Towards a subsiding diabetes epidemic: trends from a large population-based study in Israel.
BACKGROUND
With increasing diabetes prevalence worldwide, an impending diabetes "pandemic" has been reported. However, definitions of incident cases and the population at risk remain varied and ambiguous. This study analyzed trends in mortality and screening that contribute to diabetes prevalence and incidence, distinguishing between new incident cases and newly detected cases.


METHODS
In an integrated provider-and-payer-system covering 53% of Israel's population, a composite diabetes case-finding algorithm was built using diagnoses, lab tests, and antidiabetic medication purchases from the organization's electronic medical record database. Data were extracted on adult members aged 26+ each year from January 1, 2004 through December 31, 2012. Rates of diabetes prevalence, incidence, screening, and mortality were reported, with incidence rates evaluated among the total, "previously-screened," and "previously-unscreened" at-risk populations.


RESULTS
There were 343,554 diabetes cases in 2012 (14.4%) out of 2,379,712 members aged 26+. A consistent but decelerating upward trend in diabetes prevalence was observed from 2004-2012. Annual mortality rates among diabetics decreased from 13.8/1000 to 10.7/1000 (p = 0.0002). Total population incidence rates declined from 13.3/1000 in 2006 to 10.8/1000 in 2012 (p < 0.0001), with similar incidence trends (13.2/1000 to 10.2/1000; p = 0.0007) among previously-screened at-risk members, and a rise in testing rates from 53.0% to 66.7% (p = 0.0004). The previously-unscreened group decreased 28.6%, and the incidence rates within this group remained stable.


CONCLUSIONS
The increase in diabetes prevalence is decelerating despite declining mortality and increasing testing rates. A decline in previously-screened incident cases and a shrinking pool of previously-unscreened members suggests that diabetes trends in Israel are moving toward equilibrium, rather than a growing epidemic.
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel.
Tomas
T
Karpati
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel.
Chandra J
CJ
Cohen-Stavi
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel ; Department of Medicine, New York University School of Medicine, New York, USA.
Morton
M
Leibowitz
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel.
Moshe
M
Hoshen
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel.
Becca S
BS
Feldman
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, 62098 Tel Aviv, Israel ; Department of Public Health, |Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Ran D
RD
Balicer
Diabetes epidemiology; Diabetes incidence; Diabetes mortality; Diabetes prevalence; Diabetes screening rates; Population at risk