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Diabetes and Women's Health Across the Life Stages: A Public Health
Perspective
Fact Sheet
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Contents
Message from
Frank Vinicor, MD, MPH
Director, CDC Diabetes Program
Writing this monograph has been important for many reasons for the diabetes
program at the Centers for Disease Control and Prevention (CDC). More
than just a "report," it has become a model of thought, interaction,
and commitment to make a difference in the lives of peoplewomen
or menfacing the daily challenges of diabetes.
We have come to better understand the impact of greater societal forces
and policies on the lives of people with diabetes, though individuals
and health care providers make their own essential contributions. Many
cultural, social, organizational, and environmental forces facilitate
or limit the impact of our individual decisions, and the need to coordinate
science and clinical medicine with programs and policies has become much
more obvious to us.
CDC and many partners plan to convert the ideas in this monograph into
concrete action. Our goal is to augment programs to both prevent diabetes
and improve care for those with the disease. This will synergistically
blend clinical and public health strategies. CDC and its primary cosponsors,
the American Diabetes Association, the American Public Health Association,
and the Association of State and Territorial Health Officials, will convene
a national call-to-action meeting to develop and then implement the National
Public Health Action Plan for Diabetes and Women. Much more work is
required, but with the monograph, Diabetes and Women's Health Across
the Life Stages: A Public Health Perspective, the process has begun.
Diabetes and Women's Health Across the Life Stages:
A Public Health Perspective
Diabetes is a serious health condition that affects women in all life
stages. It is unique to women because it can affect the health of both
a mother and her unborn children. With the increasing life span of women
and the rapid growth of minority populations in the United States, the
number of women at high risk for diabetes and its complications will continue
to increase. This will place added demands on the health care delivery
system. Diabetes and Women's Health Across the Life Stages: A Public
Health Perspective examines the challenges and risks of diabetes in
each stage of a woman's life.
- Of the 15.7 million people with diabetes in the United States, more
than half (8.1 million) are women. Minority racial and ethnic groups
are the hardest hit by type 2 diabetes; the prevalence is at least 2-4
times higher among black, Hispanic, American Indian, and Asian Pacific
Islander women than among white women.
- About 90 to 95 percent of women with diabetes have
type 2 diabetes (formerly called adult-onset).
Type 2 diabetes usually develops after age 40 and occurs when the body's
cells become resistant to insulin. Insulin is a hormone secreted by
the pancreas that allows glucose (sugar) to enter the body's cells and
be converted to energy. Type 1 diabetes (formerly called juvenile-onset)
occurs because the pancreas makes little or no insulin.
- The risk of heart disease, the most common complication of diabetes,
is more serious among women than men. Among people with diabetes who
have had a heart attack, women have lower survival rates and a poorer
quality of life than men.
- Children exposed to diabetes in the womb have a greater likelihood
of becoming obese during childhood and adolescence and for developing
type 2 diabetes, later in life.
- Women with diabetes have a shorter life expectancy than women without
diabetes, and women are at greater risk of blindness from diabetes than
men.
- Social, economic, and political barriers sometimes block high-quality
care and easy access to health care for women with diabetes.
- Social and economic issues will leave many older women with diabetes
living alone and poor. Poverty is also a major concern for women of
childbearing age who have diabetes.
- All parts of societypublic and privatehave a role in addressing
the public health issues of reducing the burden of diabetes among women.
The Adolescent Years (10-17)
- Most adolescents aged 10-19 years with diabetes have type 1, an autoimmune
form of the disease in which the pancreas produces little or no insulin.
Without insulin, fat and sugar remain in the blood and eventually can
damage vital organs.
- Acute complications such as ketoacidosis (acid buildup in the blood)
or hypoglycemia (extremely low blood sugar) are more common than chronic
complications among adolescent girls with type 1 diabetes.
- The rate of death among girls with type 1 diabetes is nearly 5 times
greater than the general population of girls aged 10-17 years.
- About 61,500 girls younger than 20 years have type 1 diabetes; 92
percent are white, 4 percent are black, and 4 percent are Hispanic or
Asian American.
- By age 20, 40 percent to 60 percent of people with diabetes have retinopathy,
or diabetic eye disease. Retinopathy can lead to blindness if untreated.
The risk to develop proliferative retinopathythe most severe formis
higher for girls.
- Current evidence suggests that eating disorders may be significantly
higher among young women with type 1 diabetes than among young women
in the general population.
- The incidence of type 2 diabetes appears to be increasing among both
girls and boys, particularly in some racial and ethnic minority groups.
Formerly called adult-onset diabetes, type 2 diabetes usually develops
after age 40. Unlike type 1, type 2 diabetes is linked to obesity and
physical inactivity and occurs when the body loses its ability to use
insulin. Complications from type 2 closely resemble those associated
with type 1 diabetes.
- The increased prevalence of obesity among adolescent girls may play
a role in the 10-fold increase in type 2 diabetes among adolescents
in the 1990s.
- Physical and mental changes during puberty make diabetes management
and control harder.
The Reproductive Years (18-44)
- From 1990 to 1998, diabetes rates increased 70 percent for women aged
30-39 years.
- Death rates for women aged 25-44 years with diabetes are more than
3 times the rate for women without diabetes.
- About 1.85 million women of reproductive age (18-44 years) have diabetes;
about 500,000 of them do not know they have the disease. Women of minority
racial and ethnic origins are 2-3 times more likely than non-Hispanic
white women to have type 2 diabetes.
- Type 2 diabetes accounts for most diabetes cases identified during
this life stage. Most women with type 1 diabetes were diagnosed during
childhood or adolescence.
- Reproductive-aged women with type 2 diabetes have fewer years of education,
lower incomes, and are less likely than women without diabetes to be
employed.
- Between 2.5 percent and 4 percent of women in the United States develop
gestational diabetes during pregnancy. This type of diabetes results
from the body's resistance to the action of insulin. The increased resistance
during pregnancy is caused by hormones produced in the placenta (the
cord that connects mother and baby).
- Gestational diabetes usually ends after the baby is born, but women
with gestational diabetes have up to a 45 percent risk of recurrence
with the next pregnancy and up to a 63 percent risk of developing type
2 diabetes later in life.
- Although expectant mothers with diabetes can and do have normal, healthy
pregnancies and deliveries, they are at greater risk for complications
such as preeclampsia (a toxic condition in late pregnancy that causes
a sudden rise in blood pressure, weight gain and swelling), Cesarean
section, and infections.
- Increasing numbers of women, especially nonwhite women, are at risk
of having pregnancies complicated by diabetes. American Indian women
have considerably higher rates of gestational diabetes than the national
average. For instance, the prevalence for Zuni Indian mothers is 15.1
percent and for Navajo Indian women, the rate is 10.4 percent among
mothers aged 30-39 years.
The Middle Years (45-64)
- By 2010, the number of women in mid-life (aged 45-64 years) is expected
to grow from about 27 million to 41 million. Women in this stage of
life are more vulnerable to major chronic diseases such as diabetes.
- Nearly all women aged 45-64 years with diabetes have type 2 diabetes.
- For middle-aged women, type 2 diabetes is at least twice as common
among nonwhites as among whites. Among women aged 50-59 years, the prevalence
is 23 percent for blacks, 24 percent for Mexican Americans, and 9.7
percent for whites.
- Prevalence rates for women aged 45-55 years were less than 2 percent
in the 1960s, but rose consistently in the 1980s and 1990s. In the early
1990s, the overall rate was about 6 percent for women aged 45-64 years.
- Diabetes is a leading cause of death among middle-aged American women;
rates in 1996 follow: fifth among white women, fourth among black and
American Indian women, and third among Hispanic women aged 45-64 years.
- Coronary heart disease is an important cause of illness among middle-aged
women with diabetes and rates are 3-7 times higher among women 45-64
years old with diabetes than women without diabetes.
- Overall, middle-aged women with type 2 diabetes have less education,
lower income, and are less likely to be employed than women without
diabetes.
- More than half of women 45-64 years old with diabetes have an annual
family income of less than $20,000, and 28.5 percent have less than
$10,000. This compares with 30.5 percent and 11.3 percent respectively
for women without diabetes.
- Middle-aged women with type 2 diabetes are less likely than women
without diabetes to be married (58.3 percent versus 72.2 percent); more
likely to be widowed (15.6 percent versus 9.4 percent); or divorced
or separated (19.3 percent versus 14.5 percent).
- American Indian women are particularly vulnerable to diabetes. One
study found that 70 percent of Pima Indian women 45-64 years old have
diabetes. An estimated 41 percent of Navajo women in the same age group
have diabetes.
The Elder Years (65+)
- The number of women aged 65 and older is expected to grow from approximately
20 million in 1995 to 23 million in 2010. Because women live an average
of 7 years longer than men, there are nearly twice as many older women
as older men, thus elderly women with diabetes outnumber elderly men
with diabetes in the United States.
- About 4.5 million women aged 60 years and older have diabetes, and
one quarter, or 1.2 million, do not know they have the disease. Most
elderly women with diabetes have type 2 diabetes.
- Between 1980 and 1994, the number of recognized new cases of diabetes
among women aged 65 years and older increased from 97,000 to 181,000
(45.7 percent).
- By the age of 65 years, women are twice as likely as men to live in
poverty. Almost half (47.7 percent) of elderly women with diabetes have
an annual income of less than $10,000 compared with 31 percent of women
without diabetes.
- Diabetes is one of the leading underlying causes of death among women
aged 65 years and older. The death rate for diabetes increases with
age. Elderly black women have twice the rate of death from diabetes
as elderly white women, and elderly Mexican American women have almost
four times the rate.
- Among women aged 60-74 years, 33 percent of black or Mexican American
women have type 2 diabetes compared with 16 percent of white women.
Among American Indian women, approximately 32 percent over the age of
65 years have diabetes.
- Being older and having diabetes accelerates diabetic complications
such as heart disease, stroke, kidney disease, and blindness. Elderly
women with diabetes are at particularly high risk for heart disease,
visual problems (cataracts and glaucoma), hypergylcemia (very high blood
sugar) or hypoglcemia (very low blood sugar), and depression.
- Obesity, weight gain, and physical inactivity are the major risk factors
for type 2 diabetes among women. Among people aged 65 years and older
who have diabetes,
70.4 percent of women are 20 percent over their desired weight, compared
with 38.2 percent of men, and 25 percent are obese (50 percent over
their desired weight).
Age-Standardized Prevalence* of Diagnosed Diabetes per 100 Adult Female
Population, by State, United States, 1996-1998
*3-year moving average
Source: Centers for Disease Control and Prevention
Age-Standardized Prevalence* of Diagnosed Diabetes
per 100 Adult Female Population, by State, United States, 1996-1998
2.793 - 3.822 |
3.862 - 4.273 |
4.291 - 5.176 |
5.277 - 6.985 |
Arizona
Colorado
Idaho
Kansas
Montana
Nevada
New Hampshire
North Dakota
South Dakota
Utah
Wisconsin
Wyoming
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Alaska
Florida
Iowa
Oregon
Minnesota
Maine
Massachusetts
Missouri
Nebraska
New Jersey
New Mexico
New York
Vermont
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Arkansas
California
Connecticut
Delaware
Georgia
Indiana
Kentucky
Ohio
Pennsylvania
Rhode Island
Washington
West Virginia |
Alabama
Hawaii
Illinios
Louisiana
Maryland
Michigan
Mississippi
North Carolina
Oklahoma
South Carolina
Tennessee
Texas
Virginia
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For more information, contact
CDC's Diabetes Program
Telephone toll-free: 1-800-CDC-INFO (232-4636) 1-888-232-6348 TTY
www.cdc.gov/diabetes
E-mail: cdcinfo@cdc.gov
October 2001
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Page last modified: December 20, 2005
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
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