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Rapid response to:


Trends in type 2 diabetes

BMJ 2019; 366 doi: (Published 11 September 2019) Cite this as: BMJ 2019;366:l5407

Linked research

Trends in incidence of total or type 2 diabetes

Rapid Response:


Professor Lean and colleagues express reservations about a link between sugar consumption and type 2 diabetes (1). However, epidemiological data from the United States does suggest a link.

Firstly, the epidemic of obesity and type 2 diabetes coincided with the increased consumption of refined carbohydrates after the 1960s (2).

Secondly, when per capita added sugar consumption decreased from 100 gm per day to 76 gm per day after 1999 (3) this appears to have been followed by positive changes. The incidence of type 2 diabetes that had peaked in the US in 2008 has fallen by 25% (4). The incidence of obesity levelled out between 2006 and 2012 in native born Americans (5). The incidence of obesity in 2 to 5-year olds has decreased (6). Although, there has been a time delay between this decreasing consumption of sugar and these beneficial changes this is not unusual. Deaths from lung cancer did not begin to decline fall until 20 years after cigarette consumption began to decline.


Lean M, McCombie L, McSorely J. Trends in type 2 diabetes. BMJ 2019;366: l5407.


Gross L, Li L, Ford E, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecological assessment. Am J Clin Nutr 2004; 79:774-9.


Welsh J, Sharma A, Grellinger L, Vos M. Consumption of added sugars is decreasing in the United States. Am J Clin Nutr 2011;94:726-34.

Benoit S, Hora I, Albright A, Gregg E. New directions in incidence and prevalence of diagnosed diabetes in the USA. BMJ Open Diab Res Care 2019;7:e000657.

Tsujimoto T, Kajio H, Sugiyama T. Obesity, diabetes and length of time in the United States. Analysis of National Health and Nutrition Examination Survey 1999 to 2012. Medicine 2016;95:35(e4578).


Dietz W, Economos C. Progress in the Control of Childhood Obesity. Pediatrics 2015;135;e559.

Competing interests: No competing interests

20 September 2019
Patrick J Bradley
Retired General Practitioner
P.O. Box 5397, Wollongong, NSW 2500 , AUSTRALIA