EUTAW, Ala. — After decades of relentless rise, the number of new cases of diabetes in the United States has finally started to decline.
The rate of new cases fell by about a fifth from 2008 to 2014, according to researchers at the Centers for Disease Control and Prevention, the first sustained decline since the disease started to explode in this country about 25 years ago.
The drop has been gradual and for a number of years was not big enough to be statistically meaningful. But new data for 2014 released Tuesday serves as a robust confirmation that the decline is real, officials said. There were 1.4 million new cases of diabetes in 2014, down from 1.7 million in 2008.
"It seems pretty clear that incidence rates have now actually started to drop," said Dr. Edward Gregg, one of the CDC's top diabetes researchers. "Initially it was a little surprising because I had become so used to seeing increases everywhere we looked."
Experts say they do not know whether efforts to prevent diabetes have finally started to work, or if the disease has simply peaked in the population. But they say the shift tracks with the nascent progress that has been reported recently in the health of Americans.
There is growing evidence that eating habits, after decades of deterioration, have finally begun to improve. The amount of soda Americans drink has declined by about a quarter since the late 1990s, and the average number of daily calories children and adults consume also has fallen. Physical activity has started to rise and once-surging rates of obesity, a major driver of Type 2 diabetes, the most common form of the disease, have flattened. Type 1 diabetes, often diagnosed in childhood and adolescence and not usually associated with excess body weight, was also included in the data.
Experts cautioned that the portion of Americans with diabetes was still more than double what it was in the early 1990s. They said progress had been uneven. Educated Americans have seen improvements, for example, while the rates for the less educated have flattened but not declined. The number of new cases is dropping for whites, the 2014 data show, but the change has not been statistically significant for blacks or Hispanics, though both show a downward trend.
Still, the shift represents a profound change in one of the most vexing health problems in the United States. Diabetes afflicts 1 in every 10 American adults and is the country's leading cause of blindness, limb amputations and kidney dialysis.
"It's not yet time to have a parade," said Dr. David M. Nathan, director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital. But he noted, "It has finally entered into the consciousness of our population that the sedentary lifestyle is a real problem, that increased body weight is a real problem."
Even here in Alabama, which has the highest prevalence of diabetes in the country, the rate of new cases has begun to taper. According to figures for 2013, the most recent available by state, 12.7 percent of Alabama's residents had the disease.
In the tiny town of Eutaw, Lynette Carpenter got serious about staving off diabetes around the time her cousin's leg was amputated because of the disease. She started to make a dish she called Sexy Pork Chops, involving a bell pepper, an onion and the oven. She weaned herself off Coca-Cola, going from about 50 cans a week to fewer than seven. And she started walking, leaving rubber bands in her mailbox to pull onto her arm — one for each mile walked — to remind her how many miles she had gone. The result made her doctor proud: She lost 42 pounds, and two years later has still not developed full-blown diabetes.
Diabetes "has got my respect and attention," she said. "I take it real serious."
Robin Williams, a music teacher in Birmingham, lost 33 pounds by cutting out candy, packing her lunch and not buying fast food during long bus trips to band practice, habits she learned in a YMCA program on diabetes prevention. She started watching "My 600-lb Life," a television show about people losing weight, with her teenage daughter. The show frightened her, as did her father's leg amputations two years ago. She is down to 222 pounds, and is determined to keep going.
"I want to see my child grow up," Williams said. She uses an app on her phone to track her calories. "It made me much more conscious of what I was putting in my mouth."
Diabetes has been particularly devastating here in what is known as the Black Belt — a strip of counties that originally got its name for its fertile soil. Its majority black populations were once slaves and later, after the Civil War, they were sharecroppers. The area had some of the worst racial violence of the Jim Crow era, said Hasan Kwame Jeffries, associate professor of history at Ohio State University, and today is among the poorest in the country.
"Black folk in the Black Belt have never not been living in poverty," Jeffries said. "It's not a cycle, it's linear. It's an unbroken line from slavery forward. And it's really critical for understanding why there's such a health crisis in these counties."
Ethel Johnson, a nurse in Camden, a little town in Wilcox County, said diagnoses were coming so thick and fast in the 1990s that many people thought something had been added to the water.
"Diabetes was coming up everywhere — among friends, family, church members," she said in her small office adorned with posters of fruit and vegetables and one of the Rev. Martin Luther King Jr.
Amputations became common. Eleanor Randolph, a retired schoolteacher in Livingston, said her cousin last year lost a toe, and then, a few months later, a leg. He recently lost the other leg.
"It kind of shakes you up," she said. "It makes you think. It makes you want to do right."
Bernice Wright, 40, a driver of a medical van, said several patients had lost so many limbs that they could no longer move without being lifted.
"It's like a shark did that to their body," she said.
But that devastation, deeply frightening, is also inspiring change. Pamela Moton, 30, a resident of Pine Apple, cut a pink streak down a leafy trail on a recent morning, power walking in yoga pants and a fuchsia top to escape her genes, her culture and her history.
Her father, now dead, had diabetes and so did an aunt. Her mother, who weighs over 350 pounds and had a heart attack in her 50s, does not move around much anymore because of her weight.
"That just like motivated me," she said. "I thought: 'I can't get like that.' No way can I get like that."
Some say prevention programs have helped keep them on track. Carpenter, the woman who cut her consumption of Coca-Cola, swears she would not have managed to change her habits without her weekly telephone call from a health counselor and monthly support groups, programs funded by the University of Alabama at Birmingham, and the federal government. The meetings are fun, like church socials, she says. In two years, she has missed only one.
Four of her 14 siblings and half siblings have diabetes. "If I wasn't going to the class, I'd probably be on all kinds of medications," she said.
Still, it is unclear whether these improvements are affecting overall rates of new cases in the Black Belt. The CDC does not measure new cases by county.
Dr. Monika Safford, an internist School of Medicine, at the University of Alabama at Birmingham, who has conducted random trials with community health workers in the Black Belt, found patients lost weight and improved blood pressure but had no change in glucose.
"Individually there have been some successes, but as an epidemic, I don't think we've made a dent," said Dr. Roseanne Cook, a physician at the Pine Apple Health Center.
Others detect a meaningful shift in people's attitudes. When Kim Catlin, a nurse with the Bryan W. Whitfield Memorial Hospital in Demopolis, began preaching better health in church basements and health centers in rural Alabama in 2007, she was met with blank stares.
"There was no education about it, I mean nothing," she recalled. "It was, 'Blood sugar, what? Blood pressure who?' They didn't know what these things were."
Now, she said, "people are more conscious of what they are eating. They are more active."
For Carpenter, the result has been a better life.
"Baby, I got my self-esteem going and I'm gone," she said. "It used to be, 'All you ever do is sit up in the house.' Now it's 'You ain't never staying at home.'"