Diabetes Facts and Figures Copyright © 1997 American Diabetes Association The Dangerous Toll of DiabetesDirect and Indirect Costs Profile of the DiagnosedDiabetes Among African Americans Diabetes Among HispanicsDiabetes Among Native Americans Diabetes in YouthDiabetes and Seniors The Dangerous Toll Of Diabetes There are 15.7 million people or 5.9% of the population in the United States who have diabetes. While an estimated 10.3 million have been diagnosed, unfortunately, 5.4 million people are not aware that they have the disease. Each day approximately 2,200 people are diagnosed with diabetes. About 798,000 people will be diagnosed this year. Diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States. Based on death certificate data, diabetes contributed to more than 187,000 deaths in 1995. Diabetes is a chronic disease that has no cure. Diabetes is a Silent Killer Many people first become aware that they have diabetes when they develop one of its life-threatening complications. Blindness. Diabetes is the leading cause of new cases of blindness in people ages 20-74. Each year, from 12,000 to 24,000 people lose their sight because of diabetes. Kidney Disease. Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of new cases. In 1995, approximately 27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. Nerve Disease and Amputations. About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15-40 times greater for a person with diabetes. Each year, more than 56,000 amputations are performed among people with diabetes. Heart Disease and Stroke. People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths (more than 77,000 deaths due to heart disease annually). And, they are 2 to 4 times more likely to suffer a stroke. Direct and Indirect Costs of Diabetes Diabetes is one of the most costly health problems in America. Health care and other costs directly related to diabetes treatment, as well as the costs of lost productivity, run $92 billion annually. Some estimates run as high as $138 billion which includes all health care costs incurred by people with diabetes. What is Diabetes? Diabetes is a 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 life. The cause of diabetes is a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are two major types of diabetes: Type 1. An autoimmune disease in which the body does not produce any insulin, most often occurring in children and young adults. People with type 1 diabetes must take daily insulin injections to stay alive. Type 1 diabetes accounts for 5-10 percent of diabetes. Type 2. A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. It is the most common form of the disease. Type 2 diabetes accounts for 90-95 percent of diabetes. Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans, and a greater prevalence of obesity and a sedentary lifestyle. Gestational diabetes develops in 2 % to 5% of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. "Other specific types" of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Who is at Greater Risk for Type 1 Diabetes? Siblings of people with type 1 diabetes Children of parents with type 1 diabetes Who is at Greater Risk for Type 2 Diabetes? People over age 45 People with a family history of diabetes People who are overweight People who do not exercise regularly People with low HDL or high triglycerides Certain racial and ethnic groups (e.g., African Americans, Hispanic Americans, Asian & Pacific Islanders, and Native Americans) Women who had gestational diabetes, a form of diabetes occurring in 2-5 percent of all pregnancies or who have had a baby weighing 9 pounds or more at birth. Impaired Glucose Homeostasis Impaired Glucose Homeostasis (or metabolism) refers to a condition in which blood sugar levels are higher than normal but not high enough to be classified as diabetes. There are two categories that are considered risk factors for future diabetes and cardiovascular disease: Impaired Glucose Tolerance (IGT) when results of a 2-hour oral glucose tolerance test are between 140 to 199 mg/dl. IGT is a major risk factor for type 2 diabetes and is present in about 11 percent of adults, or approximately 20 million Americans. About 40-45 percent of persons age 65 years of age or older have either type 2 diabetes or IGT. Impaired Fasting Glucose (IFG) when results of an 8-hour fasting plasma glucose test are greater than 110 but less than 126 mg/dl. Type 2 diabetes is more common among these ethnic groups: African Americans. African Americans are 1.7 times as likely to have type 2 diabetes as the general population. An estimated 2.3 million African Americans, or 10.8%, have diabetes. Hispanic Americans. Hispanic Americans are almost twice as likely to have type 2 diabetes. For example, diabetes affects 1.2 million or 10.6% of the Mexican American population. Native Americans. Overall prevalence of type 2 diabetes in Native Americans is 12.2% vs. 5.2% of the general population. In some tribes, 50% of the population has diabetes. Warning Signs of Diabetes Type 1 Diabetes:Type 2 Diabetes: · Frequent urination· Any of the type 1 symptoms · Unusual thirst · Frequent infections · Extreme hunger· Blurred vision · Unusual weight loss · Cuts/bruises that are slow to heal · Extreme fatigue· Tingling/numbness in the hands or feet · Irritability· Recurring skin, gum or bladder infections * Often people with type 2 diabetes have no symptoms. Return to Top Direct and Indirect Costs of Diabetes The total annual economic cost of diabetes in 1997 was estimated to be $98 billion dollars. That includes $44.1 billion in direct medical and treatment costs and $54 billion for indirect costs attributed to disability and mortality. In 1997, total health expenditures incurred by people with diabetes amounted to $77.7 billion, including health care costs not resulting from diabetes. The per capita costs of health care for people with diabetes amounted to $10,071 while health care costs for people without diabetes amounted to $2,699 in 1997. Direct Costs of Diabetes: Estimated at $44.1 billion in 1997. Represents 5.8 percent of total personal health-care expenditures in the U.S.; however, diagnosed diabetes patients account for only 3.8 percent of the total U.S. civilian population. Approximately $27.5 billion was spent for inpatient hospital care and $5.5 billion for nursing home care. Diabetes-related hospitalizations totaled 13.9 million days in 1997. Rates of outpatient care were highest for physician office visits, which included 30.3 million visits to treat persons with diabetes. The mean length of stay for hospitalization was 5.4 days. Indirect Costs of Diabetes: Estimated to be $54 billion in 1997. Disability costs amounted to $37.1 billion and mortality amounted to approximately $16.9 billion. In 1997, diabetes accounted for a loss of nearly 88 million disability days. Of those, over 14 million workloss days from jobs outside the home were attributable to daibetes in 1997. A total of 74,927 workers were reported to be permanently disabled because of diabetes in 1997. On average, persons with diabetes age 18-64 lost 8.3 days from work as compared with 1.7 days for persons without diabetes. Based on death certificate data, diabetes was the underlying cause of death for more than 187,000 people in 1995. Return to Top Profile Of The Diagnosed There are 15.7 million people in the United States who have diabetes. There are two main types of diabetes. Type 1, which usually occurs during childhood or adolescence, and type 2, the most common form of the disease, usually occurring after age 45. What is type 1 (immune-mediated) diabetes? Type 1 (formerly known as insulin dependent) diabetes is a disease which results from the body's failure to produce insulin -- the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. There are two forms of type 1. Immune-mediated diabetes mellitus results from an automimmune process in which the body's immune system attackes and destroys the insulin producing cells of the pancreas. Since glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death. The second, Idiopathic type 1, refers to rare forms of the disease that have no known cause. People with type 1 diabetes must take daily insulin injections to stay alive. There are an estimated 500,000 to 1 million people with type 1 diabetes in the United States today. The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood. Peak incidence occurs during puberty, around 10 to 12 years of age in girls and 12 to 14 years of age in boys.z The symptoms for type 1 diabetes can mimic the flu in children. Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1diabetes have about a 10% chance of developing the disease by age 50. The identical twin of a person with type 1 diabetes has a 25 to 50 percent chance of developing type 1 diabetes. There is a higher incidence of diabetes in whites than in other racial groups. What is type 2 diabetes? Type 2 diabetes results from the body's inability to make enough or properly use insulin. The underlying problem is insulin resistance, with some degree of insulin deficiency. Often type 2 diabetes can be controlled through losing weight, improved nutrition and exercise alone, but sometimes these are not enough and either oral medications and/or insulin must be used. Of the nearly 16 million Americans with diabetes, 90-95% (14.9 million) have type 2 diabetes. Of these, roughly a third are unaware they have the disease. People with type 2 diabetes often develop the disease after age 45, but are not aware they have diabetes until severe symptoms occur or they are treated for one of its serious complications. The risk for type 2 diabetes increases with age. Nearly 18.4% of the United States population between 65 and 74 years of age has diabetes. Studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported. What are the other types of diabetes? Gestational diabetes is a temporary form of insulin resistance that usually occurs halfway through a pregnancy as a result of excessive hormone production in the body, or the pancreas’ inability to make the additional insulin that is needed during some pregnancies in women with no previous history of type 1 or type 2 diabetes. Gestational diabetes usually goes away after pregnancy, but women who have had gestational diabetes are at an increased risk for later developing type 2 diabetes. Researchers have identified a small percentage of diabetes cases that result from specific genetic syndromes, surgery, chemicals, drugs, malnutrition, infections, viruses and other illnesses. What are the complications of diabetes? With its complications, diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States. Each year, at least 180,000 people die as a result of diabetes and its complications. Blindness due to diabetic retinopathy. Each year 12,000 to 24,000 people lose their sight because of diabetes. Diabetes is the leading cause of new blindness in people 20-74 years of age. Kidney Disease due to diabetic nephropathy. Ten to twenty-one percent of all people with diabetes develop kidney disease. Diabetic nephropathy is the most common cause of end-stage renal disease, a condition where the patient requires dialysis or a kidney transplant in order to live. Heart Disease and Stroke. People with diabetes are 2 to 4 times more likely to have heart disease (more than 77,000 deaths due to heart disease annually). Heart disease death rates are also 2 to 4 times as high as adults without diabetes. And, people with diabetes are 2 to 4 times more likely to suffer a stroke. Nerve Disease and Amputations. About 60-70% of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15-40 times greater for a person with diabetes. Each year, 56,200 people lose their foot or leg to diabetes. Impotence due to diabetic neuropathy or blood vessel blockage. Impotence afflicts approximately 13% of men who have type 1 diabetes and 8% of men who have type 2 diabetes. It has been reported that men with diabetes, over the age of 50, have impotence rates as high as 50-60%. Return to Top Diabetes Among African Americans How Does Diabetes Affect African Americans? Approximately 2.3 million or 10.8% of all African Americans have diabetes, however, half of them do not know it. With its complications -- blindness, kidney failure, amputations, heart attack and stroke -- diabetes is the seventh leading cause of death (sixth leading cause of death by disease) in the United States. Diabetes is a chronic disease that has no cure. Prevalence African Americans are 1.7 times more likely to have diabetes than non-Hispanic whites. Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes. One in four African American women over 55 years of age has diabetes. African Americans and Diabetic Complications African Americans experience higher rates of at least three of the serious complications of diabetes: blindness, amputation and end stage renal disease (kidney failure). Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. African Americans are twice as likely to suffer from diabetes-related blindness. Diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year 56,000 people lose their foot or leg to diabetes. Among people with diabetes, African Americans are 1.5 to 2.5 times more likely to suffer from lower limb amputations. Ten to twenty-one percent of all people with diabetes develop kidney disease. In 1995, 27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. African Americans with diabetes are 2.6 to 5.6 times more likely to suffer from kidney disease with more than 4,000 new cases of end stage renal disease each year. What is Needed? In ideal circumstances, African Americans with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes. Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their health care team. People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels, as close to the normal range as is possible for them. Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient. Return to Top Diabetes Among Hispanics How Does Diabetes Affect Hispanic Americans? Prevalence Approximately 24% of Mexican Americans and 26% of Puerto Ricans between the ages of 45-74 have diabetes. Nearly 16% of Cuban Americans between the ages of 45-74 have diabetes. The prevalence of type 2 diabetes is 2-4 times higher in Hispanics than non-Hispanic whites. Hispanic Americans and Diabetic Complications Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. The prevalence of diabetic retinopathy in Mexican Americans is 32-40%. Ten to twenty-one percent of all people with diabetes develop kidney disease. In 1992, 19,800 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. Among people with diabetes, Mexican Americans are 4.5 to 6.6 times more likely to suffer from end stage renal disease. What is Needed? In ideal circumstances, Hispanic Americans with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes. Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their health care team. People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels, as close to the normal range as is possible for them. Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient. Return to Top Diabetes Among Native Americans How Does Diabetes Affect Native Americans? Prevalence Prevalence of type 2 diabetes among Native Americans in the United States is 12.2% for those over 19 years of age. One tribe, the Pimas of Arizona, have the highest rate of diabetes in the world. About 50% of Pimas between the ages of 30 and 64 have diabetes. Today, diabetes has reached epidemic proportions among Native Americans. Complications from diabetes are major causes of death and health problems in most Native American populations. Native Americans and Diabetic Complications The serious complications of diabetes are increasing in frequency among Native Americans. Of major concern are increasing rates of kidney failures, amputations and blindness. Ten to twenty-one percent of all people with diabetes develop kidney disease. In 1995, 27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. Among people with diabetes, the rate of diabetic end stage renal disease is six times higher among Native Americans. Diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year 54,000 people lose their foot or leg to diabetes. Amputation rates among Native Americans are 3-4 times higher than the general population. Diabetic retinopathy is a term used for all abnormalities of the small blood vessels of the retina caused by diabetes, such as weakening of blood vessel walls or leakage from blood vessels. Diabetic retinopathy occurs in 18% of Pima Indians and 24.4% of Oklahoma Indians. What is Needed? In ideal circumstances, Native Americans with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes. Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their health care team. People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels, as close to the normal range as is possible for them. Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient. Return to Top Diabetes In Youth What is diabetes? There are 15.7 million people (5.9% of the population) in the United States who have diabetes. Diabetes is actually a general term for a number of separate but related disorders. Type 1 diabetes results from the body's failure to produce insulin -- the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. Type 1 diabetes usually begins during childhood. Diabetes is a chronic disease that has no cure. It is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States; this year, more than 180,000 will die from diabetes and its related complications. There are an estimated 500,000 to 1 million people with type 1 diabetes in the United States today. How are young people affected? The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood. Peak incidence occurs during puberty, around 10 to 12 years of age in girls and 12 to 14 years of age in boys. Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1 diabetes have about a 10% chance of developing the disease by age 50. The identical twin of a person with type 1 diabetes has a 25-50% higher chance of developing type 1 diabetes than a child in an unaffected family. There is a higher incidence of type 1 diabetes in whites than in other racial groups. The symptoms for type 1 diabetes can mimic the flu in children. What are the complications of diabetes? The complications of diabetes include heart disease, stroke, vision loss/blindness, amputation and kidney disease. Cardiovascular disease caused by atherosclerosis (excess buildup on the inner wall of a large blood vessel, restricting the flow of blood) accounts for approximately 25 percent of deaths among patients with onset of diabetes before 20 years of age. Blindness due to diabetic retinopathy. Diabetic retinopathy is a more important cause of visual impairment in younger-onset people than in older-onset people. Males with younger-onset diabetes develop retinopathy more rapidly than females with younger-onset diabetes. Kidney disease due to diabetic nephropathy. Ten to twenty-one percent of all people with diabetes develop kidney disease. Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD), a condition where the patient requires dialysis or a kidney transplant in order to live. In people with type 1 diabetes who develop proteinuria (protein in the urine), ESRD or death usually follows after about 5-10 years. Diabetic ketoacidosis (DKA) is one of the most serious outcomes of poorly controlled diabetes, and primarily occurs in type 1 individuals. DKA is marked by high blood glucose levels along with ketones in the urine. DKA is responsible for about 10 percent of diabetes-related deaths in individuals with diabetes under age 45. Return to Top Diabetes And Seniors What is diabetes? Diabetes is a disease that affects the body’s ability to produce or respond to insulin, a hormone that allows blood glucose (blood sugar) to enter the cells of the body and be used for energy. Diabetes falls into two main categories: type 1, which usually begins during childhood or adolescence, and type 2, the most common form of the disease, usually occurring after age 45. Diabetes is a chronic disease that has no cure. Diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States; this year, more than 180,000 will die from the disease and its related complications. Studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported. How are seniors affected? Diabetes prevalence increases with age. Approximately half of all diabetes cases occur in people older than 55 years of age. The risk for type 2 diabetes increases with age. Nearly 18.4% of the United States population or 6.3 million people age 65 and older have diabetes. People with diabetes represent 18% of all nursing home residents and tend to be younger than non-diabetic residents. What are the complications of diabetes? The complications of diabetes include heart disease, stroke, vision loss/blindness, amputation and kidney disease. Evidence of coronary heart disease is present in 7.5 to 20 percent of people with diabetes over age 45 and the prevalence increases with age. Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years of age. People with diabetes who are over 65 years of age are twice as likely to be hospitalized for kidney infections compared with those without diabetes.   How do you prevent or delay diabetes? It may be possible to prevent or delay the onset of type 2 diabetes by reducing lifestyle risk factors through weight loss and increased physical activity. A study sponsored by the National Institutes of Health (NIH), and partially funded by the American Diabetes Association, called the "Diabetes Prevention Program" is underway now to test this hypothesis. What is needed for seniors with diabetes? In ideal circumstances, people with diabetes will have their disease under good control and have access to quality diabetes care including frequent monitoring by a health care team knowledgeable in the management of diabetes. Access to quality treatment is important. People with diabetes need affordable health care. As of July 1, 1998, Medicare will reimburse all patients with diabetes, regardless of insulin treatment, for the cost of blood glucose monitors and testing strips and non-hospital based diabetes education as provided by a certified provider. Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring this disease serves the best interests of the patient. Patient education is critical. People with diabetes can reduce their risk for complications if they are educated about their disease, learn and practice the skills necessary to better control their blood glucose levels, and receive regular checkups from their health care team. People with diabetes, with the help of their health care providers, should set goals for better control of blood glucose levels as close to the normal range as is possible for them. 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