Archive for December, 2012

Part I

Update on Diabetes in America
[Epidemiology and New Research Findings]


This is Part I of a two-part series on diabetes in this country. Part I will be an epidemiological look at this disease in terms of statistical estimates disaggregated by age, race, and gender.

Part II of the series will concentrate on presenting some of the new research findings as they relate to Type II diabetes, insulin resistance, obesity, and a new factor that is emerging as important—Inflammation.

2011 National Diabetes Fact Sheet

Diagnosed and undiagnosed diabetes in the United States, all ages, 2010

Total: 25.8 million people, or 8.3% of the U.S. population, have diabetes.
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people

Estimation Methods

The estimates in this fact sheet were derived from various data systems of the Centers for Disease Control and Prevention (CDC), the Indian Health Service’s (IHS) National Patient Information Reporting System (NPIRS), the U.S. Renal Data System of the National Institutes of Health (NIH), the U.S. Census Bureau, and published studies.

The estimated percentages and the total number of people with diabetes and prediabetes were derived from 2005–2008 National Health and Nutrition Examination Survey (NHANES), 2007–2009 National Health Interview Survey (NHIS), 2009 IHS data, and 2010 U.S. resident population estimates.

The diabetes and prediabetes estimates from NHANES were applied to the 2010 U.S. resident population estimates to derive the estimated number of adults with diabetes or prediabetes. The methods used to generate the estimates for the fact sheet may vary over time and need to be considered before comparing fact sheets. In contrast to the 2007 National Diabetes Fact Sheet, which used fasting glucose data to estimate undiagnosed diabetes and prediabetes, the 2011 National Diabetes Fact Sheet used both fasting glucose and hemoglobin A1c (A1c) levels to derive estimates for undiagnosed diabetes and prediabetes. These tests were chosen because they are most frequently used in clinical practice.

Diagnosed and undiagnosed diabetes among people aged 20 years or older, United States, 2010

Age 20 years or older: 25.6 million, or 11.3% of all people in this age group, have diabetes.

Age 65 years or older: 10.9 million, or 26.9% of all people in this age group, have diabetes.

Men: 13.0 million, or 11.8% of all men aged 20 years or older, have diabetes.

Women: 12.6 million, or 10.8% of all women aged 20 years or older, have diabetes.

Non-Hispanic whites: 15.7 million, or 10.2% of all non-Hispanic whites aged 20 years or older, have diabetes.

Non-Hispanic blacks: 4.9 million, or 18.7% of all non-Hispanic blacks aged 20 years or older, have diabetes.

Sufficient data are not available to estimate the total prevalence of diabetes (diagnosed and undiagnosed) for other U.S. racial/ethnic minority populations.

Diagnosed diabetes in people younger than 20 years of age, United States, 2010

About 215,000 people younger than 20 years have diabetes (type 1 or type 2). This represents 0.26% of all people in this age group. Estimates of undiagnosed diabetes are unavailable for this age group.

Racial and ethnic differences in diagnosed diabetes

National estimates of diagnosed diabetes for some but not all minority groups are available from national survey data and from the IHS NPIRS, which includes data for approximately 1.9 million American Indians and Alaska Natives in the United States who receive health care from the IHS. Differences in diabetes prevalence by race/ethnicity are partially attributable to age differences. Adjustment for age makes results from racial/ethnic groups more comparable.
• Data from the 2009 IHS NPIRS indicate that 14.2% of American Indians and Alaska Natives aged 20 years or older who received care from IHS had diagnosed diabetes.

• After adjusting for population age differences, 16.1% of the total adult population served by IHS had diagnosed diabetes, with rates varying by region from 5.5% among Alaska Native adults to 33.5% among American Indian adults in southern Arizona.

• After adjusting for population age differences, 2007–2009 national survey data for people aged 20 years or older indicate that 7.1% of non-Hispanic whites, 8.4% of Asian Americans, 11.8% of Hispanics, and 12.6% of non-Hispanic blacks had diagnosed diabetes. Among Hispanics, rates were 7.6% for both Cubans and for Central and South Americans, 13.3% for Mexican Americans, and 13.8% for Puerto Ricans.

• Compared to non-Hispanic white adults, the risk of diagnosed diabetes was 18% higher among Asian Americans, 66% higher among Hispanics, and 77% higher among non-Hispanic blacks. Among Hispanics compared to non-Hispanic white adults, the risk of diagnosed diabetes was about the same for Cubans and for Central and South Americans, 87% higher for Mexican Americans, and 94% higher for Puerto Ricans.

New cases of diagnosed diabetes among people aged 20 years or older, United States, 2010

About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010.

New cases of diagnosed diabetes among people younger than 20 years of age, United States, 2002–2005

SEARCH for Diabetes in Youth is a multicenter study funded by CDC and NIH to examine diabetes (type 1 and type 2) among children and adolescents in the United States. SEARCH findings for the communities studied include the following:
• During 2002–2005, 15,600 youth were newly diagnosed with type 1 diabetes annually, and 3,600 youth were newly diagnosed with type 2 diabetes annually.

• Among youth aged

• Non-Hispanic white youth had the highest rate of new cases of type 1 diabetes (24.8 per 100,000 per year among those younger than 10 years and 22.6 per 100,000 per year among those aged 10–19 years).

• Type 2 diabetes was extremely rare among youth aged 9%) were 2.9 times more likely to have severe periodontitis than those without diabetes. The likelihood was even greater (4.6 times) among smokers with poorly controlled diabetes.

• About one-third of people with diabetes have severe periodontal disease consisting of loss of attachment (5 millimeters or more) of the gums to the teeth.

Complications of pregnancy
• Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. On the other hand, for a woman with pre-existing diabetes, optimizing blood glucose levels before and during early pregnancy can reduce the risk of birth defects in their infants.

• Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other complications
• Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.

• People with diabetes are more susceptible to many other illnesses. Once they acquire these illnesses, they often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

• People with diabetes aged 60 years or older are 2–3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework compared with people without diabetes in the same age group.

• People with diabetes are twice as likely to have depression, which can complicate diabetes management, than people without diabetes. In addition, depression is associated with a 60% increased risk of developing type 2 diabetes.

Preventing diabetes complications

As indicated above, diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner.

Glucose control
• Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1c blood test results (e.g., from 8.0% to 7.0%) can reduce the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%. The absolute difference in risk may vary for certain subgroups of people.

• In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.

Blood pressure control
• Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among people with diabetes by 33% to 50%, and the risk of microvascular complications (eye, kidney, and nerve diseases) by approximately 33%.

• In general, for every 10 mmHg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.

• No benefit of reducing systolic blood pressure below 140 mmHg has been demonstrated in randomized clinical trials.

• Reducing diastolic blood pressure from 90 mmHg to 80 mmHg in people with diabetes reduces the risk of major cardiovascular events by 50%.
Control of blood lipids
• Improved control of LDL cholesterol can reduce cardiovascular complications by 20% to 50%.

Preventive care practices for eyes, feet, and kidneys
• Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.

• About 65% of adults with diabetes and poor vision can be helped by appropriate eyeglasses.

• Comprehensive foot care programs, i.e., that include risk assessment, foot-care education and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.

• Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with particular medications for hypertension called angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is more effective in reducing the decline in kidney function than is treatment with other blood pressure lowering drugs.

• In addition to lowering blood pressure, ARBs and ACEIs reduce proteinuria, a risk factor for developing kidney disease, by about 35%.

Post Script

In Part I, data were presented on diabetes in order to give the reader an epidemiological look at this disease. In Part II data will be presented on some of the research looking to understand, or at least better treat, this dreadful disease. It is hoped that as each year passes, researchers will eventually find the cure for diabetes.


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