Half of Americans Have Diabetes or Prediabetes

Man Testing his Blood Sugar
Keeping track of your blood sugar is essential for diabetics, and good for prediabetics too.. Glow Wellness/Getty Images

No one should be surprised at the news, but sometimes a certain number has an impact. It seems that at this point, roughly half of adults in the United States have either diabetes or prediabetes. The number continues to rise in all the different groups studied: race, age, and gender. 12-14% of us have diabetes, and about 38% have prediabetes. Those are enormous numbers.  If true, it means that most of us have glucose metabolisms that are seriously out of whack.

The research, which was published in the Journal of the American Medical Association on September 8, 2015, also showed some good news: a greater percentage of diabetes is now being diagnosed (although about a third of people with the disorder still don't know they have it - almost half in Asian-Americans and Hispanics), and the rate of increase is leveling off.

Still, there are signs that the real numbers actually could be higher. The definition used in the study for diabetes and prediabetes was that one of three tests fell in the range of the disorder: Hemoglobin A1C, fasting plasma glucose, or a 2-hour glucose tolerance test. However, many of the participants only received one or two of these tests, which will miss some cases: for example, there are those with impaired fasting glucose who pass their glucose tolerance test, and vice versa. Also, we always need to keep in mind that people with values near the cutoff for prediabetes, for example a fasting blood glucose of 98 or a HA1C of 5.4%, although "in the normal range", are truly on the diabetes spectrum, with at least some damage in the pancreas.

It also does not count people with metabolic syndrome and insulin resistance who don't fit the criteria for prediabetes or diabetes, even though they are almost certainly part of the same constellation of problems.

Why Lump Prediabetes in With Diabetes?

Prediabetes and Type 2 diabetes are taken together in this study because they are the same disorder.

The cells in the pancreas that produce insulin are damaged, and amount of glucose in the blood begins to rise. Prediabetics are at risk for most of the problems affecting diabetics, although at lower percentages. For example, most diabetics end up getting some sort of nerve damage, such as damage in the eye called diabetic retinopathy (this is the cause of blindness in diabetics). However several studies showed that somewhere around 8% - 13% of prediabetics have signs of retinopathy. Prediabetics are also at a greater risk of heart disease (although, again, not as high a risk as diabetics).

What Should We Do?

Diabetes is a disorder of glucose metabolism. One would think that the first order of business would be to lower the amount of glucose we are taking in. Where is glucose? In carbohydrate-rich foods. Starches such as those in grains, potatoes, and other starchy foods are long strings of glucose. Sugars such as table sugar, honey, etc. are usually about half glucose (although the other half is fructose, which has problems of its own).

In terms of effects on blood glucose, the worst foods are simple sugars (such as those in candies, sugar-sweetened beverages, and other sweetened foods) and refined carbohydrates  (such as those in most baked goods and packaged breakfast cereals).

We don't tell people with diarrhea due to lactose intolerance that the answer is to take anti-diarrheal medication. We tell them to stop consuming products with lactose. We are now at a point where most adults in the US (and a growing number of children) have some level of glucose intolerance. So why are we telling them to keep eating large amounts of glucose? More than one article about this study (Web MD, I'm looking at you) recommend a low-fat diet to prevent diabetes. A low-fat diet is a high-glucose diet!! Why would it be a good idea to consume more glucose to prevent diabetes? It makes no sense at all.

Obviously there are other things we can do besides diet to prevent diabetes. Chief among these is regular exercise, which improves insulin sensitivity. Also, people should be aware of their blood glucose numbers, particularly if they are at high risk for diabetes (for example, being overweight). If you are prediabetic or diabetic, find out how different foods affect your blood sugar, and use this knowledge to help tailor your diet. This site can help you find the amount of carbohydrate that is good for you, and to help you eat that way.

How Much Carbohydrate Should You Eat?

Reduce Carbs Gradually, or All At Once?

How to Cut Carbs


Halban, PA, et al. ß-cell Failure in Type 2 Diabetes: Postulated Mechanisms and Prospects for Prevention and Treatment Journal of Clinical Endocrinology Metab, June 2014, 99(6):1983–1992

Menke A, Casagrande S et al. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. Journal of the American Medical Association. 2015;314(10):1021-1029.

Wong TY, et al. Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies Lancet 2008; 371: 736-743.

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