Diabetes: Sounding the Alert on a Debilitating Disease

America Diabetes Alert Day is March 25. This one-day health observation helps to inform the American public about the seriousness of diabetes.

Diabetes is a group of diseases characterized by high levels of blood sugar (also known as blood glucose) resulting from inaction or defects in production of insulin, a hormone that helps the body use blood glucose for energy.

Deadly, debilitating, and costly, diabetes affects the lives of millions of people in different ways. Whether it's living with diabetes, caring for a loved one or family member with diabetes, experiencing healthcare costs due to diabetes and related complications, or any combination thereof, diabetes significantly impacts the day-to-day lives of people across the county.

Diabetes is the sixth leading cause of death, and more than more than 20 million Americans have diabetes. Of these people living with diabetes, 6 million do not know they have it.

The lifetime risk for diabetes for people born in the United States in 2000 is:

• For all Americans: 1 of 3

• For African Americans and Hispanics: 2 of 5

• For Hispanics girls and women: 1 of 2

According to the American Diabetes Association, the cost of diabetes in the U.S. 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): $58 billion

• Cost of caring for someone with diagnosed diabetes: $1 out of every $5 in total healthcare costs

Risk Factors for Diabetes

There are two main types of diabetes: type 1 and type 2.

Type 1 diabetes – which accounts for 5%-10% of all cases of diagnosed 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, although disease onset can occur at any age.

Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors.

Type 2 diabetes may account for about 90% to 95% 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.

Risk factors for type 2 diabetes include 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.

Complications from Diabetes

Diabetes is also a leading cause for complications such as blindness, kidney disease, lower extremity amputations, and cardiovascular disease.

Cardiovascular Disease

Heart disease and stroke are two forms of cardiovascular disease (the #1 killer of Americans). For people with diabetes, these complications are considerably burdensome. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher for all people with diabetes.

In 2005, 5.7 million persons aged 35 years and older with diabetes reported having cardiovascular disease, a 36% increase from 1997.¹

Kidney Disease

Chronic kidney disease (CKD) is the permanent loss of kidney function, resulting from physical injury or a disease that damages the kidneys. Approximately 3.8 million people in the U.S. have kidney disease, of which diabetes is a leading cause.

The final state of kidney disease is end-stage renal disease (ESRD), which requires kidney dialysis (filtering of blood through a machine) or transplantation. In 2005, nearly 46,000 people with diabetes initiated treatment for ESRD compared to approximately 7,300 in 1984.

Visual Impairment

People with diabetes can develop diabetic eye disease, in which the vessels of the eye swell and leak liquid into the retina, blurring the vision and sometimes leading to blindness.

Among adults aged 20 – 74 years, diabetes is the leading cause of new cases of blindness.

People with diabetes are also more likely to develop cataracts – a clouding of the eye's lens, and glaucoma – optic nerve damage.

In 2005, 3.2 million adults with diabetes (aged 18 years or older) reported visual impairment (trouble seeing even with their glasses or contact lenses on).

Amputation

Resulting from nerve damage, circulation problems, and/or infections, lower-extremity amputations (LEA) present a serious risk for people with diabetes. In 2003, there were about 75,000 diabetes-related hospital discharges with LEA. That same year, LEA discharges accounted for about 803,000 days of hospital stay.

Neuropathy, a form of nerve damage, can lead to LEA. From 1997 to 2004, hospital discharges among people with diabetes listing neuropathy as first-listed diagnosis increased from every year, up to 66,000 in 2003.

Ways You Can Help Prevent Diabetes

Prediabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, stroke and eye disease.

People with prediabetes have impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or both—conditions where blood glucose levels are higher than normal but not high enough to be classified as diabetes.

Progression to diabetes among those with prediabetes is not inevitable. Recent studies have shown that people at high risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight. You can do it by eating healthier and getting 30 minutes of physical activity 5 times a week.

Diabetes Management and Control

Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.

• Talk to your health care provider about how to manage your blood glucose (A1C), blood pressure and cholesterol.

• Learning how to eat right is an important part of controlling your diabetes. Food such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese are recommended as part of a healthy diet. Eating the right portions of healthy foods is also important.

• Engage in physical activity for 30 – 60 minutes on most days of the week. Physical activity can help you control your blood glucose, weight, and blood pressure, as well as raise your "good" cholesterol and lower your "bad" cholesterol.

• Stay at a healthy weight.

• Check your feet every day for cuts, blisters, red spots, and swelling. Call your doctor immediately if you have sores that will not heal.

• Check your blood glucose and take medicines the way you doctor tells you to.

• Get routine care. See your health care team at least twice a year to find and treat problems.

Diabetes Information and Resources

CDC's Division of Diabetes Translation (DDT) offers a wide range of information on diabetes, including details on prevention; diabetes control and maintenance; risk factors; complications; tips for a healthy lifestyle; and other diabetes related information. In addition, DDT offers significant data and trend information on diabetes (and relating issues) for the nation and all 50 states.

The National Diabetes Education Program, a joint CDC and NIH project, offers a wide range of resources around three major public education campaigns (listed below). These campaigns provide the foundation for conducting outreach activities in communities across the country. Each campaign provides a wealth of tools – brochures, tip sheets, provider kits, public service advertising, and more – that you can use to reach out to people with diabetes, people at risk, or health care providers.

• Control Your Diabetes. For Life

• Be Smart about Your Heart. Control the ABCs of Diabetes

• Small Steps. Big Rewards. Prevent type 2 Diabetes

For More Information

• CDC Podcasts ( Select "Diabetes" under Browse by Topic)
• CDC Division of Diabetes Translation
• Prevent Diabetes
• Frequently Asked Questions: Staying Healthy with Diabetes
• National Diabetes Education Program
• American Diabetes Alert Day*

*Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

¹MMWR: Prevalence of Self-Reported Cardiovascular Disease among Persons Aged ≥35 Years with Diabetes: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5643a2.htm.