Information On Diabetes
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Type 1 Diabetes & Type 2 diabetes:
Cost of diabetes in the United States, 2002
Total (direct and indirect) : $132 billion
Direct medical costs : $92 billion
Indirect costs : $40 billion (disability, work loss, premature mortality)
General Information on diabetes
What is diabetes?
Diabetes is a group of diseases characterized by high levels of blood
glucose resulting from defects in insulin production, insulin action,
or both. Diabetes can be associated with serious complications and premature
death, but people with diabetes can take steps to control the disease
and lower the risk of complications.
Types of diabetes
Type 1 diabetes was previously called insulin-dependent diabetes mellitus
(IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's
immune system destroys pancreatic beta cells, the only cells in the body
that make the hormone insulin that regulates blood glucose. This form
of diabetes usually strikes children and young adults, although disease
onset can occur at any age. Type 1 diabetes may account for 5% to 10%
of all diagnosed cases of diabetes. Risk factors for type 1 diabetes include
autoimmune, genetic, and environmental factors.
Type 2 diabetes was previously called non-insulin-dependent diabetes
mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account
for about 90% to 95% of all diagnosed cases of diabetes. It usually begins
as insulin resistance, a disorder in which the cells do not use insulin
properly. As the need for insulin rises, the pancreas gradually loses
its ability to produce insulin. Type 2 diabetes is associated with older
age, obesity, family history of diabetes, prior history of gestational
diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.
African Americans, Hispanic/Latino Americans, Native Americans, and some
Asian Americans, Native Hawaiian, or other Pacific Islanders are at particularly
high risk for type 2 diabetes. Type 2 diabetes is increasingly being diagnosed
in children and adolescents.
Gestational diabetes is a form of glucose intolerance that is diagnosed
in some women during pregnancy. Gestational diabetes occurs more frequently
among African Americans, Hispanic/Latino Americans, and Native Americans.
It is also more common among 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% of women with gestational diabetes
are found to have type 2 diabetes. Women who have had gestational diabetes
have a 20% to 50% chance of developing diabetes in the next 5-10 years.
Other specific types of diabetes result from specific genetic conditions
(such as maturity-onset diabetes of youth), surgery, drugs, malnutrition,
infections, and other illnesses. Such types of diabetes may account for
1% to 5% of all diagnosed cases of diabetes.
Treatment of diabetes
In order to survive, people with type 1 diabetes must have insulin delivered
by a pump or injections. Many people with type 2 diabetes can control
their blood glucose by following a careful diet and exercise program,
losing excess weight, and taking oral medication. Many people with diabetes
also need to take medications to control their cholesterol and blood pressure.
Diabetes self-management education is an integral component of medical
care. Among adults with diagnosed diabetes, about 12% take both insulin
and oral medications, 19% take insulin only, 53% take oral medications
only, and 15% do not take either insulin or oral medications. Pre-diabetes:
Impaired glucose tolerance and impaired fasting glucose Pre-diabetes is
a term used to distinguish people who are at increased risk of developing
diabetes. People are considered to have re-diabetes if they have impaired
fasting glucose (IFG) and/or impaired glucose tolerance (IGT). IFG is
a condition in which the fasting blood sugar level is elevated (between
110 and 125 mg/dL after an overnight fast) but is not high enough to be
classified as diabetes. IGT is a condition in which the blood sugar level
is elevated (between 140 and 199 milligrams per deciliter or mg/dL after
a 2-hour oral glucose tolerance test), but not high enough to be classified
as diabetes. In a cross section of US adults tested in 1988 to 1994, 9.6
million (10.1%) adults aged 40-74 years had IFG, 14.2 million (14.9%)
have IGT, and 20.1 million (21.1%) had pre-diabetes (IGT or IFG).
Progression to diabetes among those with pre-diabetes is not inevitable.
Studies suggest that weight loss and increased physical activity among
people with pre-diabetes prevents or delays diabetes and may return blood
glucose levels to normal. People with pre-diabetes are already at increased
risk for heart disease and stroke.
Prevention or delay of diabetes
Research studies in the United States and abroad have found that lifestyle
changes can prevent or delay the onset of type 2 diabetes among high-risk
adults. These studies included people with IGT and other high-risk characteristics
for developing diabetes. Lifestyle interventions included diet and moderate-intensity
physical activity (such as walking for 2 1/2 hours each week). In the
Diabetes Prevention Program, a large prevention study of people at high
risk for diabetes, the development of diabetes was reduced 58% over three
(3) years.
Studies have also shown that medications have been successful in preventing
diabetes in some population groups. In the Diabetes Prevention Program,
people treated with the drug metformin reduced their risk of developing
diabetes by 31% over three (3) years. Treatment with metformin was most
effective among younger, heavier people (those 25-40 years of age who
were 50 to 80 pounds overweight) and less effective among older people
and people who were not as overweight. Similarly, in the STOP-NIDDM Trial,
treatment of people with IGT with acarbose reduced the risk of developing
diabetes by 25% over three (3) years. Other medication studies are ongoing.
In addition to preventing progression from IGT to diabetes, both lifestyle
and medication have also been shown to increase the probability of reverting
from IGT to normal glucose tolerance. There are no known methods to prevent
type 1 diabetes. Several clinical trials are currently in progress, and
being planned.
From ADA article:Note This publication is not subject to copyright restrictions;
please duplicate and distribute copies as desired.
Citation Centers for Disease Control and Prevention. National diabetes
fact sheet: general information and national estimates on diabetes in
the United States, 2002. Atlanta, GA: US Department of Health and Human
Services, Centers for Disease Control and Prevention, 2003. |
