Diabetes is a group
of diseases characterized by high levels of blood glucose resulting
from defects in insulin production, insulin action, or both. Insulin
is a hormone that is needed to convert sugar, starches and other food
into energy needed for daily life. The cause of diabetes continues to
be a mystery, although both genetics and environmental factors such
as obesity and lack of exercise appear to play roles. 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
million people in the United States, or 6.2% of the population, have
diabetes. While an estimated 11.1 million have been diagnosed, unfortunately,
5.9 million people (or one-third) are unaware that they have the disease.
are three major types 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% to 10% of all diagnosed cases of diabetes. Risk factors
for type 1 diabetes include autoimmune, genetic, and environmental factors.
diabetes was previously called non-insulin-dependent diabetes
mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account
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 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, Native
Americans, 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.
- Pre-diabetes is a condition that occurs when a person's blood glucose
levels are higher than normal but not high enough for a diagnosis of
type 2 diabetes. It is estimated that at least 16 million Americans
have pre-diabetes, in addition to the 17 million with diabetes.
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 Native Americans.
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. Gestational diabetes affects about 4% of all pregnant women
- about 135,000 cases in the United States each year. 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.
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% of all diagnosed cases of diabetes.
information and national estimates on diabetes in the United States,
New cases diagnosed
per year : 1 million people aged 20 years or older.
among people with diabetes
In 1999, approximately
450,000 deaths occurred among people with diabetes aged 25 years and
older. This figure represents about 19% of all deaths in the United
States in people aged 25 years and older.
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 25-44
years versus 1.5 for those aged 65-74 years) and women (that is, 2.7
times for women aged 45-64 years versus 2.0 for men in that age group).
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% have it listed anywhere on
the certificate and only about 10% to 15% have it listed as the underlying
cause of death.
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
The risk for stroke
is 2 to 4 times higher among people with 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.
Diabetes is the
leading cause of new cases of blindness among adults 20-74 years old.
causes from 12,000 to 24,000 new cases of blindness each year.
Diabetes is the
leading cause of treated end-stage renal disease, accounting for 43%
of new cases.
In 1999, 38,160
people with diabetes began treatment for end-stage renal disease.
In 1999, a total
of 114,478 people with diabetes underwent dialysis or kidney transplantation.
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.
Severe forms of
diabetic nerve disease are a major contributing cause of lower-extremity
More than 60% of
nontraumatic lower-limb amputations in the United States occur among
people with diabetes.
From 1997 to 1999,
about 82,000 nontraumatic lower-limb amputations were performed each
year among people with diabetes.
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.
of people with diabetes have severe periodontal diseases with loss of
attachment of the gums to the teeth measuring 5 millimeters or more.
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.
diabetes during the second and third trimesters of pregnancy can result
in excessively large babies, posing a risk to the mother and the child.
often leads to biochemical imbalances that can cause acute life-threatening
events, such as diabetic ketoacidosis and hyperosmolar (nonketotic)
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.
In order to survive,
people with type 1 diabetes must have insulin delivered by a pump or
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.
Many people with
diabetes also need to take medications to control their cholesterol
and blood pressure.
Among adults with
diagnosed diabetes, about 11% take both insulin and oral medications,
22% take insulin only, 49% take oral medications only, and 17% do not
take either insulin or oral medications.
tolerance and impaired fasting glucose
tolerance (IGT) and impaired fasting glucose (IFG) are considered to
be prediabetic conditions, and studies suggest that they may be reversible.
IGT is a condition
in which the blood sugar level is elevated (between 140 and 199 milligrams
per deciliter or mg/dL in a 2-hour oral glucose tolerance test), but
not high enough to be classified as diabetes.
IFG is a condition
in which the fasting blood sugar level is elevated (between 110 and
125 mg/dL after an overnight fast) but is not high enough to be classified
Among U.S. adults
40-74 years of age, 16.0 million (15.6%) have IGT and 10.0 million (9.7%)
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 1/2 hours each week). For both
sexes and all age and racial and ethnic groups, the development of diabetes
was reduced 40% to 60% 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%. Treatment with metformin was most effective among younger, heavier
people (those 25-40 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
of diabetes complications
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% reduction in A1C, the risk of developing microvascular diabetic
complications (eye, kidney and nerve disease) is reduced by 40%.
Blood pressure control
Blood pressure control
can reduce cardiovascular disease (heart disease and stroke) by approximately
33% to 50% and can reduce microvascular disease (eye, kidney, and nerve
disease) 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
of cholesterol and lipids (for example, HDL, LDL, and triglycerides)
can reduce cardiovascular complications by 20% to 50%.
Preventive care practices for eyes, kidneys, and feet
Detection and treatment
of diabetic eye disease with laser therapy can reduce the development
of severe vision loss by an estimated 50% to 60%.
care programs can reduce amputation rates by 45% to 85%.
Detection and treatment
of early diabetic kidney disease can reduce the development of kidney
failure by 30% to 70%.
estimates on diabetes
The data in this
fact sheet were derived from various surveys of the Centers for Disease
Control and Prevention (CDC) [i.e., 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], C 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 staff.
Estimates of the
total number of persons 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-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% 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).
Cost estimate 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
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, it is the consensus opinion of the participating organizations
that they are the best current estimates of the burden of diabetes.
More detail on the data sources, references, and methods are available
following information has been taken from the American Diabetes Association.
All the following information is correct to the best of our knowledge,
but should not substitute for medical care and information provided
by your doctor.