Disabling Disease to Double by 2050
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“New evidence shows that approximately 54 million
people in the United States have prediabetes. Coupled with the nearly 21
million who already have diabetes, this places almost 25% of our
population at risk for further complications and suffering. Together, we
can and must do more to prevent and control this growing epidemic.”
Julie Louise Gerberding, MD, MPH
Director, Centers for Disease Control and Prevention
Diabetes: A Leading Cause of Death in America
In the last 15 years, the number of people in the United States with
diagnosed diabetes has more than doubled, reaching 14.6 million in 2005.
Although more than 20.8 million Americans have diabetes, 6.2 million do
not know they have the disease.
People with diabetes have a shortage of insulin or a decreased ability to
use insulin, a hormone that allows glucose (sugar) to enter cells and be
converted to energy. When diabetes is not controlled, glucose and fats
remain in the blood and, over time, damage vital organs. Diabetes is the
leading cause of new cases of adult blindness, kidney failure, and
nontraumatic lower extremity amputation. It can lead to heart disease,
stroke, pregnancy complications, and deaths related to flu and pneumonia. Heart
disease is the leading cause of diabetes-related deaths, and death rates are
about 2–4 times higher for adults with diabetes than for those without the
There are two main types of diabetes. Type 1 most often appears during
childhood or adolescence. Type 2 diabetes, which is linked to obesity and
physical inactivity, accounts for 90%–95% of diabetes cases and most often
appears in people older than 40. However, it is now being found in younger
people and is even being diagnosed among children and teens.
Data published in 2006 by CDC indicated that about 1 in 523 people
younger than age 20 had diabetes. Among this group, 79% were aged 10–19
years. The data also indicated that American Indians aged 10–19 years had
the highest prevalence of type 2 diabetes, at nearly 2 in 1,000. Diabetes
has its greatest effects on older adults, women, and certain racial and
ethnic groups. One in five U.S. adults over age 65 has diabetes. African
American, Hispanic, American Indian, and Alaska Native adults are twice as
likely as white adults to have diabetes.
In addition to the millions of Americans with diabetes, an estimated 54
million U.S. adults aged 20 or older have prediabetes—that is, their blood
sugar level is elevated but is not high enough to be classified as diabetes.
People with prediabetes are at high risk for developing type 2 diabetes.
Cost of Diabetes
According to the American Diabetes Association, the cost of diabetes
in the United States in 2007 was as follows:
- Total costs (direct and indirect): $174 billion.
- Direct medical costs: $116 billion.
- Indirect costs (related to disability, work loss, premature death):
- Cost of caring for someone with diagnosed diabetes: $1 out of every
$5 in total health care costs.
Diabetes Is Preventable and Controllable
Although the increasing burden of diabetes and its complications is
alarming, recent studies have found that lifestyle changes that include
moderate weight loss and exercise can prevent the onset of diabetes
among adults at high risk. For people already living with diabetes, much
of this burden could be prevented with early detection, improved
delivery of care, proper self-management measures such as regular blood
pressure, cholesterol, and A1C testing, as well as education initiatives
that provide the knowledge and resources for people to take action to
control their diabetes. For example,
- Studies in the United States and abroad have found that better blood
sugar control reduces the risk for eye disease, kidney disease, and
nerve disease by 40% in people with type 1 or type 2 diabetes.
- Blood pressure control reduces the risk for heart disease and stroke
among people with diabetes by 33%–50%. It also reduces the risk for eye,
kidney, and nerve diseases by about 33%. Detecting and treating early
diabetic kidney disease by lowering blood pressure can reduce the
decline in kidney function by 30%–70%.
- Improved control of blood cholesterol levels can reduce
cardiovascular complications by 20%–50%.
- Detecting and treating diabetic eye disease with laser therapy can
reduce the risk for loss of eyesight by about 50%–60%. Comprehensive
foot care programs can reduce amputation rates by 45%–85%.
Things Are Improving, But We Have Much To Do
people with diabetes:
2 in 5 have poor cholesterol control
1 in 3 have poor blood pressure control
1 in 5 have poor blood sugar control
An integrated, systemic approach is key to improving diabetes care
CDC Provides National Leadership and Builds Partnerships
CDC is committed to ensuring that all people, especially those at
greater risk for health disparities, will achieve their optimal lifespan
with the best possible quality of health in every stage of life. With
agency-wide health protection goals that support healthy people in
healthy places across all life stages, CDC is setting the agenda to
enable people to enjoy a healthy life by delaying death and the onset of
illness and disability by accelerating improvements in the health of the
CDC also provides leadership and funding to diabetes prevention and
control programs nationwide. In addition, CDC works with partners to provide
data for public health decision-making, educate the public about diabetes,
and ensure good care and education for people with the disease. In 2008, CDC
received about $63 million for its Division of Diabetes Translation (DDT).
Promoting Effective State Programs
In 2007, CDC provided funding for capacity building to 22 states, 8
current or former U.S. territories, and the District of Columbia for
diabetes prevention and control programs. CDC also provided funding for
basic implementation to 28 states. State programs identify the disease
burden in their states, develop and evaluate new prevention strategies,
establish partnerships, increase awareness of prevention and control
opportunities, and improve access to quality care. CDC also works with
its partners to develop national public health performance standards for
diabetes care. CDC has adopted the concept of conducting assessments
based on well-established principles of public health services (http://www.cdc.gov/diabetes).
Results of the assessments will help to identify areas of strength and
areas for improvement needed to develop the best public health programs
for diabetes prevention and control.
Monitoring the Burden and Translating Science
Timely data and public health research are essential for developing a
better understanding of how diabetes affects different population groups
and how quality of care can be improved. CDC analyzes data from several
national sources, including the Behavioral Risk Factor Surveillance
System, and explores ways to collect better diabetes data on groups most
at risk. To translate scientific data into higher quality care, CDC
works with many research partners, managed care organizations, and
community health centers to assess how accepted standards of care are
applied in clinical settings. CDC and its partners also examine
disparities in diabetes care and develop strategies to improve existing
Providing Education and Sharing Expertise
The National Diabetes Education Program (NDEP) is sponsored by CDC
and the National Institutes of Health (NIH). NDEP comprises a network of
more than 200 public and private partners who work to increase knowledge
about diabetes and its control among employers, people with or at risk
for diabetes, and health care providers. The goals are to help people
with diabetes better manage the disease and to promote policies that
improve quality of care and access to care. NDEP partners, including six
national groups representing minorities at increased risk, also develop
community interventions and tools to improve care and prevention,
especially for communities with a high burden of diabetes.
NDEP products are available on the Internet (http://www.ndep.nih.gov) in
English, Spanish, and 15 Asian and Pacific Islander languages. NDEP also
provides the following three Web sites that target specific audiences:
http://www.diabetes atwork.org (for business and managed care companies),
http://www.betterdiabetescare.nih.gov (for health care providers), and
description of this map is also available.]
Supporting Primary Prevention
Research suggests that the progression from prediabetes to type 2
diabetes can be prevented or delayed. In 2001, results from landmark
clinical trials, including the Diabetes Prevention Program (DPP), showed
that sustained lifestyle changes that included modest weight loss and
physical activity substantially reduced progression to type 2 diabetes
among adults who were at very high risk.
Results from the DPP were so compelling that the trial was ended a year
early. The lifestyle intervention worked equally well for men and women and
all racial/ethnic groups, and it was most effective among people aged 60 or
older. A healthy diet and modest physical activity can help people cut their
risk for type 2 diabetes.
State Program In Action: Utah
Diabetes is a significant public health burden for
Utah residents. More than 130,000 people in Utah have
diabetes, resulting in more than 20,000 hospitalizations
and 1,000 deaths each year. In 1998, the Utah Diabetes
Prevention and Control Program (DPCP) created the Utah
Diabetes Partnership to address the risk for
complications among program participants. The
partnership brings together health care groups to find
common solutions to improve diabetes care in the state.
In 2005, the Utah DPCP reported the following
improvements in diabetes control:
- 47% of program participants had improved their
blood glucose levels (i.e., A1C below 7%), nearly
double the rate from 1998.
- 57% of participants reported having an eye exam,
a 37% increase from 1998.
- 57% of participants reporting having a urine
protein test for kidney disease, a 72% increase from
The Utah DPCP also offers self-management classes to
help participants reduce complications from diabetes by
eating healthier diets, being physically active, and
managing their medications properly. Sixteen state-certified diabetes self-management programs are
operating in Utah. Among participants who have completed
one class, 70% monitor their blood glucose levels
regularly and correctly, 66% follow recommended meal
plans, and 66% exercise regularly.
Targeting Populations at Risk
- Primary prevention for people most at risk. CDC has
initiated primary prevention pilot programs in five states and
is developing methods to identify people at high risk for type 2 diabetes,
policies to help these people reduce their risk, and public health
programs that will slow the diabetes epidemic.
- Native Diabetes Wellness Program. In response to the diabetes
epidemic among American Indians and Alaska Natives, CDC is working
with these communities to develop culturally relevant and
scientifically sound interventions to prevent complications from
- Translating Research Into Action for Diabetes (TRIAD).
The first and largest of its kind, TRIAD is a multicenter study
designed to assess the level of care provided to people with
diabetes, identify barriers to care, and find new ways to provide
- SEARCH for Diabetes in Youth. Co-funded by CDC and NIH,
this study seeks to examine the status of diabetes among U.S.
children and adolescents and provide direction for addressing the
diabetes burden among this age group.
Envisioning a world free of diabetes, CDC will continue to
- Strengthen public health surveillance for diabetes.
- Enhance state diabetes prevention and control programs.
- Conduct primary prevention research and public health interventions.
- Translate research findings into clinical and public health
- Support the development and dissemination of NDEP materials that
help to improve treatment and outcomes for people with diabetes,
increase early diagnosis, and prevent or delay the onset of type 2
For more information please contact
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health
4770 Buford Highway NE, Mailstop K–28, Atlanta, GA 30341-3717
Telephone: 800-CDC-INFO (232-4636) • TTY: 888-232-6348
E-mail: firstname.lastname@example.org • Web:
Page last reviewed: February 14, 2008
Page last modified: February 14, 2008
Content source: National Center for
Chronic Disease Prevention and Health Promotion