In 2014 total prevalence of diabetes in the United States in all ages was 29.1 million people (15.5 million adult men and 13.4 adult women), or 9.3% of the population. Of these, 21.0 million are diagnosed, and 8.1 million undiagnosed.

Diabetes prevalence also increases with age, affecting 11.2 million people age 65 years and older, or 25.9% of all people in this age group.

Much of the increase in prevalence is because the prevalence of type 2 diabetes is increasing dramatically in younger age groups in the last decade, especially in minority populations.

The prevalence of type 2 diabetes is highest in ethnic groups in the United States. Data indicate in people aged 20 years or older,

  • 9% of American Indians and Alaska Natives,
  • 2% of non-Hispanic blacks,
  • 8% of Hispanics, and
  • 0% of Asian Americans had diagnosed diabetes.

Among Hispanics, rates were 14.8% for Puerto Ricans, 13.9% for Mexican Americans, and 9.3% for Cubans (CDC, 2014).

Of great concern, are the 86 million people (37% of adults 20 years or older and 51% of adults 60 years or older) with prediabetes, which includes impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). All are a high risk for conversion to type 2 diabetes and cardiovascular disease if lifestyle prevention strategies are not implemented.

According to L. Kathleen Mahan and Janice L Raymond, (authors of Krause’s Food & the Nutrition Care Process) in the healthy individual, omission of a specific food group or intake of high-energy, nutrient-poor foods does not lead to failed nutritional status overnight. It is the prolonged imbalance intake that leads to chronic disease.


This is the significance of our eight practices at Pathology Prevention. Following these practices will reduce the risk of diabetes, and other chronic diseases. Prevention is much more effective than waiting until your either within the prediabetes stage, or already diagnosed with Type 2 diabetes. Of course, regardless of when performed, any pathology prevent activity will help prevent further susceptibility and damage.   

Step three of the Krause Nutrition Care Process requires planning and goal-setting, followed by the selection of interventions that deal with the cause of the problem, and not just any symptoms that may be presented.

For example, nutrition education is an appropriate intervention for the person who has little knowledge of how to manage his or her gluten-free diet. And, this requires a counseling approach, keeping the person’s level of readiness to change in mind. It may be helpful to refer the individual to available cookbooks, health services, and support groups. Manipulation of dietary components, provision of enteral or parenteral nutrition, or in-depth nutrition counseling may also be needed.

Coordination of care between hospital and home and community is important for lifelong management of nutrition and chronic disease.

These lines of thinking reflect the evolution of nutritional science, from the identification of nutrient requirements and the practical application of this knowledge to the concepts that relate nutrition, to the prevention of chronic and degenerative disease, and to optimization of health and performance.

The relationship between nutrition and dental disease has long been recognized. In more recent decades the possibility of reducing the incidence of osteoporosis by emphasizing appropriate nutrition has accumulated supportive evidence. Medical research now shows the role of nutrition on gene expression (epigenetics); dietary intake can turn on or turn off the inflammatory process, a key factor in disease onset and management.

 Individuals with a stage of impaired glucose homeostasis that includes IFG and IGT are referred to as having prediabetes, indicating their relatively high risk for the development of diabetes and CVD. People at risk may have IFG (fasting plasma glucose 100-125 mg/dl) IGT (2-hour post-challenge glucose of 140 to 199 mg/dl), both, or a hemoglobin A1c (A1C) of 5.7% to 6.4% and should be counseled about strategies, such as reduced energy intake, weight loss, and physical activity, to lower their risks.

In no other disease does lifestyle—healthy and appropriate food choices and physical activity—play a more important role in prevention and treatment than in diabetes. Studies comparing lifestyle modifications to medication have provided support for the benefit of weight loss (reduced energy intake) and physical activity as the first choice to prevent or delay diabetes.

Clinical trials comparing lifestyle interventions to a control group have reported risk reduction for T2DM from lifestyle interventions ranging from 29% to 67% (Youssef, 2012). Two frequently cited studies are the Finnish Diabetes Prevention Study and the Diabetes Prevention Program (DPP), in which lifestyle interventions focused on a weight loss of 5% to 10%, physical activity of at least 150 min/week of moderate activity, and ongoing counseling and support. Both reported a 58% reduction in the incidence of T2DM in the intervention group compared with the control group and persistent reduction in the rate of conversion to T2DM within 3 to 14 years postintervention follow-up.”

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