1.
National Diabetes
Statistics
What is Diabetes ?
Diabetes mellitus 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.
Type 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, who need several insulin injections a day or an
insulin pump to survive. Type 1 diabetes may account for 5 percent to 10
percent 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 percent
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, American Indians, and some Asian Americans and 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 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 percent of women with gestational diabetes are found to have type 2
diabetes. Women who have had gestational diabetes have a 20 to 50 percent
chance of developing diabetes in the next 5 to 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 percent of all diagnosed cases of
diabetes.
Treatment of Diabetes
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In order to survive, people with type 1
diabetes must have insulin delivered by a pump or injections.
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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.
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Many people with diabetes also need to take
medications to control their cholesterol and blood pressure.
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Among adults with diagnosed diabetes, about
11 percent take both insulin and oral medications, 22 percent take
insulin only, 49 percent take oral medications only, and 17 percent do
not take either insulin or oral medications.
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Impaired Glucose Tolerance
and Impaired Fasting Glucose
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Impaired glucose tolerance (IGT) and
impaired fasting glucose (IFG) are considered to be prediabetic
conditions, and studies suggest that they may be reversible.
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IGT is a condition in which the
blood-glucose level is elevated (between 140 and 199 milligrams per
deciliter or mg/dL in a 2-hour oral glucose tolerance test), but is not
high enough to be classified as diabetes.
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IFG is a condition in which the fasting
blood-glucose level is elevated (between 110 and 125 mg/dL after an
overnight fast) but is not high enough to be classified as diabetes.
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Among U.S. adults 40 to 74 years of age, 16
million (15.6 percent) have IGT and 10 million (9.7 percent) have IFG.
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Prevention 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˝ hours each
week). For both sexes and all age and racial and ethnic groups, the development
of diabetes was reduced 40 to 60 percent during these studies that lasted 3 to 6
years.
Studies have also shown that medications have been successful
in preventing diabetes in some population groups. In the Diabetes Prevention
Program, a large prevention study of people at high risk for diabetes, people
treated with the drug metformin reduced their risk of developing diabetes by 31
percent. Treatment with metformin was most effective among younger, heavier
people (those 25 to 40 years of age who were 50 to 80 pounds overweight) and
less effective among older people and people who were not as overweight.
There are no known methods to prevent type 1 diabetes. Several
clinical trials are currently in progress.
Prevention of Diabetes Complications
| Research 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, for every 1 percent reduction in results of
A1C blood tests, the risk of developing microvascular diabetic complications
(eye, kidney, and nerve disease) is reduced by 40 percent.
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Blood Pressure Control
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Blood pressure control can reduce cardiovascular
disease (heart disease and stroke) by approximately 33 to 50 percent and can
reduce microvascular disease (eye, kidney, and nerve disease) by
approximately 33 percent.
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In general, for every 10 millimeters of mercury
(mm Hg) reduction in systolic blood pressure, the risk for any complication
related to diabetes is reduced by 12 percent.
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Control of Blood Lipids
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Improved control of cholesterol and lipids (for
example, HDL, LDL, and triglycerides) can reduce cardiovascular
complications by 20 to 50 percent.
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Detection and treatment of diabetic eye disease
with laser therapy can reduce the development of severe vision loss by an
estimated 50 to 60 percent.
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Comprehensive foot care programs can reduce
amputation rates by 45 to 85 percent.
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Detection and treatment of early diabetic kidney
disease can reduce the development of kidney failure by 30 to 70 percent.
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Methods
The data in this fact sheet were derived from various surveys of the
Centers for Disease Control and Prevention (CDC)—the National Health
Interview Survey (NHIS), the Third National Health and Nutrition Examination
Survey (NHANES III), the National Hospital Discharge Survey, and surveys
conducted through the Behavioral Risk Factor Surveillance System. Other data
sources include CDC’s National Vital Statistics System, the outpatient
database of the Indian Health Service (IHS), the U.S. Renal Data System of the
National Institutes of Health (NIH), and published studies. Many of the
estimates were calculated from these data sources by CDC and NIH staffs.
Estimates of the total number of people with diabetes and the prevalence of
diabetes (both diagnosed and undiagnosed) per 100 population are model-based
estimates calculated from NHIS data, NHANES III data, and census data. Age-,
race-, and sex-specific diabetes prevalence estimates from the NHIS and the
outpatient database of the IHS were applied to 2000 census estimates to
calculate the number of diagnosed cases of diabetes. The total number of
persons with diabetes and the number with undiagnosed diabetes were calculated
using the ratio of undiagnosed to total cases of 35 percent and the number of
persons with diagnosed diabetes. It was assumed there were no undiagnosed
cases under 20 years of age because most of these cases are type 1 diabetes
for which the undiagnosed period is likely to be short. Prevalence was
calculated based on the total number of people with diabetes (both diagnosed
and undiagnosed).
We acknowledge that the summary estimates reported in this
fact sheet have some variability due to the limits of the measurements and the
estimation procedures. However, the consensus of the participating organizations
is that these data are the best current estimates of the burden of diabetes.
More detail on the data sources, references, and methods is available.
Prevention of Diabetes
| Total: |
17 million people–6.2 percent
of the population – have diabetes. |
| Diagnosed: |
11.1 million people |
| Undiagnosed: |
5.9 million people |
Prevalence of Diabetes Among People
Under 20 Years of Age
About 151,000 people less than 20 years of age have diabetes.
This represents 0.19 percent of all people in this age group.
Approximately one in every 400 to 500 children and adolescents
has type 1 diabetes.
Clinic-based reports and regional studies indicate that type
two diabetes is becoming more common among American Indian, African American,
and Hispanic and Latino children and adolescents.
Prevalence of Diabetes Among People
20 Years or Older
| Age 20 years or older: |
16.9 million. 8.6 percent of all
people in this age group have diabetes.
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| Age 65 years or older: |
7 million. 20.1 percent of all people
in this age group have diabetes.
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| Men: |
7.8 million. 8.3 percent of all men have diabetes. |
| Women: |
9.1 million. 8.9 percent of all women have diabetes.
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Prevalence of
Diabetes by Race/Ethnicity Among People 20 Years or Older
| Non-Hispanic whites: |
11.4 million. 7.8 percent of all
non-Hispanic whites have diabetes. |
| Non-Hispanic blacks: |
2.8 million. 13 percent of all
non-Hispanic blacks have diabetes. On average, non-Hispanic blacks
are two times more likely to have diabetes than non-Hispanic
whites of similar age. |
| Hispanic/Latino Americans: |
2 million. 10.2 percent of all Hispanic/Latino
Americans have diabetes. On average, Hispanic/Latino Americans
are 1.9 times more likely to have diabetes than non-Hispanic
whites of similar age. Mexican Americans, the largest
Hispanic/Latino subgroup, are two times more likely to have
diabetes than non-Hispanic whites of similar age. Similarly,
residents of Puerto Rico are two times more likely to have
diagnosed diabetes than U.S. non-Hispanic whites. Sufficient data
are not available to derive more specific current estimates for
other groups. |
| American Indians and
Alaska Natives who receive care from the Indian Health Service
(IHS): |
105,000. 15.1 percent of American Indians
and Alaska Natives receiving care from IHS have
diabetes. At the regional level, diabetes is least common
among Alaska Natives (5.3 percent) and most common
among American Indians in the southeastern United States (25.7 percent)
and in certain tribes from the Southwest. On average, American
Indians and Alaska Natives are 2.6 times more likely to have
diabetes than non-Hispanic whites of similar age. |
| Asian Americans and
Native Hawaiian or other
Pacific Islanders: |
Prevalence data for diabetes among Asian
Americans and Native Hawaiians or other Pacific
Islanders are limited. Some groups within these populations are at
increased risk for diabetes. For example, data collected from 1996
to 2000 suggest that Native Hawaiians are 2.5 times more likely to
have diagnosed diabetes than white residents of Hawaii of similar
age.
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Incidence of Diabetes
New cases diagnosed per year: 1 million people aged 20 years
or older.
Deaths Among People
With Diabetes
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In 1999, approximately 450,000 deaths occurred
among people with diabetes aged 25 years and older. This
figure represents about 19 percent of all deaths in the
United States in people aged 25 years and older.
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Overall, the risk for death among people with
diabetes is about 2 times that of people without diabetes.
However, the increased risk associated with diabetes is
greater for younger people (that is, 3.6 times for people
aged 25 to 44 years versus 1.5 for those aged 65 to 74
years) and women (that is, 2.7 times for women aged 45 to 64
years versus 2 for men in that age group).
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Diabetes was the sixth leading cause of death
listed on U.S. death certificates in 1999. This is based on
the 68,399 death certificates in which diabetes was listed
as the underlying cause of death. Diabetes was listed as a
contributing cause of death on an additional 141,265 death
certificates. However, many decedents with diabetes do not
have the disease entered on their death certificate; only
about 35 to 40 percent have it listed anywhere on the
certificate and only about 10 to 15 percent have it listed
as the underlying cause of death.
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Complications Of
Diabetes
Heart Disease
| Heart disease is the leading cause of
diabetes-related deaths. Adults with diabetes have heart
disease death rates about 2 to 4 times higher than adults
without diabetes.
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Stroke
| The risk for stroke is 2 to 4 times higher
among people with diabetes.
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High Blood Pressure
| About 73 percent of adults with diabetes have
blood pressure greater than or equal to 130/80 mm Hg or use
prescription medications for hypertension.
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Blindness
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Diabetes is the leading cause of new cases of
blindness among adults 20 to 74 years old.
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Diabetic retinopathy causes from 12,000 to
24,000 new cases of blindness each ear.
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Kidney Disease
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Diabetes is the leading cause of treated
end-stage renal disease, accounting for 43 percent of new
cases.
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In 1999, 38,160 people with diabetes began
treatment for end-stage renal disease.
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In 1999, a total of 114,478 people with
diabetes underwent dialysis or kidney transplantation.
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Nervous System Disease
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About 60 to 70 percent 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.
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Severe forms of diabetic nerve disease are a
major contributing cause of lower-extremity amputations.
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Amputations
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More than 60 percent of non-traumatic
lower-limb amputations in the United States occur among
people with diabetes.
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From 1997 to 1999, about 82,000 non-traumatic
lower-limb amputations were performed each year among people
with diabetes.
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Dental Disease
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Periodontal or gum diseases are more common among
people with diabetes than among people without diabetes. Among
young adults, those with diabetes are often at twice the risk of
those without diabetes.
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Almost one third of people with diabetes
have severe periodontal diseases with loss of attachment
of the gums to the teeth measuring 5 millimeters or
more.
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Complications of Pregnancy
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Poorly controlled diabetes before
conception and during the first trimester of pregnancy
can cause major birth defects in 5 to 10 percent of
pregnancies and spontaneous abortions in 15 to 20
percent of pregnancies.
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Poorly controlled diabetes during the
second and third trimesters of pregnancy can result in
excessively large babies, posing a risk to the mother
and the child.
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Other Complications
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Uncontrolled diabetes often leads to
biochemical imbalances that can cause acute
life-threatening events, such as diabetic ketoacidosis
and hyperosmolar (nonketotic) coma.
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People with diabetes are more susceptible
to many other illnesses and, once they acquire these
illnesses, often have a worse prognosis than people
without diabetes. For example, they are more likely to
die with pneumonia or influenza than people who do not
have diabetes.
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Cost of
Diabetes in the United States
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Total (direct and indirect): $98 billion
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Direct medical costs: $44 billion
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Indirect costs: $54 billion (disability,
work loss, premature mortality)
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These data are based on an American Diabetes Association
study and are 1997 estimates of both the direct costs (cost
of medical care and services) and indirect costs (cost of
short-term and permanent disability, and premature death)
attributable to diabetes itself. This study is a
cost-of-disease study and estimates of the health-care costs
that are due specifically to diabetes.
ACKNOWLEDGEMENTS
The following organizations collaborated in compiling the
information for this fact sheet.
American Association of
Diabetes Educators
www.aadenet.org
American Diabetes Association
www.diabetes.org
Centers for Disease Control
and Prevention
www.cdc.gov/diabetes
www.cdc.gov/nchs
Centers for Medicare and
Medicaid Services
www.hcfa.gov
Department of Veterans Affairs
www.va.gov/health/diabetes
Health Resources and Services
Administration
www.hrsa.gov
Indian Health Service
www.ihs.gov
Juvenile Diabetes Research
Foundation International
www.jdrf.org
National Council of La Raza
www.nclr.org
National Diabetes Education
Program, a joint program of NIH and CDC
http://ndep.nih.gov
www.cdc.gov/diabetes
National Institute of Diabetes
and Digestive and Kidney Diseases of the National
Institutes of Health
www.niddk.nih.gov
U.S. Department of Health and
Human Services Office of Minority Health
www.omhrc.gov
Source: National Institute of Diabetes and Digestive and
Kidney Diseases. National Diabetes Statistics fact sheet:
general information and national estimates on diabetes in
the United States, 2000. Bethesda, MD: U.S. Department of
Health and Human Services, National Institutes of Health,
2002.
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Email: ndic@info.niddk.nih.gov
The National Diabetes Information Clearinghouse (NDIC)
is a service of the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK). The NIDDK is part
of the National Institutes of Health under the U.S.
Department of Health and Human Services. Established in
1978, the clearinghouse provides information about
diabetes to people with diabetes and to their families,
health-care professionals, and the public.
NDIC answers inquiries, develops and distributes
publications, and works closely with professional and
patient organizations and Government agencies to
coordinate resources about diabetes.
Publications produced by the clearinghouse are
carefully reviewed by both NIDDK scientists and outside
experts.
This e-text is not copyrighted. The clearinghouse
encourages users of this e-pub to duplicate and distribute
as many copies as desired.