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National Diabetes Fact Sheet
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Data Sources, References, and Methods
Treating diabetes
2001–2003 National Health Interview Survey (NHIS), National Center for
Health Statistics, Centers for Disease Control and Prevention. Available at
http://www.cdc.gov/nchs/nhis.htm.
Methods: The percent distribution of the type of treatment among
civilian, noninstitutionalized adults aged 18 years or older with
diagnosed diabetes was calculated using treatment questions from the
2001–2003 NHIS.
Prediabetes: Impaired glucose tolerance and impaired fasting glucose
The Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–1197.
Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship
between glucose and incident cardiovascular events. A metaregression
analysis of published data from 20 studies of 95,783 individuals followed
for 12.4 years. Diabetes Care 1999;22:233–240.
Meigs JB, Nathan DM, D'Agostino RB Sr, Wilson PW; Framingham
Offspring Study. Fasting and postchallenge glycemia and cardiovascular
disease risk. Diabetes Care
2002;10:1845–1850.
Smith NL, Barzilay JI, Shaffer D, et al. Fasting and 2-hour
postchallenge serum glucose measures and risk of incident cardiovascular
events in the elderly: the Cardiovascular Health Study. Archives of
Internal Medicine 2002;162:209–216.
Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM,
Saydah SH, Williams DE, Geiss LS, Gregg EW.
Prevalence of diabetes and impaired fasting glucose in adults in the U.S.
population: National Health and Nutrition Examination Survey 1999–2002.
Diabetes Care 2006;29:1263–8
Third National Health and Nutrition Examination Survey (NHANES
III) 1988–1994, National Center for Health Statistics, Centers for Disease
Control and Prevention. Available at
http://www.cdc.gov/nchs/nhanes.htm.
U.S. Census Bureau, 2000 resident population estimates.
Methods: The prevalences of IGT, IFG, and prediabetes in the
civilian noninstitutionalized population were estimated using 1988–1994
NHANES data (i.e., NHANES III). Persons previously diagnosed with diabetes
and those with undiagnosed diabetes (i.e., without a history of diabetes but
with a fasting plasma glucose of 126 or more) were excluded from the
prevalence counts of IGT, IFG, and prediabetes. Persons were classified as
having IGT if they had 2-hour plasma glucose values of 140 to 199 mg/dL
after an oral glucose tolerance test. They were classified as having IFG if
they had fasting plasma glucose values of 100 to 125 mg/dL (regardless of
their 2-hour plasma glucose values). Those with IGT or IFG or both were
classified as having prediabetes. To estimate the number of people in 2000
with these conditions, these 1988–1994 prevalence estimates were applied to
estimates of the 2000 resident population of the United States.
National Estimates on Diabetes
Many of the estimated numbers and percentages of people with
diabetes were derived by applying diabetes prevalence estimates from health
surveys of the civilian, noninstitutionalized population to the most recent
2005 resident population estimates. Generally, these methods used three age
groups (20–44, 45–59, and ≥60 years), three race groups (non-Hispanic white,
non-Hispanic blacks, and all other races), and sex (male, female) to
estimate diabetes prevalence in 2005. These estimates have some variability
due to the limits of the measurements and estimation procedures. The
procedures assumed that age-race-sex–specific percentages of adults with
diabetes (diagnosed and undiagnosed) in 2005 are the same as they were in
earlier time periods (e.g., 1999–2002) and that the age-race-sex percentages
of adults with diabetes in resident population is identical to that in the
civilian, noninstitutionalized population. Deviations from these assumptions
may result in over- or under-estimated numbers and percentages.
Total
prevalence of diabetes in the United States, all ages, 2005
1999–2002 National Health and Nutrition Examination Survey (NHANES),
National Center for Health Statistics, Centers for Disease Control and
Prevention. Available at
http://www.cdc.gov/nchs/nhanes.htm.
1999–2003 National Health Interview Survey (NHIS), National
Center for Health Statistics, Centers for Disease Control and Prevention.
Available at
http://www.cdc.gov/nchs/nhis.htm.
U.S. Census Bureau, resident population estimates for
03/01/05. Available at
http://www.census.gov/popest/national/asrh/2004_nat_res.html
Cowie CC, Rust KF, Byrd-Holt D, et al. Prevalence of diabetes and
impaired fasting glucose in adults—United States, 1999–2000. MMWR
2003;52(35):833–837.
Methods:
Total number of persons with diabetes (both diagnosed and
undiagnosed) and percentage of the population with diabetes.
The total number of people with diabetes is the sum of the
estimated number of those aged 20 years or older with diagnosed and
undiagnosed diabetes in 2005 and the estimated number of those younger than
20 years with diagnosed diabetes in 2005. (See next paragraph for methods of
calculating these numbers.) Because of a lack of
population-based data for undiagnosed diabetes among persons younger than 20
years, an estimate of the number of undiagnosed persons in this age group
could not be included in the total. The percentage of the population
with diabetes is the estimated total number with diabetes in 2005 divided by
the estimated 2005 U.S. resident population.
The 2005 estimate of the number of persons younger than 20
years with diagnosed diabetes was derived by applying the estimated
percentage of persons younger than 20 years with diagnosed diabetes from the
1999–2003 NHIS to the 2005 estimated resident population for this age group.
The 2005 estimated number of those aged 20 years or older with diagnosed and
undiagnosed diabetes is the sum of the numbers derived by applying the
age-race-sex–specific estimates of total diabetes prevalence (both diagnosed
and undiagnosed) from the 1999–2002 NHANES to 2005 resident population
estimates.
Information on the use of NHANES data to measure diabetes
prevalence (including diagnosed and undiagnosed diabetes) is available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a1.htm.
Number of persons with diagnosed diabetes
The total number of persons with diagnosed diabetes in 2005
is the sum of the estimated numbers of those younger than 20 years and those
aged 20 years or older with diagnosed diabetes. The 2005 estimated number of
persons younger than 20 years with diagnosed diabetes was derived by
applying the estimated prevalence of diagnosed diabetes from the 1999–2003
NHIS to the estimated 2005 resident population of this age group. The 2005
estimated number of those aged 20 years or older with diagnosed diabetes is
the sum of the numbers derived by applying to 2005 resident population
estimates the age-race-sex–specific estimates of diagnosed diabetes from the
1999–2002 NHANES.
Number of persons with undiagnosed diabetes
The 2005 estimated number of persons with undiagnosed
diabetes was derived by applying the age-race-sex–specific estimated
prevalence of undiagnosed diabetes in persons aged 20 years or older from
the 1999–2002 NHANES to 2005 resident population estimates. Because
population-based data are lacking for undiagnosed diabetes among persons
younger than 20 years, an estimate of undiagnosed persons in this age group
could not be included.
Prevalence
of diagnosed diabetes among people aged 20 years or younger,
United States
1999–2003 National Health Interview Survey (NHIS), National
Center for Health Statistics, Centers for Disease Control and Prevention.
Available at
http://www.cdc.gov/nchs/nhis.htm.
U.S. Census Bureau, resident population estimates for
03/01/05. Available at
http://www.census.gov/popest/national/asrh/2004_nat_res.html
Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al.
Type 2 diabetes among North American children
and adolescents: an epidemiologic review and a public health perspective. Journal of Pediatrics 2000;136:664–672.
Ludwig DS, Ebbeling CB.
Type 2 diabetes mellitus in children: primary
care and public health considerations. JAMA 2001;286:1427–1430.
Methods: The number of persons under 20 years of age with
diagnosed diabetes in 2005 was estimated by applying the 1999–2003 NHIS
prevalence estimate of diagnosed diabetes in the civilian,
noninstitutionalized population younger than 20 years to the 2005 resident
population estimate of this age group.
The percentage of persons under 20 years of age with diagnosed diabetes in
2005 was assumed to be the same as the 1999-2003 NHIS estimate.
Total
prevalence of diabetes among people aged 20 years or older,
United States,
2005
1999–2002 National Health and Nutrition Examination Survey (NHANES),
National Center for Health Statistics, Centers for Disease Control and
Prevention. Available at
http://www.cdc.gov/nchs/nhanes.htm.
U.S. Census Bureau, resident population estimates for
03/01/05. Available at
http://www.census.gov/popest/national/asrh/2004_nat_res.html
Cowie CC, Rust KF, Byrd-Holt D, et al. Prevalence of
diabetes and impaired fasting glucose in adults—United States, 1999–2000.
MMWR 2003;52(35):833–837.
Methods:
Age 20 years or older
The 2005 estimated number of persons aged 20 years or older
with diabetes was derived by applying to 2005 resident population estimates
the age-race-sex–specific estimates of total diabetes prevalence (both
diagnosed and undiagnosed diabetes) from the 1999–2002 NHANES. The
percentage of the population with diabetes aged 20 years or older is this
estimated number divided by the estimated 2005 U.S. resident population aged
20 years or older.
Age 60 years or older
The 2005 estimated number of those aged 60 years or older
with diabetes was derived by applying race-sex–specific estimates of total
diabetes prevalence (both diagnosed and undiagnosed diabetes) in this age
group from the 1999–2002 NHANES to 2005 resident population estimates. The
percentage of the population with diabetes aged 60 years or older is this
estimated number divided by the estimated 2005 U.S. resident population aged
60 years or older.
Men and women
The 2005 estimated number of men and women aged 20 years or
older with diabetes is the sum of the sex-specific numbers derived by
applying age-race-sex–specific estimates of total diabetes prevalence (both
diagnosed and undiagnosed diabetes) from the 1999–2002 NHANES to 2005
resident population estimates. The percentage of men and women with diabetes
are these estimated numbers divided by the sex-specific estimated 2005 U.S.
resident population aged 20 years or older.
Information on the use of NHANES data to measure diabetes
prevalence (including diagnosed and undiagnosed diabetes) is available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a1.htm.
Total
prevalence of diabetes by race/ethnicity among people aged 20 years or
older,
United States, 2005
1999–2002 National Health and Nutrition Examination Survey (NHANES),
National Center for Health Statistics, Centers for Disease Control and
Prevention. Available at
http://www.cdc.gov/nchs/nhanes.htm.
Indian Health Service (IHS), 2003 outpatient database.
2003 data from the Behavioral Risk Factor Surveillance
System (BRFSS), National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention.
Personal communication with Florentina
R. Salvail, BRFSS coordinator, state of Hawaii.
U.S. Census Bureau, resident population estimates for
03/01/05. Available at
http://www.census.gov/popest/national/asrh/2004_nat_res.html
California Health Interview Survey Online Data Query System,
available at:
www.chis.ucla.edu
Cowie CC, Rust KF, Byrd-Holt D, et al. Prevalence of
diabetes and impaired fasting glucose in adults—United States, 1999–2000.
MMWR 2003;52(35):833–837.
Methods:
All estimates presented are for persons aged 20 years or
older.
Non-Hispanic whites and non-Hispanic blacks
The 2005 estimated numbers of non-Hispanic whites and the
number of non-Hispanic blacks aged 20 years or older with diabetes are the
sums of the race-specific numbers derived by applying age-race-sex–specific
estimates of total diabetes prevalence (both diagnosed and undiagnosed
diabetes) from the 1999–2002 NHANES to 2005 resident population estimates.
The percentages of non-Hispanic whites and non-Hispanic blacks with diabetes
are these estimated numbers divided by the race-specific estimates of the
2005 U.S. resident population aged 20 years or older.
The relative risk of diabetes among non-Hispanic blacks
(compared to non-Hispanic whites) in 2005 was calculated by dividing the
age-adjusted prevalence of diabetes among non-Hispanic blacks by the
age-adjusted prevalence of diabetes among non-Hispanic whites.
Rates were age-adjusted by the direct method based on
the 2000 U.S. standard population.
Hispanic/Latino Americans
The relative risk of diabetes among Mexican Americans
(compared to non-Hispanic whites) was calculated by dividing the
age-adjusted prevalence of diabetes (both diagnosed and undiagnosed
diabetes) among Mexican Americans by the age-adjusted prevalence of diabetes
among non-Hispanic whites using 1999–2002 NHANES data. Rates were
age-adjusted by the direct method based on the 2000 U.S. standard
population.
The number of Hispanic/Latino persons with diabetes in 2005
was estimated by applying age-sex–specific estimates of total diabetes
prevalence (both diagnosed and undiagnosed diabetes) among Mexican Americans
from the 1999–2002 NHANES to estimates of the 2005 U.S. Hispanic/Latino
resident population. The percentage of Hispanics/Latinos with diabetes in
2005 is this number divided by the estimated 2005 U.S. resident
Hispanic/Latino population.
Sufficient data are not available to derive estimates of
total diabetes prevalence (both diagnosed and undiagnosed diabetes) for
other Hispanic/Latino groups. However, using 2003 BRFSS data, the relative
risk of diagnosed diabetes among residents of Puerto Rico (compared to U.S.
non-Hispanic whites) was calculated by dividing the age-adjusted prevalence
of diagnosed diabetes among residents of Puerto Rico by the age-adjusted
prevalence of U.S. non-Hispanic whites. Rates were age-adjusted by the
direct method based on the 2000 U.S. standard population.
American Indians and Alaska Natives
The number and percentage of American Indians and Alaska
Natives (AI/AN) with diagnosed diabetes who receive care from IHS were
calculated from the 2003 IHS outpatient database. The number of AI/AN with
undiagnosed diabetes was calculated by applying age-specific estimates of
undiagnosed diabetes in the U.S. civilian, noninstitutionalized population
from the 1999–2002 NHANES to 2003 estimates of the AI/AN IHS user
population. The total number of AI/AN with diabetes was calculated by adding
the estimated number of persons with undiagnosed diabetes to the number of
diagnosed AI/AN who receive care from the IHS. Total prevalence was
calculated by dividing this number by the total number of AI/AN IHS
outpatient users in 2003. Estimates of regional differences and relative
risk were based on these calculations of total prevalence. The relative risk
of diabetes among AI/AN (compared to U.S. non-Hispanic whites) was
calculated by dividing the age-adjusted prevalence of diabetes among AI/AN
by the age-adjusted prevalence among U.S. non-Hispanic whites. Rates were
age-adjusted by the direct method based on the 2000 U.S. standard
population.
Asian Americans and Pacific Islanders
The total prevalence of diabetes (both diagnosed and
undiagnosed diabetes) is not available for Asian Americans or Pacific
Islanders. However, using 2003 BRFSS data, the relative risk of diagnosed
diabetes among Asians, Native Hawaiians, and other Pacific Islander
residents of Hawaii aged 20 years or older (compared to white residents aged
20 years or older) was calculated by dividing the age-adjusted prevalence of
diagnosed diabetes among resident Asians, Native Hawaiians, and other
Pacific Islanders by the age-adjusted prevalence among white residents.
Rates were age-adjusted by the direct method based on the 2000 U.S. standard
population. Similarly, 2003 data from the California Health Interview Survey
were used to calculate the relative risk of diagnosed diabetes among Asian
residents of California (compared to white residents).
Incidence
of diabetes, United States, 2005
2001–2003 National Health Interview Survey (NHIS), National
Center for Health Statistics, Centers for Disease Control and Prevention.
Available at
http://www.cdc.gov/nchs/nhis.htm.
U.S. Census Bureau, resident population estimates for
03/01/05. Available at
http://www.census.gov/popest/national/asrh/2004_nat_res.html
Methods: Age-specific estimates of the incidence of
diagnosed diabetes in the civilian, noninstitutionalized population aged 20
years or older from the 2001–2003 NHIS were applied to 2005 estimates of the
U.S. resident population without diabetes diagnosed in the past year to
calculate the number of new cases of diabetes. Incidence was calculated from
data on respondents' age at diagnosis and age at interview. Adults who
reported being diagnosed with diabetes were asked at what age they were
diagnosed. We calculated the number of years each person had been diagnosed
with diabetes by subtracting the age at which they were diagnosed from their
current age. Adults who had a value of zero were identified as having been
diagnosed with diabetes within the last year. In addition, we assumed that
half of the adults who had a value of one were classified as having been
diagnosed with diabetes within the last year.
Deaths
among people with diabetes, United States, 2002
Multiple cause-of-death data, National Center for Health
Statistics, Centers for Disease Control and Prevention.
Gu K, Cowie CC, Harris MI.
Mortality in adults with and without diabetes in
a national cohort of the U.S.
population, 1971-1993. Diabetes Care 1998;21:1138–1145.
Hu FB, Stampfer MJ, Solomon CG, et al. The impact of
diabetes mellitus on mortality from all causes and coronary heart disease in
women: 20 years of follow-up. Archives of Internal Medicine
2001;161:1717–1723.
Anderson RN, Smith BL. Deaths: leading causes for 2002.
National Vital Statistics Reports 2005;53(17):1–92.
Complications
of diabetes in the United States
Heart disease and stroke
Geiss LS, Herman WH, Smith PJ. Mortality in non-insulin-dependent diabetes.
In: National Diabetes Data Group, editors.
Diabetes in America, 2nd ed.
Washington, DC: U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Diabetes and Digestive and
Kidney Diseases, 1995. NIH Publication No. 95-1468. p. 233–257.
Kuller LH. Stroke and diabetes. In: National Diabetes Data
Group, editors.
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2nd ed.
Washington, DC: U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Diabetes and Digestive and
Kidney Diseases, 1995. NIH Publication No. 95-1468. 449–456.
High blood pressure
Geiss LS, Rolka DB, Engelgau MM. Elevated blood pressure among U.S. adults
with diabetes, 1988-1994. American Journal of Preventive Medicine
2002;22:43–49.
Blindness
Klein R, Klein BEK. Vision disorders in diabetes. In: National Diabetes Data
Group, editors,
Diabetes in America,
2nd ed.
Washington, DC: U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Diabetes and Digestive and
Kidney Diseases, 1995. NIH Publication No. 95-1468. 293–336.
Will JC, Geiss LS, Wetterhall SF.
Diabetic retinopathy [letter]. New England Journal of Medicine 1990;323:613.
Kidney disease
United States Renal Data System, Standard
Analysis Files, 2004 [data query online]. Available at
http://www.usrds.org/odr/xrender_home.asp*.
Accessed July 2005.
Nervous system disease
Eastman RC. Neuropathy in diabetes. In: National Diabetes Data Group,
editors.
Diabetes in America, 2nd ed.
Washington, DC: U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Diabetes and Digestive and
Kidney Diseases, 1995. NIH Publication No. 95-1468. 339–348.
Gregg EW, Sorlie P, Paulose-Ram R, et al. Prevalence of
lower-extremity disease in the US adult population ≥40 years of age with and
without diabetes: 1999–2000 National Health and Nutrition Examination
Survey. Diabetes Care 2004;27:1591–1597.
Amputations
Centers for Disease Control and Prevention. National Diabetes Surveillance
System. Available at:
http://www.cdc.gov/diabetes/statistics/index.htm
Dental disease
Personal communication from R. H. Selwitz, DDS, National Institute of Dental
and Craniofacial Research, Bethesda, MD, concerning unpublished data from
the third National Health and Nutrition Examination Survey, 1988–1994.
Complications of pregnancy
Personal communication from Thomas A. Buchanan, MD, Professor, Medicine,
Obstetrics and Gynecology, and Physiology and Biophysics, USC Keck School of
Medicine, Los Angeles, CA.
Other complications
Fishbein H, Palumbo PJ. Acute metabolic complications in diabetes. In:
National Diabetes Data Group, editors.
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Washington, DC: U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Diabetes and Digestive and
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Valdez R, Narayan KM, Geiss LS, Engelgau MM.
Impact of diabetes mellitus on mortality
associated
with pneumonia and influenza among non-Hispanic black and white
US adults. American Journal of
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Prevention
of complications of diabetes
Glucose control
Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with
macrovascular and microvascular complications of type 2 diabetes (UKPDS 35):
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The Diabetes Control and Complications Trial Research Group.
The effect of intensive treatment of diabetes on
the
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Blood pressure control
Curb JD, Pressel SL, Cutler JA, et al.
Effect of diuretic-based antihypertensive
treatment on cardiovascular disease
risk in older diabetic patients with
isolated systolic hypertension.
Systolic Hypertension in the Elderly Program Cooperative Research Group.
JAMA 1996;276:1886–1892.
Hansson L, Zanchetti A, Carruthers SG, et al.
Effects of intensive blood-pressure lowering and
low-dose aspirin in
patients with hypertension: principal results of the
Hypertension Optimal Treatment (HOT) randomised trial.
HOT Study Group. Lancet 1998;351:1755–1762.
UK Prospective Diabetes Study Group.
Efficacy of atenolol and captopril in reducing
risk of macrovascular and
microvascular complications in type 2 diabetes (UKPDS
39). BMJ 1998;317:713–720.
Adler AI, Stratton IM, Neil HA, et al.
Association of systolic blood pressure with
macrovascular and microvascular
complications of type 2 diabetes (UKPDS 36):
prospective observational study.
BMJ 2000;321:412–419.
Control of blood lipids
Scandinavian Simvastatin Survival Study Group.
Randomised trial of cholesterol lowering in 4444
patients with
coronary heart disease: the Scandinavian Simvastatin Survival
Study (4S). Lancet
1994;344:1383–1389.
Downs JR, Clearfield M, Weis S, et al.
Primary prevention of acute coronary events with
lovastatin in men and
women with average cholesterol levels: results of the AFCAPS/TexCAPS. Air Force/Texas Coronary
Atherosclerosis Prevention Study. JAMA 1998;279:1615–1622.
Sacks FM, Moye LA, Davis BR, et al.
Relationship between plasma LDL concentrations
during treatment with
pravastatin and recurrent coronary events in the
Cholesterol and Recurrent Events trial. Circulation 1998;97:1446–1452.
Preventive care practices for eyes, kidneys, and feet
Ferris FL 3rd.
How effective are treatments for diabetic
retinopathy? JAMA
1993;269:1290–1291.
Bild DE, Selby JV, Sinnock P, Browner WS, et al.
Lower-extremity amputation in people with
diabetes.
Epidemiology and prevention. Diabetes Care 1989;12:24–31.
Litzelman DK, Slemenda CW, Langefeld CD, et al.
Reduction of lower extremity clinical
abnormalities in patients
with non-insulin-dependent diabetes mellitus. A
randomized, controlled trial.
Annals of Internal Medicine 1993;119:36–41.
Lewis EJ, Hunsicker LG, Clarke WR, et al. for the
Collaborative Study Group.
Renoprotective effect of the
angiotensin-receptor
antagonist irbesartan in patients with nephropathy due to type 2 diabetes. New England Journal of Medicine 2001;345:851–860.
Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study
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Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R,
Andersen S, Arner P; Irbesartan in Patients with Type 2 Diabetes and
Microalbuminuria Study Group.
The effect of irbesartan on the development of
diabetic nephropathy in
patients with type 2 diabetes. New England Journal of Medicine 2001;345:870–878.
Hostetter TH. Prevention of
end-stage renal disease due to
type 2 diabetes. New England Journal of Medicine 2001;345:910–912.
Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of
angiotensin-converting-enzyme inhibition on diabetic nephropathy. The
Collaborative Study Group. New England Journal of Medicine
1993;329:1456–1462.
Cost
of diabetes in the United States in 2002
Hogan P, Dall T, Nikolov P; American Diabetes Association.
Economic costs of diabetes mellitus in the US in 2002. Diabetes Care
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Page last reviewed: July 12, 2007
Page last modified: August, 2006
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
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