Gallup-Sharecare Report Shows How Diabetes Ranks Grew Across the US

Rates of obesity and diabetes continue to rise at alarming rates in the United States, and a decade’s worth of data show how another 1.7 million Americans were diagnosed with diabetes because the disease is becoming more common, according to a new report.

The Gallup-Sharecare 2017 State and Community Rankings for the Prevalence of Diabetes, gleaned from the Gallup-Sharecare Well-Being Index, found that the overall diabetes rate increased from 10.8% nationwide in 2008-2009 to 11.5% in 2016-2017.

But distribution patterns of the disease, as well as obesity that helps drive it, are hardly equal. According to Dan Witters, research director of the Gallup-Sharecare Well-Being Index, states and communities that had high rates of diabetes a decade ago generally still do.

In general, these states have higher rates of poverty and smoking; dietary patterns and sedentary lifestyles also contribute to rates of diabetes that top 13% and obesity rates that exceed 30% for the 10 states with the unhealthiest profiles: Indiana, Oklahoma, Tennessee, Alabama, Arkansas, Louisiana, Kentucky, Mississippi, South Carolina, and West Virginia.

The index also breaks down diabetes and obesity rates by metropolitan statistical area, and the 10 communities with the highest rates of diabetes and obesity are: Spartanburg, South Carolina; Lakeland-Winter Haven, Florida; Visalia-Porterville, California; McAllen-Edinburg-Mission, Texas; Youngstown-Warren-Boardman, Ohio and Pennsylvania; Beaumont-Port Arthur, Texas; Shreveport-Bossier City, Louisiana; Ocala, Florida; Kingsport-Bristol, Tennessee and Virginia; and Fort Smith, Arkansas and Oklahoma.

Both the report and years of CDC data show the strong relationship between high obesity rates and subsequent high rates of diabetes. “About 54% of middle-aged Americans who are obese and have not yet developed diabetes will do so in their lifetime,” the report states. Indeed, the report found that over the past decade, obesity rates climbed in 34 states, and 15 of these states also had a corresponding rise in diabetes. “States with a rising obesity rate are about 2.3 times more likely to also be experiencing rising diabetes prevalence than are states without a rising obesity rate,” the report states.

Both Witters and Sheila Holcomb, RD, LD, CDE, vice president for Sharecare, discussed the implications of these trends for the nation’s healthcare system as the population ages and more Americans move into Medicare. “It was eye-popping for us,” Witters said in an interview with The American Journal of Managed Care^®. “It was more grim than what I was bracing for.”

“The basic rule is for every 3% increase in obesity, there is a 1% increase in diabetes. You’ll find that in the states, too. And no states have seen obesity go down.” This finding is consistent with data released by the CDC that show the number of Americans with diabetes rising past 30 million in 2017, with all but 1.25 million having type 2 diabetes.

Holcomb said turning the tide on diabetes as well as obesity is going to take a collaboration at the community level—from getting local leaders to provide more green spaces, to getting stores to put produce at the front of the store, to getting restaurants to put healthier items on the menu. Schools and workplaces will need to participate by putting healthier items in cafeterias and encouraging people to exercise. Employers will need to pay for gym memberships, she said.

When asked about the resistance former First Lady Michelle Obama encountered when she promoted healthy eating, including healthier school lunches, Holcomb acknowledged that change will come slowly. “It starts in the home,” she said. “Children do whatever they are being exposed to in the home, and that’s the habit they develop for the rest of their lives.”

Witters said changing the culture of American food and exercise patterns will be a long-term struggle. He likened it to the public health effort to combat smoking, which began with the 1964 report to the Surgeon General and continues to this day. In the 1950s, at least half of American adults smoked; today, less than 20% do.

“You don’t turn the Titanic on a dime to get those cultural shifts,” he said. “It takes a generation.”

The good news is some states are passing sugar and soda taxes. “We’re recognizing that more of the cheap, bad-for-you junk food that’s high in processed sugar is turning around and costing our society huge amounts of money down the road,” Witters said.

The report profiles a pair of local health systems—Parkview Health in Fort Wayne, Indiana, and Our Lady of Lourdes in Binghampton, New York—that adapted their delivery systems for better diabetes care. Our Lady of Lourdes, in particular, has developed systems to avoid severe hypoglycemia.

Witters and Holcomb see the alarm about diabetes and obesity finally moving out of the healthcare policy and human resources domain, and reaching the level of broader public awareness.

“It has to be local community leaders and healthcare professionals developing these changes,” Holcomb said. “It’s not going to happen overnight.”