Diabetes
Overview
On this page:
Almost everyone knows
someone who has diabetes. An estimated 20.8
million people in the United States—7.0
percent of the population—have diabetes, a
serious, lifelong condition. Of those, 14.6
million have been diagnosed, and 6.2 million
have not yet been diagnosed. In 2005, about
1.5 million people aged 20 or older were
diagnosed with diabetes. For additional
statistics, see the National Diabetes
Statistics fact sheet online at www.diabetes.niddk.nih.gov/dm/pubs/statistics
or call the National Diabetes Information
Clearinghouse at 1–800–860–8747 to
request a copy.
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What is diabetes?
Diabetes is a
disorder of metabolism—the way our bodies
use digested food for growth and energy. Most
of the food we eat is broken down into
glucose, the form of sugar in the blood.
Glucose is the main source of fuel for the
body.
After digestion,
glucose passes into the bloodstream, where it
is used by cells for growth and energy. For
glucose to get into cells, insulin must be
present. Insulin is a hormone produced by the
pancreas, a large gland behind the stomach.
When we eat, the
pancreas automatically produces the right
amount of insulin to move glucose from blood
into our cells. In people with diabetes,
however, the pancreas either produces little
or no insulin, or the cells do not respond
appropriately to the insulin that is produced.
Glucose builds up in the blood, overflows into
the urine, and passes out of the body in the
urine. Thus, the body loses its main source of
fuel even though the blood contains large
amounts of glucose.
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What are the types
of diabetes?
The three main types
of diabetes are
- type 1 diabetes
- type 2 diabetes
- gestational
diabetes
Type 1 Diabetes
Type 1 diabetes is an
autoimmune disease. An autoimmune disease
results when the body’s system for fighting
infection (the immune system) turns against a
part of the body. In diabetes, the immune
system attacks and destroys the
insulin-producing beta cells in the pancreas.
The pancreas then produces little or no
insulin. A person who has type 1 diabetes must
take insulin daily to live.
At present,
scientists do not know exactly what causes the
body’s immune system to attack the beta
cells, but they believe that autoimmune,
genetic, and environmental factors, possibly
viruses, are involved. Type 1 diabetes
accounts for about 5 to 10 percent of
diagnosed diabetes in the United States. It
develops most often in children and young
adults but can appear at any age.
Symptoms of type 1
diabetes usually develop over a short period,
although beta cell destruction can begin years
earlier. Symptoms may include increased thirst
and urination, constant hunger, weight loss,
blurred vision, and extreme fatigue. If not
diagnosed and treated with insulin, a person
with type 1 diabetes can lapse into a
life-threatening diabetic coma, also known as
diabetic ketoacidosis.
Type 2 Diabetes
The most common form
of diabetes is type 2 diabetes. About 90 to 95
percent of people with diabetes have type 2.
This form of diabetes is most often associated
with older age, obesity, family history of
diabetes, previous history of gestational
diabetes, physical inactivity, and certain
ethnicities. About 80 percent of people with
type 2 diabetes are overweight.
Type 2 diabetes is
increasingly being diagnosed in children and
adolescents. However, nationally
representative data on prevalence of type 2
diabetes in youth are not available.
When type 2 diabetes
is diagnosed, the pancreas is usually
producing enough insulin, but for unknown
reasons the body cannot use the insulin
effectively, a condition called insulin
resistance. After several years, insulin
production decreases. The result is the same
as for type 1 diabetes—glucose builds up in
the blood and the body cannot make efficient
use of its main source of fuel.
The symptoms of type
2 diabetes develop gradually. Their onset is
not as sudden as in type 1 diabetes. Symptoms
may include fatigue, frequent urination,
increased thirst and hunger, weight loss,
blurred vision, and slow healing of wounds or
sores. Some people have no symptoms.
Gestational Diabetes
Some women develop
gestational diabetes late in pregnancy.
Although this form of diabetes usually
disappears after the birth of the baby, women
who have had gestational diabetes have a 20 to
50 percent chance of developing type 2
diabetes within 5 to 10 years. Maintaining a
reasonable body weight and being physically
active may help prevent development of type 2
diabetes.
About 3 to 8 percent
of pregnant women in the United States develop
gestational diabetes. As with type 2 diabetes,
gestational diabetes occurs more often in some
ethnic groups and among women with a family
history of diabetes. Gestational diabetes is
caused by the hormones of pregnancy or a
shortage of insulin. Women with gestational
diabetes may not experience any symptoms.
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How is diabetes
diagnosed?
The fasting blood
glucose test is the preferred test for
diagnosing diabetes in children and
nonpregnant adults. It is most reliable when
done in the morning. However, a diagnosis of
diabetes can be made based on any of the
following test results, confirmed by retesting
on a different day:
- A blood glucose
level of 126 milligrams per deciliter (mg/dL)
or more after an 8-hour fast. This test is
called the fasting blood glucose test.
- A blood glucose
level of 200 mg/dL or more 2 hours after
drinking a beverage containing 75 grams of
glucose dissolved in water. This test is
called the oral glucose tolerance test (OGTT).
- A random (taken at
any time of day) blood glucose level of
200 mg/dL or more, along with the presence
of diabetes symptoms.
Gestational diabetes
is diagnosed based on blood glucose levels
measured during the OGTT. Glucose levels are
normally lower during pregnancy, so the cutoff
levels for diagnosis of diabetes in pregnancy
are lower. Blood glucose levels are measured
before a woman drinks a beverage containing
glucose. Then levels are checked 1, 2, and 3
hours afterward. If a woman has two blood
glucose levels meeting or exceeding any of the
following numbers, she has gestational
diabetes: a fasting blood glucose level of 95
mg/dL, a 1-hour level of 180 mg/dL, a 2-hour
level of 155 mg/dL, or a 3-hour level of 140
mg/dL.
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What is
pre-diabetes?
People with
pre-diabetes have blood glucose levels that
are higher than normal but not high enough for
a diagnosis of diabetes. This condition raises
the risk of developing type 2 diabetes, heart
disease, and stroke.
Pre-diabetes is also
called impaired fasting glucose (IFG) or
impaired glucose tolerance (IGT), depending on
the test used to diagnose it. Some people have
both IFG and IGT.
- IFG is a condition
in which the blood glucose level is high
(100 to 125 mg/dL) after an overnight
fast, but is not high enough to be
classified as diabetes. (The former
definition of IFG was 110 mg/dL to 125 mg/dL.)
- IGT is a condition
in which the blood glucose level is high
(140 to 199 mg/dL) after a 2-hour oral
glucose tolerance test, but is not high
enough to be classified as diabetes.
Pre-diabetes is
becoming more common in the United States,
according to new estimates provided by the
U.S. Department of Health and Human Services.
About 40 percent of U.S. adults ages 40 to
74—or 41 million people—had pre-diabetes
in 2000. New data suggest that at least 54
million U.S. adults had pre-diabetes in 2002.
Many people with pre-diabetes go on to develop
type 2 diabetes within 10 years.
The good news is that
if you have pre-diabetes, you can do a lot to
prevent or delay diabetes. Studies have
clearly shown that you can lower your risk of
developing diabetes by losing 5 to 7 percent
of your body weight through diet and increased
physical activity. A major study of more than
3,000 people with IGT, a form of pre-diabetes,
found that diet and exercise resulting in a 5
to 7 percent weight loss—about 10 to 14
pounds in a person who weighs 200
pounds—lowered the incidence of type 2
diabetes by nearly 60 percent. Study
participants lost weight by cutting fat and
calories in their diet and by exercising (most
chose walking) at least 30 minutes a day, 5
days a week.
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What are the scope
and impact of diabetes?
Diabetes is widely
recognized as one of the leading causes of
death and disability in the United States. In
2002, it was the sixth leading cause of death.
However, diabetes is likely to be
underreported as the underlying cause of death
on death certificates. About 65 percent of
deaths among those with diabetes are
attributed to heart disease and stroke.
Diabetes is
associated with long-term complications that
affect almost every part of the body. The
disease often leads to blindness, heart and
blood vessel disease, stroke, kidney failure,
amputations, and nerve damage. Uncontrolled
diabetes can complicate pregnancy, and birth
defects are more common in babies born to
women with diabetes.
In 2002, diabetes
cost the United States $132 billion. Indirect
costs, including disability payments, time
lost from work, and premature death, totaled
$40 billion; direct medical costs for diabetes
care, including hospitalizations, medical
care, and treatment supplies, totaled $92
billion.
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Who gets diabetes?
Diabetes is not
contagious. People cannot “catch” it from
each other. However, certain factors can
increase the risk of developing diabetes.
Type 1 diabetes
occurs equally among males and females but is
more common in whites than in non-whites. Data
from the World Health Organization’s
Multinational Project for Childhood Diabetes
indicate that type 1 diabetes is rare in most
African, American Indian, and Asian
populations. However, some northern European
countries, including Finland and Sweden, have
high rates of type 1 diabetes. The reasons for
these differences are unknown. Type 1 diabetes
develops most often in children but can occur
at any age.
Type 2 diabetes is
more common in older people, especially in
people who are overweight, and occurs more
often in African Americans, American Indians,
some Asian Americans, Native Hawaiians and
other Pacific Islander Americans, and
Hispanics/Latinos. On average, non-Hispanic
African Americans are 1.8 times as likely to
have diabetes as non-Hispanic whites of the
same age. Mexican Americans are 1.7 times as
likely to have diabetes as non-Hispanic whites
of similar age. (Data are not available for
estimation of diabetes rates in other
Hispanic/Latino groups.) American Indians have
one of the highest rates of diabetes in the
world. On average, American Indians and Alaska
Natives are 2.2 times as likely to have
diabetes as non-Hispanic whites of similar
age. Although prevalence data for diabetes
among Asian Americans and Pacific Islanders
are limited, some groups, such as Native
Hawaiians, Asians, and other Pacific Islanders
residing in Hawaii (aged 20 or older) are more
than twice as likely to have diabetes as white
residents of Hawaii of similar age.
Diabetes prevalence
in the United States is likely to increase for
several reasons. First, a large segment of the
population is aging. Also, Hispanics/Latinos
and other minority groups at increased risk
make up the fastest-growing segment of the
U.S. population. Finally, Americans are
increasingly overweight and sedentary.
According to recent estimates from the Centers
for Disease Control and Prevention (CDC),
diabetes will affect one in three people born
in 2000 in the United States. The CDC also
projects the prevalence of diagnosed diabetes
in the United States will increase 165 percent
by 2050.
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How is diabetes
managed?
Before the discovery
of insulin in 1921, everyone with type 1
diabetes died within a few years after
diagnosis. Although insulin is not considered
a cure, its discovery was the first major
breakthrough in diabetes treatment.
Today, healthy
eating, physical activity, and taking insulin
are the basic therapies for type 1 diabetes.
The amount of insulin must be balanced with
food intake and daily activities. Blood
glucose levels must be closely monitored
through frequent blood glucose checking.
People with diabetes also monitor blood
glucose levels several times a year with a
laboratory test called the A1C. Results of the
A1C test reflect average blood glucose over a
2- to 3-month period.
Healthy eating,
physical activity, and blood glucose testing
are the basic management tools for type 2
diabetes. In addition, many people with type 2
diabetes require oral medication, insulin, or
both to control their blood glucose levels.
Adults with diabetes
are at high risk for cardiovascular disease (CVD).
In fact, at least 65 percent of those with
diabetes die from heart disease or stroke.
Managing diabetes is more than keeping blood
glucose levels under control—it is also
important to manage blood pressure and
cholesterol levels through healthy eating,
physical activity, and use of medications (if
needed). By doing so, those with diabetes can
lower their risk. Aspirin therapy, if
recommended by the health care team, and
smoking cessation can also help lower risk.
People with diabetes
must take responsibility for their day-to-day
care. Much of the daily care involves keeping
blood glucose levels from going too low or too
high. When blood glucose levels drop too
low—a condition known as hypoglycemia—a
person can become nervous, shaky, and
confused. Judgment can be impaired, and if
blood glucose falls too low, fainting can
occur.
A person can also
become ill if blood glucose levels rise too
high, a condition known as hyperglycemia.
People with diabetes
should see a health care provider who will
help them learn to manage their diabetes and
who will monitor their diabetes control. Most
people with diabetes get care from primary
care physicians—internists, family practice
doctors, or pediatricians. Often, having a
team of providers can improve diabetes care. A
team can include
- a primary care
provider such as an internist, a family
practice doctor, or a pediatrician
- an endocrinologist
(a specialist in diabetes care)
- a dietitian, a
nurse, and other health care providers who
are certified diabetes educators—experts
in providing information about managing
diabetes
- a podiatrist (for
foot care)
- an ophthalmologist
or an optometrist (for eye care)
and other health care
providers, such as cardiologists and other
specialists. In addition, the team for a
pregnant woman with type 1, type 2, or
gestational diabetes should include an
obstetrician who specializes in caring for
women with diabetes. The team can also include
a pediatrician or a neonatologist with
experience taking care of babies born to women
with diabetes.
The goal of diabetes
management is to keep levels of blood glucose,
blood pressure, and cholesterol as close to
the normal range as safely possible. A major
study, the Diabetes Control and Complications
Trial (DCCT), sponsored by the National
Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK), showed that keeping blood
glucose levels close to normal reduces the
risk of developing major complications of type
1 diabetes.
This 10-year study,
completed in 1993, included 1,441 people with
type 1 diabetes. The study compared the effect
of two treatment approaches—intensive
management and standard management—on the
development and progression of eye, kidney,
nerve, and cardiovascular complications of
diabetes. Intensive treatment aimed to keep
A1C levels as close to normal (6 percent) as
possible. Researchers found that study
participants who maintained lower levels of
blood glucose through intensive management had
significantly lower rates of these
complications. More recently, a follow-up
study of DCCT participants showed that the
ability of intensive control to lower the
complications of diabetes has persisted more
than 10 years after the trial ended.
The United Kingdom
Prospective Diabetes Study, a European study
completed in 1998, showed that intensive
control of blood glucose and blood pressure
reduced the risk of blindness, kidney disease,
stroke, and heart attack in people with type 2
diabetes.
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Hope through
Research
NIDDK conducts
research in its own laboratories and supports
a great deal of basic and clinical research in
medical centers and hospitals throughout the
United States. It also gathers and analyzes
statistics about diabetes. Other Institutes at
the National Institutes of Health (NIH)
conduct and support research on
diabetes-related eye diseases, heart and
vascular complications, autoimmunity,
pregnancy, and dental problems.
Other Government
agencies that sponsor diabetes programs are
the CDC, the Indian Health Service, the Health
Resources and Services Administration, the
Department of Veterans Affairs, and the
Department of Defense.
Many organizations
outside the Government support diabetes
research and education activities. These
organizations include the American Diabetes
Association (ADA), the Juvenile Diabetes
Research Foundation International (JDRF), and
the American Association of Diabetes
Educators.
In recent years,
advances in diabetes research have led to
better ways of managing diabetes and treating
its complications. Major advances include
- development of
quick-acting, long-acting, and inhaled
insulins
- better ways to
monitor blood glucose and for people with
diabetes to check their own blood glucose
levels
- development of
external insulin pumps that deliver
insulin, replacing daily injections
- laser treatment
for diabetic eye disease, reducing the
risk of blindness
- successful kidney
and pancreas transplantation in people
whose kidneys fail because of diabetes
- better ways of
managing diabetes in pregnant women,
improving their chances of a successful
outcome
- new drugs to treat
type 1 and type 2 diabetes and better ways
to manage this form of diabetes through
weight control
- evidence that
intensive management of blood glucose
reduces and may prevent development of
diabetes complications
- demonstration that
two types of antihypertensive drugs, ACE (angiotensin-converting
enzyme) inhibitors and ARBs (angiotensin
receptor blockers), are more effective
than other antihypertensive drugs in
reducing a decline in kidney function in
people with diabetes
- advances in
transplantation of islets (clusters of
cells that produce insulin and other
hormones) for type 1 diabetes
- evidence that
people at high risk for type 2 diabetes
can lower their chances of developing the
disease through diet, weight loss, and
physical activity
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What will the future
bring?
Researchers continue
to look for the cause or causes of diabetes
and ways to manage, prevent, or cure the
disorder. Scientists are searching for genes
that may be involved in type 1 or type 2
diabetes. Some genetic markers for type 1
diabetes have been identified, and it is now
possible to screen relatives of people with
type 1 diabetes to determine whether they are
at risk.
Type 1 Diabetes
A number of
Federally-funded research studies and clinical
trials are under way. Studies focus on the
prevention and causes of type 1 diabetes as
well as experimental treatments such as islet
transplantation.
The
Environmental Determinants of Diabetes in the
Young Consortium
The main mission of The Environmental
Determinants of Diabetes in the Young (TEDDY)
consortium, an international group of clinical
centers, is to identify infectious agents,
dietary factors, or other environmental
factors (including psychosocial events) that
trigger type 1 diabetes in those who are
genetically susceptible. In addition, the
consortium aims to
- create a central
repository of data and biological samples
for use by researchers
- develop novel
approaches to finding the causes of type 1
diabetes
- find ways to
understand how the disease starts and
progresses
- discover new
methods to prevent, delay, and reverse
type 1 diabetes
TEDDY is funded by
the NIDDK, the National Institute of Allergy
and Infectious Diseases (NIAID), the Eunice
Kennedy Shriver National Institute of
Child Health and Human Development (NICHD),
the National Institute of Environmental Health
Sciences, the CDC, the JDRF, and the ADA. For
more information, see www.niddk.nih.gov/patient/TEDDY/TEDDY.htm.
Type 1
Diabetes TrialNet
Type 1 Diabetes TrialNet is a network of
experts and facilities dedicated to developing
new approaches to the understanding,
prevention, and treatment of type 1 diabetes.
Clinical centers are located in the United
States, Canada, Europe, and Australia.
TrialNet studies are
focusing on
- understanding the
natural history of type 1 diabetes (to
determine its causes and how the disease
progresses)
- preventing type 1
diabetes in those at risk
- developing ways to
preserve the function of the
insulin-producing cells in the pancreas in
people recently diagnosed with type 1
diabetes
For more information,
see www.DiabetesTrialNet.org
or call 1–800–HALT–DM1
(1–800–425–8361).
In many ways, the
TrialNet studies build on the advances and
insights gained from earlier research in type
1 diabetes. For example, researchers learned a
great deal about how to predict type 1
diabetes in at-risk people from the Diabetes
Prevention Trial—Type 1 (DPT–1). This
study showed that people at risk of developing
type 1 diabetes can be identified. The DPT-1
researchers discovered ways to identify two
populations at risk of developing type 1
diabetes within 5 years: those at high risk
(with at least a 50 percent chance) and those
with an intermediate risk (having a 25 to 50
percent risk). Then researchers explored
possible ways of preventing type 1 diabetes in
both groups. TrialNet will identify people at
risk who may be eligible for clinical trials.
In addition, TrialNet will conduct trials to
save beta cell function in those with new
onset type 1 diabetes.
TrialNet is funded by
the NIDDK, NICHD, and NIAID. JDRF and ADA also
support this effort.
The Immune
Tolerance Network
TrialNet works closely with the Immune
Tolerance Network, another international,
collaborative consortium. Its goal is to find
safe and effective ways to induce long-term
immune tolerance—prevention of an unwanted
immune response by the body. For example, type
1 diabetes might be prevented if scientists
could learn how to prevent the immune system
from mistakenly attacking the
insulin-producing cells in the pancreas.
Effective immune tolerance could possibly
- prevent the
body’s rejection of organ or tissue
transplants
- prevent or treat
autoimmune diseases
- prevent or treat
allergies and asthma
Islet
Transplantation
Researchers are working on a way for people
with type 1 diabetes to live without daily
insulin injections. In an experimental
procedure called islet transplantation, islets
are taken from a donor pancreas and
transferred into a person with type 1
diabetes. Once implanted, the beta cells in
these islets begin to make and release
insulin.
Scientists have made
many advances in islet transplantation in
recent years. Since reporting their findings
in the June 2000 issue of the New England
Journal of Medicine, researchers at the
University of Alberta in Edmonton, Alberta,
Canada, have continued to use a procedure
called the Edmonton protocol to transplant
pancreatic islets into people with type 1
diabetes. Before use of the Edmonton protocol,
during the 1990s, less than 10 percent of
islet cell transplant recipients were able to
control blood glucose levels for more than 1
year without insulin injections.
The Collaborative
Islet Transplant Registry (CITR), funded by
NIDDK, was created in 2001. CITR’s mission
is to expedite progress and promote safety in
islet transplantation by collecting,
analyzing, and communicating data on islet
transplantation. The CITR will study islet
transplantation alone as well as islet
transplantation following kidney transplant.
The September 2005
CITR annual report noted that with use of the
Edmonton protocol, after 1 year, 58 percent of
those who had transplants no longer needed to
inject insulin. Of those who were still
insulin-dependent 1 year after transplantation
(33 percent of those followed by the
registry), requirements for insulin were
decreased. The average reduction in insulin
requirements was 69 percent. In summary, a
total of 91 percent of those with transplants
showed improvement following transplantation.
The success of the Edmonton protocol has been
confirmed at other study sites, including the
NIDDK.
The goal of islet
transplantation is to infuse enough islets to
control the blood glucose level without
insulin injections. For an average-sized
person (154 pounds), a typical transplant
requires about 1 million islets, extracted
from two donor pancreases. Because good
control of blood glucose can slow or prevent
the progression of complications associated
with diabetes, such as nerve or eye damage, a
successful transplant may reduce the risk of
these complications. However, transplanted
islets lose their ability to function over
time. Also, a transplant recipient needs to
take immunosuppressive drugs to stop the
immune system from rejecting the transplanted
islets.
These drugs have
significant side effects, and their long-term
effects are still unknown. Immediate side
effects of immunosuppressive drugs may include
mouth sores and gastrointestinal problems,
such as stomach upset or diarrhea. Patients
may also have increased blood cholesterol
levels, decreased white blood cell counts,
decreased kidney function, and increased
susceptibility to bacterial and viral
infections. Taking immunosuppressive drugs
increases the risk of tumors and cancer as
well. Researchers are trying to find safer or
less toxic immunosuppressants or new
approaches that will allow successful
transplantation without the use of
immunosuppressive drugs.
The results of the
Edmonton protocol are very encouraging, but
more research is needed to develop safer and
more effective immunosuppression and to
enhance islet survival after transplantation.
Another obstacle to
widespread use of islet transplantation is the
severe shortage of islets. Only about 6,000
pancreases a year become available for
transplantation or for harvesting of islets.
However, researchers are pursuing alternative
sources, such as creating islets from other
types of cells. New technologies could then be
employed to grow islets in the laboratory.
Type 2 Diabetes
Diabetes
Prevention Program
In 1996, NIDDK launched its Diabetes
Prevention Program (DPP). The goal of this
research effort was to learn how to prevent or
delay type 2 diabetes in people with impaired
glucose tolerance (IGT), a strong risk factor
for type 2 diabetes.
The findings of the
DPP, released in August 2001, showed that
people at high risk for type 2 diabetes could
sharply lower their chances of developing the
disorder through diet and exercise. In
addition, treatment with the oral diabetes
drug metformin also reduced diabetes risk,
though less dramatically. Metformin lowers the
amount of glucose released by the liver and
also fights insulin resistance, a condition in
which the body doesn't use insulin properly.
Participants randomly
assigned to intensive lifestyle intervention
reduced their risk of getting type 2 diabetes
by almost 60 percent. On average, this group
maintained their physical activity at 30
minutes per day, usually with walking or other
moderate intensity exercise, and lost 5 to 7
percent of their body weight. Participants
randomized to treatment with metformin reduced
their risk of getting type 2 diabetes by 31
percent.
Of the 3,234
participants enrolled in the DPP, 45 percent
were from minority groups that suffer
disproportionately from type 2 diabetes:
African Americans, Hispanics/Latinos, Asian
Americans and Pacific Islanders, and American
Indians. The trial also recruited other groups
known to be at higher risk for type 2
diabetes, including individuals aged 60 and
older, women with a history of gestational
diabetes, and people with a first-degree
relative with type 2 diabetes. Participants
are being followed to check for long-term
effects of the interventions, including the
effects on risk of CVD.
Type 2
Diabetes in Children and Teens
Two studies focusing on type 2 diabetes in
children and teens are under way. The TODAY
(Treatment Options for type 2 Diabetes in
Adolescents and Youth) study, a 13-site study
sponsored by NIDDK, will compare treatments
for type 2 diabetes in children and teens.
Participants will undergo one of three
treatments:
- taking one
diabetes medication (metformin)
- taking two
diabetes medications (metformin and
rosiglitazone, another medication that
fights insulin resistance)
- taking metformin
and participating in an intensive
lifestyle change program designed to
promote weight loss by cutting calories
and increasing physical activity
The main goal of the
study is to determine how well each type of
treatment controls blood glucose levels. The
study also will evaluate how long each type of
treatment is effective.
The STOPP-T2D
(Studies to Treat or Prevent Pediatric Type 2
Diabetes) study, sponsored by NIDDK with
support from the ADA, is exploring methods to
lower risk factors for type 2 diabetes and CVD
in middle-school children (grades 6 through 8)
at eight sites. A 3-year program will focus on
the benefits of improving nutrition, promoting
physical activity, and making changes in
behavior.
Preventing
and Treating CVD in People with Type 2
Diabetes
CVD is the main killer of people with type 2
diabetes. For this reason, the NIH is studying
the best strategies to prevent and treat CVD
in people with diabetes in three major
studies. These studies are all joint efforts
of the NIDDK and the National Heart, Lung, and
Blood Institute.
The Look AHEAD
(Action for Health in Diabetes) trial is the
largest clinical trial to date to examine the
long-term health effects of voluntary weight
loss. This multi-center, randomized clinical
trial is studying the effects of a lifestyle
intervention designed to achieve and maintain
weight loss over the long term through
decreased caloric intake and increased
exercise. Look AHEAD will focus on the
disorder most associated with being overweight
or obese, type 2 diabetes, and on the outcome
that causes the greatest morbidity and
mortality in people with type 2 diabetes, CVD.
The Action to Control
Cardiovascular Risk in Diabetes (ACCORD)
trial, a multi-center, randomized trial, is
studying three approaches to preventing major
cardiovascular events in individuals with type
2 diabetes. ACCORD is designed to compare
current practice guidelines with more
intensive glycemic control in 10,000
individuals with type 2 diabetes, including
those at especially high risk for CVD events
because of age, evidence of subclinical
atherosclerosis, or existing clinical CVD.
More intensive control of blood pressure than
is called for in current guidelines and a
medication to reduce triglyceride levels and
raise HDL (good) cholesterol levels will also
be studied in subgroups of these 10,000
volunteers. Each treatment strategy will be
accompanied by standard advice regarding
lifestyle choices, including diet, physical
activity, and smoking cessation, appropriate
for individuals with diabetes.
The primary outcome
to be measured is the first occurrence of a
major CVD event, specifically heart attack,
stroke, or cardiovascular death. In addition,
the study will investigate the impact of the
treatment strategies on other cardiovascular
outcomes; total mortality; limb amputation;
eye, kidney, or nerve disease; health-related
quality of life; and cost-effectiveness.
The Bypass
Angioplasty Revascularization Investigation 2
Diabetes (BARI 2D) trial, a 5-year,
multi-center clinical trial, is comparing
medical versus early surgical management of
patients with type 2 diabetes who also have
coronary artery disease and stable angina or
ischemia. At the same time, BARI 2D will study
the effect of two different strategies to
control blood glucose—providing insulin
versus increasing the sensitivity of the body
to insulin—on the risk of cardiovascular
mortality and morbidity.
A complete listing of
clinical trials can be found at www.ClinicalTrials.gov.
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Points to Remember
What is diabetes?
- a disorder of
metabolism—the way the body uses or
converts food for energy and growth
What are the main
types of diabetes?
- type 1 diabetes
- type 2 diabetes
- gestational
diabetes
What are the impacts
of diabetes?
- It affects 20.8
million people—7.0 percent of the U.S.
population.
- It is a leading
cause of death and disability.
- It costs $132
billion per year.
Who gets diabetes?
- people of any age
- people with a
family history of diabetes
- others at high
risk for type 2 diabetes: older people,
overweight and sedentary people, African
Americans, Alaska Natives, American
Indians, Asian Americans, Native
Hawaiians, some Pacific Islander
Americans, and Hispanics/Latinos
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For More Information
To learn more about
type 1, type 2, and gestational diabetes, as
well as diabetes research, statistics, and
education, contact:
National Diabetes
Education Program
1 Diabetes Way
Bethesda, MD 20892–3560
Phone: 1–800–438–5383
Internet: www.ndep.nih.gov
To find a clinical
trial, check NIH’s database at www.ClinicalTrials.gov
online.
To participate in
studies about type 1 diabetes, contact:
Type 1
Diabetes TrialNet
Phone: 1–800–425–8361
Internet: www.DiabetesTrialNet.org
The following
organizations also distribute materials and
support programs for people with diabetes and
their families and friends:
American Diabetes
Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–342–2383
Internet: www.diabetes.org
Juvenile
Diabetes Research Foundation International
120 Wall Street, 19th Floor
New York, NY 10005
Phone: 1–800–533–2873
Internet: www.jdrf.org
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