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HHS Secretary Tommy G. Thompson has made diabetes prevention and management a key part of HHS' broader efforts to encourage a healthier America. With partners in the private and public sectors, HHS works to reduce the impact of diabetes across the country -- in part by addressing its underlying preventable causes, obesity and lack of physical activity. HHS also conducts research into diabetes prevention and treatment, provides health coverage and services to millions of Americans with diabetes, and conducts targeted education and awareness efforts to help people manage the disease's effects and to prevent others from developing the disease.

BACKGROUND

Diabetes is actually a group of diseases that impair the body's ability to produce or respond to insulin, a hormone that allows the sugar glucose to enter the cells and be used for energy. When diabetes develops, glucose levels rise in the blood, damaging blood vessels and other tissues. There are three major types of diabetes:

• Type 1, formerly known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, most often occurs in children and young adults. This form of diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin. People with type 1 diabetes must take daily insulin injections to stay alive. Type 1 diabetes accounts for 5 to10 percent of diabetes cases.

• Type 2, formerly known as non-insulin-dependent diabetes mellitus or adult-onset diabetes, is the most common form of the disease and accounts for up to 95 percent of cases. It often develops later in life and is associated with preventable factors such as obesity and lack of physical activity. Type 2 diabetes usually begins as insulin resistance, a disorder in which muscle, fat, and liver cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Many people can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication. The longer a person has type 2 diabetes, the more likely he or she will need insulin injections.

• Gestational Diabetes develops in about 3 to 5 percent of pregnancies and is more common in African-Americans, Hispanics, and American Indians, as well as obese women and women 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 percent of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next 5 to 10 years. Also, their children are more prone to developing obesity and type 2 diabetes in adulthood.

Nationally, more than 17 million people have diabetes -- more than one out of every 12 Americans ages 20 years and older. This includes about 7 million Americans aged 65 years and older, or about one in five senior citizens. Generally, blacks, Hispanics and American Indians and Alaska Natives are more likely to develop diabetes than non-Hispanic whites. In addition, the nation's youth are experiencing a dramatic increase in prevalence of diabetes. For more statistics about diabetes, see www.cdc.gov/diabetes/pubs/.

Pre-diabetes is an increasingly common condition in which blood glucose levels are higher than normal but not yet diabetic -- known medically as impaired glucose tolerance. Pre-diabetes affects nearly 16 million Americans and sharply raises the risk for developing type 2 diabetes and increases the risk of heart disease by 50 percent. HHS-supported research shows that most people with pre-diabetes will likely develop diabetes within a decade unless they make lifestyle changes to their diet and level of physical activity, which can help them reduce their risks for the disease.

Consumer information about diabetes is available at www.cdc.gov/diabetes/pubs/ or 1-877-CDC-DIAB (1-877-232-3422) and www.niddk.nih.gov/ and through the National Diabetes Education Program, a joint effort involving HHS and more than 200 private organizations, at www.ndep.nih.gov/. Information about HHS-funded clinical trials involving diabetes can be found at www.clinicaltrials.gov/.

RESEARCH

HHS sponsors extensive research in diabetes prevention, treatment and management. In August 2001, for example, HHS announced the findings of the Diabetes Prevention Program, a major clinical trial involving 3,234 overweight people with pre-diabetes, a condition in which blood glucose levels are higher than normal but not yet diabetic. The results showed that with diet and exercise, Americans at high risk of type 2 diabetes can sharply lower their chances of getting diabetes.

HHS' National Institutes of Health (NIH) alone will spend about $781 million in fiscal year 2002 for diabetes research, including an estimated $428 million through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The NIDDK is helping researchers take full advantage of compelling scientific opportunities to better understand how diabetes arises and to improve ways to prevent it, treat it, and ultimately to cure it. The NIDDK's research agenda addresses five areas of special opportunity identified by a congressionally established Diabetes Research Working Group: genetics, autoimmunity and the beta cell, cell signaling and cell regulation, obesity, and clinical research and clinical trials. NIDDK also is pursuing the group's recommendations regarding the populations most affected by diabetes and regarding complications.

More information about diabetes-related research is available atwww.niddk.nih.gov or by calling the National Diabetes Information Clearinghouse at 1-800-860-8747.

The Centers for Disease and Control Prevention (CDC) also conducts applied research to identify the public health implications of results from clinical trials and other scientific studies and to apply those findings effectively and efficiently to health care practices. See www.cdc.gov/diabetes/projects/research.htm.

PREVENTION AND EDUCATION

HHS and its agencies promote diabetes prevention as the most effective way to minimize the impact of the disease nationally. HHS also conducts outreach and education activities to help consumers manage their diabetes, and to help clinicians diagnose and treat diabetes and pre-diabetes. Major efforts include:

National Diabetes Education Program. Co-sponsored by NIH and CDC, the National Diabetes Education Program (NDEP) conducts diabetes awareness and education activities, develops and disseminates educational tools and resources, and promotes initiatives to improve the quality of and access to diabetes care. The program has more than 200 private and public-sector partners. See www.ndep.nih.gov/.

Pre-diabetes. In March 2002, HHS and the American Diabetes Association (ADA) launched a new effort to encourage Americans with pre-diabetes to take steps to reduce their risks for developing type 2 diabetes. A panel consisting of ADA and HHS experts urged doctors to screen patients for pre-diabetes and encourage prevention. See www.hhs.gov/news/press/2002pres/20020327.html.

Women and diabetes. In May 2002, HHS' Food and Drug Administration (FDA) launched a new campaign to raise awareness among women about preventing and managing diabetes. As the family's primary caregivers, women can make a positive difference to the whole family's health, including their own. See www.fda.gov/womens/taketimetocare/diabetes/. CDC also co-sponsors the National Public Health Initiative on Diabetes and Women, which is pursuing steps to improve women's health. See www.cdc.gov/diabetes/projects/women.htm.

Older Americans and diabetes. The NDEP and HHS' Centers for Medicare & Medicaid Services (CMS) and Administration on Aging (AoA) work together on a campaign to remind older Americans who have diabetes about the importance of routine blood sugar monitoring to manage their disease and that Medicare benefits are available to help them do so. See ndep.nih.gov/conduct/medicare.htm.

Healthy People 2010. HHS' Healthy People 2010, the nation's broad-based national health agenda, targets obesity, lack of physical activity and other health issues related to diabetes. See www.health.gov/healthypeople/.

Targeting diabetes disparities. Diabetes is one of the major focus areas for HHS' Closing the Health Gap campaign, which aims to bring the best health information to African-American communities and help consumers take charge of their health. For more information on diabetes and minorities, see www.omhrc.gov.

American Indian and Alaska Native programs. Through the Indian Health Service's (IHS) National Diabetes Program, HHS promotes collaborative strategies to prevent diabetes and its complications among native populations. These efforts include grants to promote diabetes prevention. See www.ihs.gov/MedicalPrograms/Diabetes/.

TREATMENT

HHS and its agencies also help to ensure people who are diagnosed with diabetes get appropriate, quality care. Examples include:

Medicare. Medicare covers a wide range of treatment and services for the estimated 4.5 million beneficiaries who have been diagnosed with diabetes. Diabetes-related benefits that Medicare may cover include diabetes self-management training; glucose monitors, test strips and other self-testing equipment; nutrition therapy services; therapeutic shoes; and glaucoma screenings. Seewww.medicare.gov/health/diabetes.asp.

Diabetes control programs. CDC funds programs in all 50 states, the District of Columbia, and U.S. territories to improve access to affordable, quality diabetes care and services, with priority on reaching high-risk individuals and disproportionately affected populations. See www.cdc.gov/diabetes/pubs/.

Community-based health centers. HHS' Health Resources and Services Administration (HRSA) supports an effort to reduce diabetes by working with HHS-funded community-based health centers to improve the effectiveness of health care services provided in underserved communities. The effort is part of a broader campaign to reduce health disparities. See www.healthdisparities.net.

Diabetes Quality Improvement Program. This project, involving CDC, CMS, the ADA, the National Committee for Quality Assurance and other public and private groups, has developed quality measures to compare and improve key elements of diabetes care across health care settings. The program also offers a "best practices" collection for clinicians. See www.dqip.org/.

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