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“New evidence shows that one in three Americans born
in 2000 will develop diabetes sometime during their lifetime. Together
we can and must do more to prevent and control this growing epidemic of
diabetes.”
Julie Louise Gerberding, MD, MPH
Director, CDC, and Administrator, ATSDR
Diabetes Is a Growing Public Health Problem
More than 18 million Americans have diabetes. Now the sixth leading
cause of death in America, diabetes is responsible for over 200,000
deaths each year. The number of U.S. adults with diagnosed diabetes,
including women with gestational diabetes (diabetes that develops during
pregnancy), has increased 61% since 1991 and is projected to more than
double by 2050.
People with diabetes have a shortage of insulin or a decreased
ability to use insulin, a hormone that allows glucose (sugar) to enter
cells and be converted to energy. When diabetes is not controlled,
glucose and fats remain in the blood and, over time, damage vital
organs. Diabetes can cause heart disease, stroke, blindness, kidney
failure, pregnancy complications, lower—extremity amputations, and
deaths related to flu and pneumonia. Particularly at risk for these
complications are the 5.2 million Americans who are unaware that they
have diabetes.
There are two main types of diabetes. Type 1 most often appears
during childhood or adolescence. Type 2 diabetes, which is linked to
obesity and physical inactivity, accounts for 90%–95% of diabetes cases
and most often appears among people older than 40. However, it is no
longer considered an adult-only disease. Type 2 is now being found at
younger ages and is even being diagnosed among children and teens.
Diabetes has its greatest effects on the elderly, women, and certain
racial and ethnic groups. One in five adults over age 65 has diabetes.
African American, Hispanic, American Indian, and Alaska Native adults
are two to three times more likely than white adults to have diabetes.
In addition to the millions of Americans with diabetes, an estimated
16 million U.S. adults aged 40–74 have prediabetes—that is, their blood
sugar level is elevated but is not high enough to be classified as
diabetes. People with prediabetes are at high risk for developing
diabetes.
Diabetes costs the nation nearly $132 billion a year—$92 billion in
direct medical costs and another $40 billion in indirect costs due to
lost productivity. The average yearly health care cost for a person with
diabetes was $13,243 in 2002, compared with $2,560 for a person without
diabetes. Diabetes costs represented 11% of national health care
expenditures during 2002.
Many Complications of Diabetes Can Be Prevented
Although the increasing burden of diabetes and its complications is
alarming, much of this burden could be prevented with early detection,
improved delivery of care, and better education on diabetes
self-management. The following are examples of diabetes-related
complications that could be prevented or reduced:
Eye disease and blindness. Each year, 12,000–24,000 people in
this country become blind because of diabetic eye disease. Regular eye
exams and timely treatment could prevent up to 90% of diabetes-related
blindness; however, only 64.2% of people with diabetes received annual
dilated eye exams in 2002.
Kidney disease. About 42,813 people with diabetes develop
kidney failure each year, and over 100,000 are treated for this
condition. Treatment to better control blood pressure and blood glucose
levels could reduce diabetes-related kidney failure by about 50%.
Amputations. About 82,000 people have diabetes-related leg,
foot, or toe amputations each year. Foot care programs that include
regular examinations and patient education could prevent up to 85% of
these amputations.
Cardiovascular disease. Heart disease and stroke cause about
65% of deaths among people with diabetes. These deaths could be reduced
by 30% with improved care to control blood pressure, blood glucose, and
blood cholesterol levels.
Pregnancy complications. About 18,000 women with preexisting
diabetes and about 135,000 women with gestational diabetes give birth
each year. These women and their babies have an increased risk for
serious complications such as stillbirths, congenital malformations, and
the need for cesarean sections. Women with gestational diabetes and
their babies are also at higher risk of becoming obese and developing
diabetes later in life. These risks can be reduced with screenings and
diabetes care before, during, and after pregnancy.
Flu- and pneumonia-related deaths. Each year, 10,000–30,000
people with diabetes die of complications from flu or pneumonia. They
are roughly three times more likely to die of these complications than
people without diabetes; however, only 55% of people with diabetes get
an annual flu shot.
CDC Provides National Leadership and Builds Partnerships
CDC provides leadership and funding to diabetes prevention and
control programs nationwide. CDC also works with many partners to
provide data for public health decisions, inform the public about
diabetes, and ensure good care and education for Americans with
diabetes.
Promoting Effective State Programs
With fiscal year 2004 funding of $66.9 million, CDC provides limited
support to 26 states, 8 territories, and the District of Columbia for
capacity-building diabetes prevention and control programs. CDC provides
substantial support to 24 states for basic implementation programs. In
addition, CDC works with its partners to develop national public health
performance standards for diabetes care. Partners include the
Association of State and Territorial Health Officials, National
Association of County and City Health Officials, National Association of
Local Boards of Health, American Public Health Association, and the
Public Health Foundation.
The CDC National Diabetes Program has adopted the concept of
conducting assessments based on the 10 essential public health services
(http://www.cdc.gov/diabetes).
Results of the assessments will help to identify areas of strength and
areas for improvement needed to develop the best public health programs
for diabetes prevention and control.
Monitoring the Burden and Translating Science
Timely data and public health research are essential for
developing a better understanding of how diabetes affects different
populations and how quality of care can be improved. CDC analyzes
information from several national data sources, including the
Behavioral Risk Factor Surveillance System, and explores ways to
collect better diabetes data on groups most at risk.
To translate scientific data into higher quality care, CDC works
with many research partners, managed care organizations, and
community health centers to assess how accepted standards of
diabetes care are applied in clinical care settings. CDC and its
partners also explore population-based quality of care, examining
disparities in the quality of diabetes care and developing
strategies to improve existing care practices.
Providing Education and Sharing Expertise
The National Diabetes Education Program (NDEP), sponsored by CDC
and the National Institutes of Health (NIH), comprises a network of
more than 200 public and private partners that works to increase
awareness about diabetes and its control among health care providers
and people with or at risk for diabetes. The goals are to help
people with diabetes better manage the disease and to promote
policies that improve the quality of care provided and access to
such care. NDEP partners, including six national minority
organizations, also develop community interventions and tools to
improve diabetes care and prevention, especially for communities
with a high burden of diabetes. NDEP products are available on the
Internet (http://www.ndep.nih.gov/)
and in many different languages.
CDC also develops other resources for health professionals,
people with diabetes, and communities. For example, Diabetes
Today is a train–the–trainer program that guides health
professionals and community leaders in developing a community plan
for preventing the complications of diabetes. A Spanish version of
Diabetes Today is available, and a regional training site
serves Hawaii and the Pacific Basin.
Supporting Prevention Research
Studies suggest that the progression from prediabetes to diabetes
can be prevented or delayed. In 2001, results from two landmark
clinical trials—the Finnish Diabetes Prevention Study and the U.S.
Diabetes Prevention Program (DPP)—demonstrated that sustained
lifestyle changes that included modest weight loss and physical
activity substantially reduced progression to diabetes among older
adults who were at very high risk. Results from the DPP were so
compelling that the trial was ended a year early. The lifestyle
intervention worked equally well for men and women and all
racial/ethnic groups, and it was most effective among people aged 60
or older.
Target Populations at Risk
- Diabetes Detection Initiative. CDC is leading the
development and implementation of the Secretary’s Diabetes
Detection Initiative. This national public health program uses
social marketing and health communications strategies within
health systems and communities to find some 5 million Americans
who have type 2 diabetes but do not know it. Early diagnosis and
proper treatment of diabetes can delay or even prevent serious
diabetes-related health problems.
- Primary prevention for people most at risk. A healthy
diet and modest physical activity can help people cut their risk
for type 2 diabetes. CDC is developing methods to identify people
at high risk for diabetes, policies to help these people reduce
their risk, and public health programs that will slow the diabetes
epidemic.
- National Diabetes Prevention Center. CDC funds a center
in Gallup, New Mexico, that is working with American Indian and
Alaska Native communities to develop culturally relevant and
scientifically sound interventions to prevent complications from
diabetes.
- National Agenda for Public Health Action: A National
Public Health Initiative on Diabetes and Women’s Health offers
recommendations to help professionals, women and their families,
health care systems, work sites, communities, and schools address
the burden of diabetes among women. CDC is working with numerous
partners to carry out the plan.
- SEARCH for Diabetes in Youth. Rising rates of diabetes
among youth are a growing public health concern. CDC and NIH are
funding this 5-year, multicenter study to examine the status of
diabetes among U.S. children and adolescents.
Future Directions
CDC will continue to work with its partners to strengthen
diabetes surveillance, prevention research, interventions, and
communications. In support of Secretary of Health and Human Services
Tommy Thompson’s Steps to a HealthierUS prevention initiative
(http://www.healthierus.gov/steps),
CDC plans to increase the number of diabetes prevention and control
programs that receive basic implementation funding to put their
plans into action, expand research and surveillance activities to
address the unique needs of women and children with diabetes,
develop and carry out a national public health strategy to address
type 2 diabetes among children, and expand the activities of the
National Diabetes Education Program. |
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