those of minority race/ethnicity.