mellitus is one of the most common and serious chronic
diseases in the United States.
About 16 million Americans have diabetes, 5.4 million
of whom do not know they have the disease.
Each year, approximately 800,000 people are diagnosed
with diabetes. The
prevalence of diabetes has increased steadily in the last
half of this century and will continue to rise with the
aging U.S. population, the growth in minority populations
most susceptible to type 2 diabetes, and the increasing
prevalence of obesity among Americans.
WHAT IS DIABETES?
is a metabolic 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
is characterized by high levels of blood glucose (sugar).
WHAT ARE THE DIFFERENT
TYPES OF DIABETES?
are three main types of diabetes:
formerly called insulin-dependent diabetes mellitus (IDDM)
or juvenile-onset diabetes, is an autoimmune disease that
results when the body’s immune system attacks and destroys
its own insulin-producing beta cells in the pancreas.
People with type 1 diabetes need daily injections of
insulin to live. Type 1 diabetes develops most often in
children or young adults and accounts for about 5 to 10
percent of diagnosed diabetes in the United States.
Although risk factors are not well defined for type 1
diabetes, autoimmune, genetic and environmental factors are
involved in its development.
formerly called noninsulin-dependent diabetes mellitus (NIDDM)
or adult-onset diabetes, is a disease that occurs when the
body makes enough insulin but cannot use it effectively.
This form of diabetes usually develops in adults over the
age of 40. About
90 to 95 percent of people with diabetes have type 2; about
80 percent are overweight.
Type 2 diabetes is more common among people who are
older; obese; have a family history of diabetes; have had
gestational diabetes; and are of African American, Hispanic
American, Asian American, Pacific Islander, and Native
develops or is discovered during pregnancy.
This type usually disappears when the pregnancy is
over, but women who have had gestational diabetes have a
greater risk of developing type 2 diabetes later in their
WHAT IS THE SCOPE AND
IMPACT OF DIABETES?
is widely recognized as one of the leading causes of death and
disability in the United States.
It was the seventh leading cause of death listed on
U.S. death certificates in 1995 and contributed to 187,800
deaths that same year.
type 1 and type 2 diabetes are associated with long-term
complications that threaten life and the quality of life.
Diabetes is the leading cause of adult blindness,
end-stage renal disease, and nontraumatic lower-extremity
amputations (as a result of nerve disease). People with
diabetes are 2 to 4 times more likely to have coronary heart
disease and stroke than people without diabetes.
In addition, poorly controlled diabetes can complicate
pregnancy, and birth defects are more common in babies born to
women with diabetes.
costs the United States $98.2 billion each year.
Medical costs for diabetes care -- including
hospitalizations, medical care and treatment supplies -- total
$44.1 billion. Indirect
costs -- including disability payments, time lost from work
and premature death -- total $54.1 billion.
IS DIABETES DIAGNOSED?
of type 1 diabetes usually develop over a short period of
time, although beta cell destruction can begin months, even
years, earlier. Symptoms
include increased thirst and urination, constant hunger,
weight loss, blurred vision, and extreme fatigue.
If not diagnosed and treated with insulin, a person can
lapse into a life-threatening coma.
symptoms of type 2 diabetes develop gradually and are not as
noticeable as in type 1 diabetes.
Symptoms include feeling tired or ill, frequent
urination (especially at night), unusual thirst, weight loss,
blurred vision, frequent infections, and slow-healing wounds
1997 the Expert Committee on the Diagnosis and Classification
of Diabetes published new guidelines for the diagnosis of
guidelines lowered the blood sugar values for diagnosis and
recommended use of the fasting plasma glucose test to diagnose
diabetes, a simpler and faster test than the commonly used
oral glucose tolerance test. Glucose levels greater than or
equal to 126mg/dl with the fasting plasma glucose test, or
greater than or equal to 200 mg/dl with the oral glucose
tolerance test indicate a diagnosis of diabetes.1
IS DIABETES MANAGED
is a self-managed disease because people with diabetes must
take responsibility for their day-to-day care.
Much of the daily care involves keeping blood glucose
near normal levels at all times.
of type 1 diabetes: People
with type 1 diabetes need daily injections of insulin because
their bodies no longer produce insulin.
Treatment requires a strict regimen that typically
includes a carefully calculated diet, planned physical
activity, self-testing of blood glucose, and multiple daily
of type 2 diabetes:
Treatment for people with type 2 diabetes typically includes
diet management, exercise, self-testing of blood glucose, and,
in some cases, oral medication and/or insulin.
Approximately 40 percent of people with type 2 diabetes
require insulin injections.
goal of diabetes management is to keep blood glucose levels as
close to a normal range as safely possible, while avoiding
blood glucose levels that are too high (hyperglycemia) or too
low (hypoglycemia). A 1993 study called the Diabetes Control
and Complications Trial (DCCT), conclusively showed that
intensive glucose control delayed the onset and progression of
eye disease, kidney disease and nerve disease by “a range of
35 to more than 70 percent.” In fact, it demonstrated that any
sustained lowering of blood glucose helps, even if the person
has a history of poor control.
This study was conducted by the National Institute of
Diabetes and Digestive and Kidney Diseases of the National
Institutes of Health.2
ARE THE MAJOR DIABETES ADVANCES?
recent years, advances in diabetes research have led to better
ways to manage diabetes and treat its complications.
Major advances include:
forms of purified insulin that are less likely to cause
allergic reactions and are nearly identical to the insulin
naturally produced by the body.
of external and implantable insulin pumps that deliver
appropriate amounts of insulin, replacing daily injections.
oral medications to improve control of type 2 diabetes.
ways for patients, doctors and other health professionals to
monitor blood glucose-- notably, new devices for
self-monitoring of blood glucose, which is performed by the
patient, and the hemoglobin A1c (also called H-b-A-one-c)
laboratory test, which measures blood glucose control during
the previous 3-month period.
treatment for diabetic eye disease.
ways to manage diabetic pregnancies, improving chances of
strategies to reduce damage to the kidneys, eyes and nerves.
from Diabetes Overview.
National Institute of Diabetes and Digestive and Kidney
Diseases, National Institutes of Health, NIH Publication No.
96-3873, October 1995.
of the Executive Committee on the Diagnosis and Classification
of Diabetes Mellitus. Diabetes
July; 20 (7): 1183-97.
Effect of Intensive Treatment of Diabetes on the Development
and Progression of Long-Term Complications in
Insulin-Dependent Diabetes Mellitus.
The New England
Journal of Medicine.
1993 September 30; 329 (14): 977-86.