New Updates on the Diabetes Epidemic Within the United States

An interview with the president of ADCES shines a light on the emergent issue of the growing rise in diabetes and prediabetes, and offers ways to help reduce this growth by spreading education.

A recent report from the Centers for Disease Control (CDC) revealed startling new updates to the number of individuals with diabetes and prediabetes in the United States. The data obtained from 2017-2020 showed that one in ten Americans have diabetes, and over one-third have prediabetes. It also mentioned that of the 37.3 million people with diabetes, around 8.5 million are undiagnosed. This was similar in those with prediabetes: of the 96 million adults that have it, approximately 19% are unaware of their prediabetes status. In addition, an even more alarming aspect of the finding was the substantial rise in diabetes and prediabetes in young adults and even children.  

To better understand why we are seeing this rise and learn more about what can help mitigate this growing epidemic, I interviewed Dr. Jan Kavookjian, president of the Association of Diabetes Care & Education Specialists (ADCES). They are headquartered in Chicago and include over 12,000 professional members, including nurses, dietitians, pharmacists, and others in the diabetes education realm. This organization has been highly involved over the last 50 years in diabetes self-management education and support (DSMES), also known as diabetes self-management training (DSMT).  

Dr. Kavookjian began by emphasizing the importance of immersion and integration during the last few years of Certified Diabetes Care and Education Specialists (CDCES), focusing on the education aspect of self-management behaviors for achieving optimal outcomes. This came after recently released research that evaluated what interprofessional specialists in this field were doing. It showed that having the strong presence of the educational component in clinical care promoted better outcomes. The organization began a partnership with the CDC around five years ago and has since disseminated this evidence-based model for the National Diabetes Prevention Program (DPP) and translated that among CDCES.  

I went on to ask Dr. Kavookjian questions relating to this information and on the recent data reported by the CDC. To begin, I was curious what she believed to be the most significant contributing factor(s) in why so many patients with prediabetes and diabetes are going undiagnosed. She stated that these disease states could often present asymptomatic and lack awareness. She mentioned that there is an enormous need for proactive screening. The organization is a big advocate of this and how assessing patients for risk factors, such as a family history of diabetes, age (those over 65), race/ethnicity (African American, Hispanic, and Asian descent have an increased risk), and lifestyle behaviors (unhealthy eating and lack of exercise). These should prompt a health care provider to begin screening for prediabetes/diabetes. To support this, she mentioned a recent study that conducted a multicenter trial at major medical centers across the country on thousands of persons diagnosed with prediabetes and tracked longitudinally through this curriculum that the national DPP is now based on. Just the impact of that lifestyle arm predicted a risk reduction of moving into the type 2 diagnosis range around 58%. These findings were imperative to the CDC’s focus on the national DPP because of the prenominal impart the lifestyle modification made on the progression from prediabetes to diabetes.  

Next, I wanted to know what aspects of the national DPP are helping most to help empower patients to self-manage their health and care. Dr. Kavookjian shared that these programs offer ways to help grow individuals’ knowledge of managing their health and improve confidence in lifestyle improvements by engaging in healthy eating and being active. One significant aspect of this was support groups of other individuals from similar circumstances or backgrounds to help form a sense of community. In addition, the National DPP utilizes evidence-based behavior change theories, strategies, and communication skills like motivational interviewing (MI). MI is a communication skill set that is intended to help people get to their internal motivation and do their goal setting because when patients hear themselves set a goal, they are much more likely to stick with that if they came up with it instead of someone telling them what to do this week. 

I also wanted to know what effect digital health technology has on prediabetes and diabetes patient care. She started by sharing how apps have been excellent for helping with self-management, whether it’s diabetes-specific or behavioral-specific. She also emphasized how the integration of Telehealth, especially since the pandemic, has opened many opportunities for those who want to become educators and those who have limited access to care. For example, it has provided access for many people who otherwise didn’t have access to the DPP classes or had to miss a class for several reasons, including childcare issues, work, somebody getting sick, or they’re providing care for an elderly patient, etc. The move to a virtual platform facilitated people to participate, and it provided the opportunity for individuals to stay connected when they couldn’t get there. It resulted in less attrition, less absenteeism, and more completion. These are some of the core reasons why ADCES has advocated and partnered with the Diabetes Advocacy Alliance to help promote legislation put forward that expands virtual access to DSMES and DPP, such as the Prevent Diabetes Act and the Expanding Access DSMT ACT. Finally, she expanded on the importance of legislative advocacy when it comes to the prevention of diabetes. She mentioned that there is an opportunity to be at the forefront of influencing policy changes pertaining to diabetes and how ADCES has partnered with other organizations like previously mentioned to expand access to DPP programs. She encourages others to advocate by writing to your local congressional representative, asking them to support the Expanding Access to DSMT Act and the Prevent Diabetes Act, because this can help bring them to the forefront. 

Lastly, I wanted to touch on the rise in prediabetes and type 2 diabetes in youth and how education can be modified for children with limited healthcare literacy. Dr. Kavookjian began by addressing the rise in overweight and obesity in childhood and how it has been linked to poor eating, poor access to healthy eating, and the sedentary lifestyle that our society is perpetuating. She suggests that a significant way to improve outcomes is to bring more awareness to pediatricians, especially those who provide care to children with limited access. Also, to encourage early screenings, educate early, and incorporate family into the DPP to help make changes within the home that promote positive lifestyle changes. Finally, the most critical aspects of the youth diabetes prevention programs are to make them fun and accessible.  

After this interview, it was clear to see how important it is that healthcare providers utilize or become CDCES and get involved with DPPs to promote better health outcomes for our patients and combat the rise of prediabetes and diabetes in all age categories, as well as getting involved with legislative advocacy to promote policy change in this area. Thanks to Dr. Jan Kavookjian for her time and expertise on this growing global health crisis. You can find more information on her and ADCES at www.diabeteseducator.org. 

Miriam E. Tucker. “More Than 1 in 10 People in the US Have Diabetes, CDC Says”. Medscape – 26 Jan. 2022. https://www.medscape.com/viewarticle/967279 

Interview conducted with Dr. Jan Kavookjian, president of the Association of Diabetes Care & Education Specialists (ADCES).

Alexa Rodriguez, PharmD Candidate 2022, University of South Florida, Taneja College of Pharmacy