WELCOME

Introduction

Asthma

Cancer

Diabetes
Gestational
Diabetes

Heart disease
and Stroke

Obesity

Nutrition

Physical
Activity

Tobacco
Use

Appendixes

Female Baby
Boomers:
Be Aware of
Diabetes Risk

Diabetes is most common in
persons over age 60 years. The
best defense
for female baby
boomers is prevention, followed by early detection, treatment, and more prevention through self-management.

Diabetes

Today, diabetes is one of the most serious health challenges facing women in the United States, especially women of color.  Complications from diabetes rank among the top 10 causes of death for all women.

As shown in the Diabetes Deaths for Women chart, whether diabetes is an underlying cause or among multiple causes of death, the toll on women, especially women of color, is significant. For African American women, the diabetes death rates are the highest in terms of both underlying cause (49.6 per 100,000) and multiple causes (156.5 per 100,000).¹

American Indian/Alaska Native and Hispanic women have high rates as well. The lowest rates are reported for Asian/Pacific Islander women. 

Even within racial and ethnic groups, disparities exist.  Diabetes takes an excessive toll on Pima Indians, who are at higher risk than other American Indians for many types of complications, including diabetic eye disease.  

Diabetes is a disease in which the pancreas, the organ that produces the hormone insulin to help glucose (a sugar) get into the body’s cells, does not work properly. The glucose then builds up in the blood, overflows into the urine, and is carried out of the body instead of being used by the cells for energy. Diabetes

can lead to serious, even life-threatening emergencies and serious damage to many parts of the body: the heart, eyes, kidneys, blood vessels, nerves, gums and teeth, feet, and legs.¹

Type 2 diabetes, previously referred to as adult onset, is a more serious problem for women of color, as indicated by the statistics below:¹ 

	Among African American women, this form of diabetes has reached epidemic proportions; for those age 20 years or older, the rate is 11.8 percent.
	About 1 in 4 black women over the age of 55 years of age has diabetes, nearly twice the rate of white women.
	Twenty-five percent of Hispanic women have been diagnosed with type 2 diabetes, and about 33 percent of deaths among them list diabetes as the underlying cause. This rate has risen rapidly in the 30-year period from 1958 to 1987.
	American Indian/Alaska Native women have almost three times the risk of being diagnosed with diabetes as whites of similar age. The disease is common in many tribes, and the sickness and mortality can be very severe.

Older American Indian/Alaska Native and Mexican American women are among the most likely to have diabetes (32 and 30 percent, respectively), followed by black women (25 percent) and white women (15 percent).²

Years of potential life lost due to diabetes before age 75 (age-adjusted per 100,000 population under 75 years ago of age) clearly reflects the toll taken by diabetes among African American and American Indian/Alaska Native women. In 1988, black women lost 369.5 years, and American Indian/Alaska Native women lost 327.8 years of potential life to diabetes. Hispanic women lost 188.7 years of potential life, white women lost 127.4 years, and Asian and Pacific Islander women lost 68.2 years.³

Diabetes-related health risks are twofold: health risks that can lead to diabetes and health risks that result from having diabetes.  The diabetes-associated risks include loss of vision and blindness, foot ulcers, lower extremity amputations, and pregnancy and cardiovascular complications.  In addition, diabetes is associated with birth defects, high blood pressure, nervous system damage, dental disease, kidney disease, stroke, and flu and pneumonia-related deaths.

Cardiovascular disease is the most costly complication of diabetes, accounting for more than $17.6 billion of the $91.8 billion annual direct medical costs for diabetes in 2002. Data about diabetes-related complications show disparities for women of color.  For example, African Americans experience

higher rates of diabetes complications such as eye disease, kidney failure, and amputations. They also experience greater disability from these complications.⁴

The link between diabetes and heart disease is especially critical for women of color. Several risk factors for diabetes, including overweight and high cholesterol, are risk factors for heart disease as well (see discussion on Heart Disease and Stroke).^{5, 6, 7} 

Unfortunately, women, even women with diabetes, are not well informed about the risks. They do not make the connection between diabetes and heart disease. 

 

Making the Connection: Diabetes and Steps to a HealthierUS Diabetes has major connections to other chronic conditions and lifestyle choices targeted by Steps to a HealthierUS.  Taking steps to prevent and control diabetes is essential in improving women’s health.  The dramatic rise in type 2 diabetes is largely a consequence of the ongoing increase in overweight and obesity.  The presence of diabetes in women is associated with a three- to four-fold increase in coronary heart disease compared with nondiabetic women.  Nutrition and physical activity are key elements in diabetes prevention, self-management, and control. Tobacco use prevention and cessation are important steps in diabetes care.

Patients’ lack of awareness suggests that doctors are not communicating about the risks. In a recent survey, half of the respondents indicated that their health care providers did not discuss ways to reduce the risks for heart disease and stroke, such as lowering cholesterol or blood pressure.  

The connection between diabetes and blindness also needs to be made.  Diabetic retinopathy affects 40 to 45 percent of the 13 million Americans diagnosed with diabetes.  Without treatment, more than 50 percent of patients with proliferative diabetic retinopathy, the most advanced stage, will become blind within 5 years.  Yet, annual eye exams, timely treatment, and appropriate followup care can reduce the risk of blindness by 90 percent. 

Unfortunately, many people with diabetic retinopathy are not receiving or availing themselves of potentially sight-saving treatments and diabetes self-management approaches. The reasons are diverse and include a knowledge gap among primary caregivers about the effectiveness of these treatments and a lack of referrals for comprehensive dilated eye exams.  

The Federal Diabetes Prevention Program has shown that lifestyle change and/or medication can dramatically reduce the development of diabetes.  Modifying lifestyle can reduce by half the number of new cases among adults at high risk.  As the HealthierUS and Steps to a HealthierUS initiatives promote, women can reduce their diabetes-related risks by:

	Being physically active every day.
	Eating a nutritious diet.
	Making healthy choices.

Gestational Diabetes

A Healthy People 2010 developmental objective calls for a decrease in the proportion of pregnant women with gestational diabetes. When reported late in 2004, baseline data are expected to illuminate the magnitude of the problem for all pregnant women, especially women of color. 

Because the Steps to a HealthierUS also targets obesity, gestational diabetes takes on greater importance:  Research shows that pregnant women who are overweight or obese are more likely to develop gestational diabetes. Furthermore, infants born to women with gestational diabetes are more likely to be overweight as children and as adults, thus facing increased risk for diabetes.⁸

Pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy are said to have gestational diabetes.  Gestational diabetes develops in 2 to 5 percent of all pregnancies, but disappears when a pregnancy is over.   

This condition occurs more frequently in women who have had a baby weighing 9 pounds or more at birth and are African American, Hispanic/Latino American, American Indian, or have a family history of diabetes.  Women who have had gestational diabetes are at increased risk for later development of type 2 diabetes.⁹

Perinatal problems such as macrosomia (large body size) and neonatal hypoglycemia (low blood sugar) are higher in babies born to women with gestational diabetes.