Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.

Diabetes is a chronic disease that has no cure. There are an estimated 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed, unfortunately, 6.2 million people are not aware that they have the disease. 54 million people have pre-diabetes.

If present trends continue, one in three Americans, and 1 in 2 minorities, born in 2000 will develop diabetes in their lifetime. Each day, approximately 4,110 people are diagnosed with diabetes. In 2005 1.5 million new cases of diabetes were diagnosed in people age 20 years or older.

Diabetes is the fifth-deadliest disease in the United States. Since 1987 the death rate due to diabetes has increased by 45 percent, while the death rates due to heart disease, stroke, and cancer have declined.

Based on death certificate data, diabetes contributed to 224,092 deaths in 2002. Studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiples chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported.

Many people first become aware that they have diabetes when they develop one of its serious and life-threatening complications such as:

Heart Disease and Stroke High Blood Pressure Blindness Kidney Disease Nervous System Damage Amputations Dental Disease Pregnancy Complications Sexual Dysfunction Others

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. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may be autoimmune, genetic, or environmental. There is no known way to prevent type 1 diabetes. Several clinical trials of methods of the prevention of type 1 diabetes are currently in progress or are being planned.

Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes accounts 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 it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications. Clinically-based reports and regional studies suggest that type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently, particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. 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. 70% of women who have had gestational diabetes will develop type 2 diabetes at some point during there lifetime.

Other 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 account for 1% to 5% of all diagnosed cases.

Pre-diabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with pre-diabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes.

• People with pre-diabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some people have both IFG and IGT.
• IFG is a condition in which the fasting blood glucose level is 100 to 125 milligrams per deciliter (mg/dL) after an overnight fast. The level is higher than normal but not high enough to be classified as diabetes.
• IGT is a condition in which the blood glucose level is 140 to 199 mg/dL after a 2-hour oral glucose tolerance test. This level is higher than normal but not high enough to be classified as diabetes.
• In a cross-section sample of U.S. adults aged 40-74 years tested from 1988 to 1994, 33.8% had IFG, 15.4% had IGT, and 40.1% had pre-diabetes (IGT or IFG or both). Applying these percentages to the entire U.S. population in 2000, an estimated 35 million adults aged 40-74 had IFG, 16 million had IGT, and 41 million had pre-diabetes (there is overlap between the IFG and IGT groups).
• Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal.
• More recent estimates from 1999-2002 indicate that, among US adults age 20 years and older, 26% had IFG, which was similar to the prevalence in 1988-1994 (25%). Applying this percentage to the entire U.S. population, 54 million American adults had IFG in 2002. Because IGT was not measured in 1999-2002, these data suggest that at least 54 million American adults had pre-diabetes in 2002.
• 2 million adolescents aged 12-19 (1 in 6 overweight adolescents aged 12-19) have pre-diabetes.

• Siblings of people with type 1 diabetes
• Children of parents with type 1 diabetes

• People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
• People over age 45
• People with a family history of diabetes
• People who are overweight
• People who do not exercise regularly
• People with low HDL cholesterol or high triglycerides, high blood pressure
• Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives)
• Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

Type 1 Diabetes

• Frequent urination
• Unusual thirst
• Extreme hunger
• Unusual weight loss
• Extreme fatigue
• Irritability

Type 2 Diabetes

• Any of the type 1 symptoms
• Frequent infections
• Blurred vision
• Cuts/bruises that are slow to heal
• Tingling/numbness in the hands/feet
• Recurring skin, gum, or bladder infections

*Often people with type 2 diabetes have no symptoms

• To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.
• Many people with type 2 diabetes can manage their blood glucose by following a healthy meal plan 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 (DMSE) is an integral component of medical care.

Among adults with diagnosed diabetes, 16% take insulin only, 12% take both insulin and oral medication, 57% take oral medication only, and 15% do not take either insulin or oral medications.

For more information in English or Spanish, contact the American Diabetes Association at 1-800-DIABETES (1-800-342-2383).

Total: 20.8 million children and adults -- 7.0% of the population -- have diabetes.

Diagnosed: 14.6 million people
Undiagnosed: 6.2 million people
Pre-diabetes: 54 million people

1.5 million new cases of diabetes were diagnosed in people aged 20 years or older in 2005.

Under 20 years of age: 176,500, or 0.22% of all people in this age group have diabetes. About one in every 400 to 600 children and adolescents has type 1 diabetes.

Two (2) million adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-diabetes. Although type 2 diabetes can occur in youth, the nationally representative data that would be needed to monitor diabetes trends in youth by type are not available. Clinically-based reports and regional studies suggest that type 2 diabetes, although still rare, is being diagnosed more frequently in children and adolescents, particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Age 20 years or older: 20.6 million, or 9.6% of all people in this age group have diabetes.

Age 60 years or older: 10.3 million, or 20.9% of all people in this age group have diabetes.

Men: 10.9 million, or 10.5% of all men aged 20 years or older have diabetes although nearly one third of them do not know it.

Women: 9.7 million, or 8.8% of all women aged 20 years or older have diabetes although nearly one third of them do not know it. The prevalence of diabetes is at least 2 to 4 times higher among non-Hispanic Black, Hispanic/Latino American, American Indian, and Asian/Pacific Islander women than among non-Hispanic white women.

Non-Hispanic whites: 13.1 million, or 8.7% of all non-Hispanic whites aged 20 years or older have diabetes.

Non-Hispanic Blacks: 3.2 million, or 13.3% of all non-Hispanic blacks aged 20 years or older have diabetes. After adjusting for population age differences, non-Hispanic blacks are 1.8 times as likely to have diabetes as non-Hispanic whites.

Hispanic/Latino Americans: After adjusting for population age differences, Mexican Americans, the largest Hispanic/Latino subgroup, are 1.7 times as likely to have diabetes as non-Hispanic whites. If the prevalence of diabetes among Mexican Americans was applied to the total Hispanic/Latino population, about 2.5 million (9.5%) Hispanic/Latino Americans aged 20 years or older would have diabetes. Sufficient data are not available to derive estimates of the total prevalence of diabetes (both diagnosed and undiagnosed diabetes) for other Hispanic/Latino groups. However, residents of Puerto Rico are 1.8 times as likely to have diagnosed diabetes as U.S. non-Hispanic whites.

American Indians and Alaska Natives: 99,500, or 12.8% of American Indians and Alaska Natives aged 20 years or older who received care from IHS in 2003 had diagnosed diabetes. 118,000 (15.1%) American Indians and Alaska Natives aged 20 years or older have diabetes (both diagnosed and undiagnosed diabetes). Taking into account population age differences, American Indians and Alaska Natives are 2.2 times as likely to have diabetes as non-Hispanic whites.

Asian Americans and Pacific Islanders: The total prevalence of diabetes (both diagnosed and undiagnosed diabetes) is not available for Asian Americans or Pacific Islanders. However, in Hawaii, Asians, Native Hawaiians, and other Pacific Islanders aged 20 years or older are more than 2 times as likely to have diagnosed diabetes as whites after adjusting for population age differences. Similarly, in California, Asians were 1.5 times as likely to have diagnosed diabetes as non-Hispanic whites. Other groups within these populations also have increased risk for diabetes.

For more information in English or Spanish, contact the American Diabetes Association at 1-800-DIABETES (1-800-342-2383).

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 management 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.

In women with diabetes, deaths from heart disease have increased 23 percent over the past 30 years compared to a 27 percent decrease in women without diabetes. Deaths from heart disease in men with diabetes have decreased by only 13 percent compared to a 36 percent decrease in men without diabetes.

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 glucose 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.

Mexican Americans are almost twice as likely and non-Hispanic blacks are almost 50% as likely to develop diabetic retinopathy as non-Hispanic whites.

Kidney disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002.
• In 2002, 44,400 people with diabetes began treatment for end-stage renal disease (ESRD).
• In 2002, a total of 153,730 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 glucose 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.

Non-Hispanic blacks are 2.6 to 5.6 times as likely to suffer from kidney disease with more than 4,000 new cases of ESRD each year. Mexican Americans are 4.5 to 6.6 times more likely and American Indians are 6 times more likely to suffer from kidney disease.

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 non-traumatic lower-limb amputations occur in people with diabetes.
• In 2002, about 82,000 non-traumatic 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.

Mexican Americans are 1.8 times as likely, non-Hispanic Blacks are 2.7 times as likely, and American Indians are 3 to 4 times as likely to suffer from lower-limb amputations.

Amputation rates are 1.4 to 2.7 times higher in men than women with 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.

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

• Men with diabetes are 2 times as likely to experience erectile dysfunction as men without diabetes.
• Women with type 1 diabetes are twice as likely to experience prevalence of sexual dysfunction compared with women without diabetes.

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.

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%.

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.

For more information in English or Spanish, contact the American Diabetes Association at 1-800-DIABETES (1-800-342-2383).

Click on this link to take the Diabetes Risk Test:
www.diabetes.org/risk-test.jsp

LINKS

American Diabetes Association   
http://www.diabetes.org/home.jsp

National Diabetes Clearing House     
http://diabetes.niddk.nih.gov/

Center for Disease Control                      
www.cdc.gov/diabetes/

National Institute of Diabetes and Digestive and Kidney Diseases  www.nlm.nih.gov/medlineplus/diabetes.html

Children With Diabetes Online    
www.childrenwithdiabetes.com

Juvenile Diabetes                                     
www.jdrf.org

How Stuff Works – Diabetes    
www.howstuffworks.com/diabetes.htm

Time Magazine: Diabetes – Are You At Risk?
www.time.com/time/covers/1101031208/

Diabetic Foot Guide
www.diabetes.nhs.uk/downloads/NDST_Diabetic_Foot_Guide.pdf