Diabetes: A Serious Public Health Problem

	See Also: • Diabetes At A Glance 2004 • Prevention Effectiveness • Diabetes Web Site

Diabetes affects more than 17 million Americans and contributes to over 200,000 deaths a year. Diabetes can cause heart disease, stroke, blind-ness, kidney failure, leg and foot amputations, pregnancy complications, and deaths related to influenza and pneumonia. About 5.9 million Americans are unaware they have the disease. 

• Among U.S. adults, diagnosed diabetes (including gestational diabetes) increased 61% since 1991 and is projected to more than double by 2050. Type 2 affects 90%–95% of people with diabetes and is linked to obesity and physical inactivity.
• More than 18% of adults older than age 65 have diabetes.
• Diabetes affects more women than men. 

Costs

The direct and indirect costs of diabetes are nearly $132 billion a year. The average health care cost for a person with diabetes in 2002 was $13,243, compared with $2,560 for a person without diabetes. 

CDC Goals

• To increase diabetes awareness.
• To promote early detection of diabetes and treatment of its complications.
• To improve the quality of and access to diabetes care.

Program Effectiveness

For every $1 spent on preconception care programs for women with diabetes, $1.86 can be saved by preventing birth defects among their offspring.

Examples of CDC Activities

• National Diabetes Prevention Center. Because diabetes is so common among American Indians, CDC funds a center in New Mexico to develop culturally relevant diabetes prevention strategies for American Indian/Alaska Native communities.
• U.S./Mexico Border Diabetes Prevention and Control Project. CDC is working with southwestern U.S. border states, Mexican border states, the Pan American Health Organization, and Mexico’s Secretariat of Health to assess the burden of diabetes, patterns of care, and barriers to good self-management.
• Children and Type 2 Diabetes. CDC and the National Institutes of Health are studying childhood diabetes. SEARCH for Diabetes in Youth is a 5-year, multicenter study to evaluate diabetes cases among children aged 19 years or younger at diagnosis. The target population comprises 4.5 million children, or about 6% of all U.S. children. 
• Diabetes Prevention Program (DPP). The DPP is a 27-center randomized clinical trial involving more than 3,200 adults aged 25 years or older. Study participants are African American, Hispanic, American Indian, and Asian American. The DPP evaluated the effectiveness of intensive lifestyle modification, standard care plus metformin, and standard care plus placebo to prevent or delay type 2 diabetes. The results of this first major clinical trial of Americans at high risk for type 2 diabetes are 1) lifestyle changes reduced participants’ risk for type 2 diabetes by 58%, 2) lifestyle changes were effective across all ages and racial/ethnic groups, and 3) those who had standard care plus metformin reduced their risk for type 2 diabetes by 31%. 

With FY 2002 funding of $58.3 million, CDC provided limited support to 34 states, 8 territories, and the District of Columbia for core diabetes control programs and more substantive support to 16 states for comprehensive programs. 

Examples of State Activities

New York: Nearly 5% of the state’s adult population has diagnosed diabetes, and more than 285,000 hospitalizations each year are diabetes-related. Over 6,500 of these hospitalizations result in lower-extremity amputations. The CDC-funded New York Diabetes Control Program works with 14 regional community coalitions and three university-based Centers of Excellence. The Centers work with community partners 1) to improve diabetes services and access to care and 2) to overcome socioeconomic, cultural, and language barriers to services. In 2 years, the community and provider-focused interventions have reduced diabetes-related hospitalization rates by 35% and decreased lower-extremity amputation rates by 39%. 

North Carolina: Diabetes death rates are 27% higher among African Americans than among whites. Project DIRECT (Diabetes Intervention Reaching and Educating Communities Together) focuses on the African American community in Raleigh and offers a comprehensive approach to reducing risk factors for diabetes, promoting early diagnosis, and improving the quality of care and self-management practices of patients. 

In its first year, Project DIRECT increased foot care counseling of diabetes patients from about 20% to 50%. Chart audits document sustained improvements in home blood glucose monitoring, diabetes education, and diabetes-related screenings. 

 
Related Information

One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader (a free application) to view and print these documents.

• The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives
• Exemplary State Programs — Diabetes (125K–PDF)
• National Diabetes Prevention Center

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This page last reviewed August 10, 2004

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion