Proof Positive
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The Attitude of Gratitude
School of Health & Wellness
By Milton G. Crane, M.D. and Barbara G. Crane, R.D. of Weimar Institute
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.
Types of diabetes
Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, who need several insulin injections a day or an insulin pump to survive. Type 1 diabetes may account for 5 percent to 10 percent of all diagnosed cases of diabetes. Risk factors for type 1 diabetes include autoimmune, genetic, and environmental factors.
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90 to 95 percent of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes. Type 2 diabetes is increasingly being diagnosed in children and adolescents.
Gestational diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5 to 10 percent of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next 5 to10 years.
Other specific types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1 to 5 percent of all diagnosed cases of diabetes.
Prevalence of Diabetes
Total:
17 million people - 6.2 percent of the population
- have diabetes.
Diagnosed: 11.1 million people
Undiagnosed: 5.9
million people
Prevalence of diabetes
among people under 20 years of age:
Prevalence
of diabetes among people 20 years or older:
Age 20 years or older:
16.9 million. 8.6 percent of all people in this age
group have diabetes.
Age 65 years or older: 7 million. 20.1 percent of all people in this age group have diabetes.
Men: 7.8 million. 8.3 percent of all men have diabetes.
Women: 9.1 million. 8.9 percent of all women have diabetes.
Prevalence
of diabetes by race/ethnicity among people 20 years
or older:
Non-Hispanic whites:
11.4 million. 7.8 percent of all non-Hispanic whites
have diabetes.
Non-Hispanic blacks: 2.8 million. 13 percent of all non-Hispanic blacks have diabetes. On average, non-Hispanic blacks are two times more likely to have diabetes than non-Hispanic whites of similar age.
Hispanic/Latino Americans: 2 million. 10.2 percent of all Hispanic/Latino Americans have diabetes. On average, Hispanic/Latino Americans are 1.9 times more likely to have diabetes than non-Hispanic whites of similar age. Mexican Americans, the largest Hispanic/Latino subgroup, are two times more likely to have diabetes than non-Hispanic whites of similar age. Similarly, residents of Puerto Rico are two times more likely to have diagnosed diabetes than U.S. non-Hispanic whites. Sufficient data are not available to derive more specific current estimates for other groups.
American Indians and Alaska Natives who receive care from the Indian Health Service (IHS): 105,000. 15.1 percent of American Indians and Alaska Natives receiving care from IHS have diabetes. At the regional level, diabetes is least common among Alaska Natives (5.3 percent) and most common among American Indians in the southeastern United States (25.7 percent) and in certain tribes from the Southwest. On average, American Indians and Alaska Natives are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age.
Asian Americans and Native Hawaiian or other Pacific Islanders: Prevalence data for diabetes among Asian Americans and Native Hawaiians or other Pacific Islanders are limited. Some groups within these populations are at increased risk for diabetes. For example, data collected from 1996 to 2000 suggest that Native Hawaiians are 2.5 times more likely to have diagnosed diabetes than white residents of Hawaii of similar age.
Incidence
of diabetes
New cases diagnosed per
year: 1 million people aged 20 years or older.
Deaths among people with diabetes:
Complications of Diabetes
Heart Disease: Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
Stroke: The risk for stroke is 2 to 4 times higher among people with diabetes.
High Blood Pressure: About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension.
Blindness: Diabetes is the leading cause of new cases of blindness among adults 20 to 74 years old. Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year.
Kidney Disease: Diabetes is the leading cause of treated end-stage renal disease, accounting for 43 percent of new cases. In 1999, 38,160 people with diabetes began treatment for end-stage renal disease. In 1999, a total of 114,478 people with diabetes underwent dialysis or kidney transplantation.
Nervous System Disease: About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
Amputations: More than 60 percent of nontraumatic lower-limb amputations in the United States occur among people with diabetes. From 1997 to 1999, about 82,000 nontraumatic lower-limb amputations were performed each year among people with diabetes.
Dental Disease: Periodontal or gum diseases are more common among people with diabetes than among people without diabetes. Among young adults, those with diabetes are often at twice the risk of those without diabetes. Almost one third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more.
Complications of Pregnancy: Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies. Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to the mother and the 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 and, once they acquire these illnesses, often have a worse prognosis than people without diabetes. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.
Cost of
diabetes in the United States:
Total (direct and indirect):
$98 billion
Direct medical costs:
$44 billion
Indirect costs:
$54 billion (disability, work loss, premature mortality)
These data are based on an American Diabetes Association study and are 1997 estimates of both the direct costs (cost of medical care and services) and indirect costs (cost of short-term and permanent disability, and premature death) attributable to diabetes itself. This study is a cost-of-disease study and estimates of the health care costs that are due specifically to diabetes.
Acknowledgments
The following organizations collaborated in compiling
the information for this fact sheet.
American Association of Diabetes Educators
www.aadenet.org
American Diabetes Association
www.diabetes.org
Centers for Disease Control and Prevention
www.cdc.gov/diabetes
www.cdc.gov/nchs
Centers for Medicare and Medicaid
Services
www.hcfa.gov
Department of Veterans Affairs
www.va.gov/health/diabetes
Health Resources and Services Administration
www.hrsa.gov
Indian Health Service
www.ihs.gov
Juvenile Diabetes Research Foundation
International
www.jdrf.org
National Council of La Raza
www.nclr.org
National Diabetes Education Program,
a joint program of NIH and CDC
http://ndep.nih.gov
www.cdc.gov/diabetes
National Institute of Diabetes and
Digestive and Kidney Diseases of the National Institutes
of Health
www.niddk.nih.gov
U.S. Department of Health and Human
Services Office of Minority Health
www.omhrc.gov