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Diabetes: Disabling, Deadly, and on the Rise
At A Glance
2004
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Percentage of Adults with Diagnosed
Diabetes*
*Includes women with gestational diabetes.
Source: CDC, Behavioral Risk Factor Surveillance System.
[A text
description of this map is also available.]
“New evidence shows that one in three Americans born in
2000 will develop diabetes sometime during their lifetime. Together we can
and must do more to prevent and control this growing epidemic of diabetes.”
Julie Louise Gerberding, MD, MPH
Director, CDC, and Administrator, ATSDR
Diabetes Is a Growing Public Health Problem
More than 18 million Americans have diabetes. Now the sixth leading cause
of death in America, diabetes is responsible for over 200,000 deaths each
year. The number of U.S. adults with diagnosed diabetes, including women
with gestational diabetes (diabetes that develops during pregnancy), has
increased 61% since 1991 and is projected to more than double by 2050.
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 can cause
heart disease, stroke, blindness, kidney failure, pregnancy complications,
lower—extremity amputations, and deaths related to flu and pneumonia.
Particularly at risk for these complications are the 5.2 million Americans
who are unaware that they have diabetes.
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 among people older than 40. However, it is no longer considered an
adult-only disease. Type 2 is now being found at younger ages and is even
being diagnosed among children and teens.
Diabetes has its greatest effects on the elderly, women, and certain
racial and ethnic groups. One in five adults over age 65 has diabetes.
African American, Hispanic, American Indian, and Alaska Native adults are
two to three times more likely than white adults to have diabetes.
In addition to the millions of Americans with diabetes, an estimated 16
million U.S. adults aged 40–74 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 diabetes.
Diabetes costs the nation nearly $132 billion a year—$92 billion in
direct medical costs and another $40 billion in indirect costs due to lost
productivity. The average yearly health care cost for a person with diabetes
was $13,243 in 2002, compared with $2,560 for a person without diabetes.
Diabetes costs represented 11% of national health care expenditures during
2002.
Many Complications of Diabetes Can Be Prevented
Although the increasing burden of diabetes and its complications is
alarming, much of this burden could be prevented with early detection,
improved delivery of care, and better education on diabetes self-management.
The following are examples of diabetes-related complications that
could be prevented or reduced:
Eye disease and blindness. Each year, 12,000–24,000 people in this
country become blind because of diabetic eye disease. Regular eye exams and
timely treatment could prevent up to 90% of diabetes-related
blindness; however, only 64.2% of people with diabetes received annual
dilated eye exams in 2002.
Kidney disease. About 42,813 people with diabetes develop kidney
failure each year, and over 100,000 are treated for this condition.
Treatment to better control blood pressure and blood glucose levels could
reduce diabetes-related kidney failure by about 50%.
Amputations. About 82,000 people have diabetes-related leg,
foot, or toe amputations each year. Foot care programs that include regular
examinations and patient education could prevent up to 85% of these
amputations.
Cardiovascular disease. Heart disease and stroke cause about 65%
of deaths among people with diabetes. These deaths could be reduced by 30%
with improved care to control blood pressure, blood glucose, and blood
cholesterol levels.
Pregnancy complications. About 18,000 women with preexisting
diabetes and about 135,000 women with gestational diabetes give birth each
year. These women and their babies have an increased risk for serious
complications such as stillbirths, congenital malformations, and the need
for cesarean sections. Women with gestational diabetes and their babies are
also at higher risk of becoming obese and developing diabetes later in life.
These risks can be reduced with screenings and diabetes care before, during,
and after pregnancy.
Flu- and pneumonia-related deaths. Each year, 10,000–30,000 people
with diabetes die of complications from flu or pneumonia. They are roughly
three times more likely to die of these complications than people without
diabetes; however, only 55% of people with diabetes get an annual flu shot.
CDC Provides National Leadership and Builds Partnerships
CDC provides leadership and funding to diabetes prevention and control
programs nationwide. CDC also works with many partners to provide data for
public health decisions, inform the public about diabetes, and ensure good
care and education for Americans with diabetes.
Promoting Effective State Programs
With fiscal year 2004 funding of $66.9 million, CDC provides limited
support to 26 states, 8 territories, and the District of Columbia for
capacity-building diabetes prevention and control programs. CDC provides
substantial support to 24 states for basic implementation programs. In
addition, CDC works with its partners to develop national public health
performance standards for diabetes care. Partners include the Association of
State and Territorial Health Officials, National Association of County and
City Health Officials, National Association of Local Boards of Health,
American Public Health Association, and the Public Health Foundation.
The CDC National Diabetes Program has adopted the concept of conducting
assessments based on the 10 essential 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.
CDC Funding for Diabetes Control
Programs, Fiscal Year 2004*
*CDC also funds the following territories for
capacity-building diabetes control programs: American Samoa, Federated
States of Micronesia, Guam, Marshall Islands, Northern Mariana Island,
Palau, Puerto Rico, and U.S. Virgin Islands and the District of Columbia.
[A text
description of this map is also available.]
Monitoring the Burden and Translating Science
Timely data and public health research are essential for developing a
better understanding of how diabetes affects different populations and how
quality of care can be improved. CDC analyzes information from several
national data 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 diabetes care are applied in
clinical care settings. CDC and its partners also explore population-based
quality of care, examining disparities in the quality of diabetes care and
developing strategies to improve existing care practices.
Providing Education and Sharing Expertise
The National Diabetes Education Program (NDEP), sponsored by CDC and the
National Institutes of Health (NIH), comprises a network of more than 200
public and private partners that works to increase awareness about diabetes
and its control among health care providers and people with or at risk for
diabetes. The goals are to help people with diabetes better manage the
disease and to promote policies that improve the quality of care provided
and access to such care. NDEP partners, including six national minority
organizations, also develop community interventions and tools to improve
diabetes care and prevention, especially for communities with a high burden
of diabetes. NDEP products are available on the Internet (http://www.ndep.nih.gov)
and in many different languages.
CDC also develops other resources for health professionals, people with
diabetes, and communities. For example, Diabetes Today is a
train–the–trainer program that guides health professionals and community
leaders in developing a community plan for preventing the complications of
diabetes. A Spanish version of Diabetes Today is available, and a
regional training site serves Hawaii and the Pacific Basin.
Supporting Prevention Research
Studies suggest that the progression from prediabetes to diabetes can be
prevented or delayed. In 2001, results from two landmark clinical trials—the
Finnish Diabetes Prevention Study and the U.S. Diabetes Prevention Program
(DPP)—demonstrated that sustained lifestyle changes that included modest
weight loss and physical activity substantially reduced progression to
diabetes among older 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.
Target Populations at Risk
- Diabetes Detection Initiative. CDC is leading the development
and implementation of the Secretary’s Diabetes Detection Initiative. This
national public health program uses social marketing and health
communications strategies within health systems and communities to find
some 5 million Americans who have type 2 diabetes but do not know it.
Early diagnosis and proper treatment of diabetes can delay or even prevent
serious diabetes-related health problems.
- Primary prevention for people most at risk. A healthy diet and
modest physical activity can help people cut their risk for type 2
diabetes. CDC is developing methods to identify people at high risk for
diabetes, policies to help these people reduce their risk, and public
health programs that will slow the diabetes epidemic.
- National Diabetes Prevention Center. CDC funds a center in
Gallup, New Mexico, that is working with American Indian and Alaska Native
communities to develop culturally relevant and scientifically sound
interventions to prevent complications from diabetes.
- National Agenda for Public Health Action: A National Public
Health Initiative on Diabetes and Women’s Health offers recommendations to
help professionals, women and their families, health care systems, work
sites, communities, and schools address the burden of diabetes among
women. CDC is working with numerous partners to carry out the plan.
- SEARCH for Diabetes in Youth. Rising rates of diabetes among
youth are a growing public health concern. CDC and NIH are funding this
5-year, multicenter study to examine the status of diabetes among U.S.
children and adolescents.
Future Directions
CDC will continue to work with its partners to strengthen diabetes
surveillance, prevention research, interventions, and communications. In
support of Secretary of Health and Human Services Tommy Thompson’s Steps
to a HealthierUS prevention initiative (http://www.healthierus.gov/steps),
CDC plans to increase the number of diabetes prevention and control programs
that receive basic implementation funding to put their plans into action,
expand research and surveillance activities to address the unique needs of
women and children with diabetes, develop and carry out a national public
health strategy to address type 2 diabetes among children, and expand the
activities of the National Diabetes Education Program.
State Diabetes Program In Action: Missouri
The Missouri Diabetes Prevention and Control Program (MDPCP)
participated in the National Diabetes Collaborative. Through the
collaborative, the state program used the Chronic Care Model to form
teams of diabetes-related health care specialists. These teams
established an initial “population of focus” registry of patients
with diabetes to monitor indicators of health behaviors, health
status, and services received. The MDPCP provided the participating
health centers with financial support, technical assistance with
registry development, health system redesign, and evaluation skills.
Over 3 years, 12 of the 16 diabetes-related care measures
improved significantly. These improvements included increases in the
prevalence of at least two A1c tests 3 months apart (15%),
dilated-eye exams (190%), foot exams (47%), flu vaccinations (76%),
and setting of self-management goals (37%). By participating in the
collaborative, the MDPCP has improved the diabetes-related care and services that it delivers. |
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