Diabetes: A Major Health Problem

Diabetes is a serious, common, costly, but controllable disease. Diabetes is the sixth leading cause of death in the United States and affects almost 21 million Americans, an estimated 6.2 million of whom are as yet undiagnosed (1). In 2002, diabetes cost the nation an estimated $132 billion in direct and indirect costs (2). Diabetes is the number one cause of lower limb amputation not related to trauma, the number one cause of acquired blindness, and the number one cause of kidney disease leading to dialysis in the United States. Diabetes is a major contributor to cardiovascular disease, the number one cause of death in this country. About 65% of people with diabetes die from cardiovascular disease (3).

Diabetes prevalence is rapidly increasing. Figure 1 shows self-reported rates of diabetes gathered through the Behavioral Risk Factor Surveillance Study (BRFSS) by state. Diabetes prevalence has tripled from 1990 to 2005, and in some states more than 25% of the adult population aged 20 years and older has diabetes. The number of people with diabetes in the United States is projected to reach 39 million by the year 2050 (4). If current trends continue, 1 in 3 Americans will develop diabetes sometime in his or her lifetime, and those with diabetes will lose, on average, 10 to 15 years of life (5).

Types of Diabetes

Type 1 diabetes. Type 1 diabetes (formerly known as insulin-dependent or juvenile-onset diabetes) is an autoimmune disease that is distinguished by the destruction of insulin-producing beta cells. Type 1 diabetes can occur at any age, but onset usually begins in childhood or the young adult years. People with type 1 diabetes are ketosis-prone, although ketoacidosis can develop in type 2 diabetes as well. People with type 1 diabetes must take insulin daily. Delivery mechanisms for insulin include injection, insulin pump, and inhalation, although at this time inhalation must be combined with another delivery method. For optimal management, people with type 1 diabetes must test their blood glucose levels several times a day, follow an individualized meal plan, and engage in regular physical activity.

Type 2 diabetes. Formerly known as non-insulin-dependent or adult-onset
diabetes, type 2 diabetes is related to insulin resistance. The pancreas continues to make insulin, but the insulin is not used well by other body tissues. Eventually, insulin production decreases. People with type 2 diabetes may be treated with insulin, oral medications, or a combination of both or be controlled with a food plan and physical activity alone. Type 2 diabetes affects 9.6% of the U.S. population aged 20 years and older, and 20.9% of the population aged 60 years or more, occurring more often in adults who are overweight and sedentary (3). In recent years, however, it has been seen increasingly in young people, including children. The prevalence of type 2 diabetes in younger age groups is of special concern because the risk of complications increases with the disease’s duration.

Type 2 diabetes disproportionately affects African Americans, Hispanics/Latinos, American Indians, and Alaska Natives, and some groups of Asians and Native Hawaiians or other Pacific Islanders. African Americans and Hispanic/Latino Americans are about twice as likely to have diabetes as non-Hispanic/Latino whites in a similar age group. Some populations of American Indians have the highest rates of diabetes in the world.
Gestational diabetes is a form of glucose intolerance 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 those 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% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5 to 10 years (5).

Other 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 account for 1% to 5% of all diagnosed cases.

Diabetes and Obesity Trends

The development of type 2 diabetes is multifactorial, with insulin resistance, sedentary lifestyle, increasing age and increasing obesity contributing to this increase. A body mass index (BMI) of 25 or more (> 23 for Asian Americans and > 26 for Pacific Islanders) is a risk factor for the development of type 2 diabetes. Figure 2 shows the parallel increases in the prevalence of diabetes and mean body weight by year in the United States from 1990 to 2000 (6–8). As of 2005, approximately two-thirds of American adults were overweight or obese, with BMI more than 25.

• The prevalence of obesity has increased by 61% since 1991.
• More than 60% of U.S. adults are overweight.
• BMI and weight gain are major risk factors for diabetes.

Diabetes Morbidity and Mortality

Adults with type 2 diabetes are two to four times more likely to have heart disease or suffer a stroke than those without diabetes. Cardiovascular disease is the major cause of death for people with diabetes. They are also at risk for other complications, such as blindness, kidney disease, amputations, nervous system disease, and oral complications, including gum or periodontal disease and tooth loss (3).

Fortunately, many studies in recent years have demonstrated effective interventions to help prevent or delay diabetes complications as well as the disease itself (9–21).

May 2007

National Diabetes Education Program (NDEP)    http://ndep.nih.gov
NIDDK, National Institutes of Health, Bethesda, MD

A Joint Initiative of the National Institutes of Health and the
Centers for Disease Control and Prevention