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Get to Know Diabetes

March 12th, 2012 - By Fit Staff




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Founded in 1940, The American Diabetes Association has been funding innovative diabetes research since 1955. Through their Nationwide Research Program, ADA is working to find the cure for diabetes and prevent its many health problems in addition to improving the lives of all people affected by diabetes.

Learning about diabetes is one of the first steps in prevention and control.

What is Diabetes?
Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Although the cause of diabetes is a mystery, both genetics and environmental factors appear to play roles.

  • Type 1: An autoimmune disease in which the body does not produce any insulin, most often occurring in children and young adults. People with type 1 diabetes must take daily insulin injections to stay alive.
  • Type 2: A metabolic disorder resulting from the body’s inability to make enough, or properly use, insulin. This form of the disease is associated with older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.
  • Gestational diabetes develops in 2 –5 percent of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes are at increased risk for developing type 2 diabetes later in life. After pregnancy, 5-10% of women with gestational diabetes are found to have type 2 diabetes, and women who have had gestational diabetes have a 20-50% chance of developing diabetes in the next 5-10 years.
  • Pre-diabetes is when a person’s blood glucose levels are higher than normal but not high enough to be type 2 diabetes. People with prediabetes are more likely to develop type 2 diabetes and may have some problems from diabetes already. Recent estimates project that as many as 1 in 3 American adults will have diabetes by 2050 unless action is taken.

    There are three different tests your doctor can use to determine whether you have pre-diabetes:

    • The A1C test
    • The fasting plasma glucose test (FPG)
    • or the oral glucose tolerance test (OGTT)

    The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes.

    If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). Both are also known as prediabetes.

Complications of diabetes in the United States
Diabetes is associated with an increased risk for a number of serious, sometimes life-threatening complications and certain populations experience an even greater threat. Good diabetes control can help reduce your risk, however many people are not even aware that they have diabetes until they develop one of its complications.

Heart disease and stroke

  • Heart disease and stroke account for about 65% of deaths in people with diabetes.
  • Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
  • The risk for stroke is 2 to 4 times higher and the risk of death from stroke is 2.8 times higher among people with diabetes.

Deaths from heart disease have decreased significantly among men with diabetes in recent years, but that trend has not been true in women.  From 1971 to 2000, the rate of death from heart disease among men with diabetes decreased from 16.8 deaths per 1000 men to 8.1 deaths per 1000. Among women with diabetes, however, deaths from heart disease did not decline from 1971 to 2000, and the difference in death rate from all causes between diabetic and nondiabetic women more than doubled, from a difference of 8.3 to 18.2 annual deaths per 1000 women (Gregg et al., Annals of Internal Medicine, 2007).

High blood pressure

  • About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.

Blindness

  • Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year making diabetes the leading cause of new cases of blindness in adults 20-74 years of age.
  • In people with type 1 diabetes, therapy that keeps blood sugar levels as close to normal as possible reduces damage to the eyes by 76% (New England Journal of Medicine, September 30, 1993). Experts believe that these results can also be applied to those with type 2 diabetes.

Kidney disease

  • Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.
  • In 2005, 46,739 people with diabetes began treatment for end-stage renal disease (ESRD).
  • In 2002, a total of 178,689 people with ESRD due to diabetes were living on chronic dialysis or with a kidney transplant.
  • In people with type 1 diabetes, therapy that keeps blood sugar levels as close to normal as possible reduces damage to the kidneys by 35% to 56% (New England Journal of Medicine, September 30, 1993). Experts believe that these results can also be applied to those with type 2 diabetes.

Nervous system disease

  • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
  • Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
  • Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

  • More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
  • In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.
  • The rate of amputation for people with diabetes is 10 times higher than for people without diabetes.

Dental disease

  • Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
  • Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.
  • Persons with poorly controlled diabetes (A1c > 9%) were nearly 3 times more likely to have severe periodontitis than those without diabetes.

Complications of pregnancy

  • Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
  • Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Sexual Dysfunction

  • Diabetes significantly increases the risk for sexual dysfunction in both men and women.

Other complications

  • Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma
  • People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.
  • Persons with diabetes aged 60 years or older are 2–3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework, or to use a mobility aid compared with persons without diabetes in the same age group.

Preventing diabetes complications
Diabetes can affect many parts of the body and can lead to serious complications such as heart disease, blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner.

Glucose control

  • Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results (e.g., from 8.0% to 7.0%) reduces the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%.
  • In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.

Blood pressure control

  • Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among persons with diabetes by 33% to 50%, and the risk of microvascular complications (eye, kidney, and nerve diseases) by approximately 33%.
  • In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.

Control of blood lipids

  • Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20% to 50%.

Preventive care practices for eyes, kidneys, and feet

  • Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.
  • Comprehensive foot care programs can reduce amputation rates by 45% to 85%.
  • Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%. Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure lowering drugs.
  • In addition to lowering blood pressure, ARBs reduce proteinuria, a risk factor for developing kidney disease, by 35%, similar to the reduction achieved by ACE inhibitors.

The Association reaches millions of people annually through its information activities and awareness efforts, such as American Diabetes Alert; Diabetes Month; 1-800-DIABETES (1-800-342-2383), the Association’s toll-free National Call Center; the Association’s Web site, diabetes.org; a monthly consumer magazine, Diabetes Forecast; outreach to communities most at risk for diabetes; and programs to help children with diabetes and their families.

The Association fights on behalf of the diabetes community to increase federal funding for diabetes research and programs, improve comprehensive health care and insurance coverage, and end discrimination against people with diabetes.

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