1. Diabetes The Numbers Renee Crichlow MD,FAAFP
Presented by
Renee Crichlow MD,FAAFP
University of Minnesota, School of Medicine, North Memorial Family Medicine Residency Program

2. Diabetes: The Numbers The National Diabetes Education Program
Changing the Way Diabetes is Treated.

3. Diabetes Mellitus

4. What is Diabetes?
Diabetes is a group of diseases characterized by high levels of blood glucose (blood sugar)
Diabetes can lead to serious health problems and premature death
Diabetes is a group of diseases characterized by high levels of blood glucose (or blood sugar) which results from problems with insulin production, insulin action, or both.
Diabetes can lead to serious problems and complications, such as heart disease, blindness, kidney failure, lower-limb amputations, and premature death. But people with diabetes can lower the occurrence of these and other diabetes complications by controlling blood glucose (sugar) blood pressure and blood lipids.

5. Diabetes & Cardiovascular Disease
Cardiovascular disease is the leading cause of death for people with diabetes
In adults with diabetes:
68% die of heart disease or stroke
the risk for stroke is two to four times higher
67% have high blood pressure
smoking doubles the risk for heart disease
National Diabetes Fact Sheet, CDC, 2011.
Cardiovascular disease is the leading cause of death for people with diabetes.
Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.
68% of adults with diabetes die of heart disease or stroke.
The risk of stroke is 2 to 4 times higher in adults with diabetes.
67% of adults with diabetes have high blood pressure (defined as greater than or equal to 140/80 mmHg).
Smoking doubles the risk for heart disease.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

6. Diabetes Complications
Diabetes is the leading cause of:
kidney failure
48,374 people with diabetes began treatment for end stage kidney disease in 2008
new cases of adult blindness
4.2 million people with diabetes aged 40 and older had diabetic retinopathy in
nontraumatic lower-limb amputations
Over 65,000 nontraumatic lower-limb amputations were performed in people with diabetes in 2006
National Diabetes Fact Sheet, CDC, 2011.
In addition to the link between diabetes and cardiovascular disease, diabetes is the leading cause of:
Kidney failure
In 2008, 48,374 people with diabetes began treatment for end stage kidney disease.
New cases of adult blindness
In , 4.2 million people with diabetes aged 40 and older had diabetic retinopathy.
Nontraumatic lower-limb amputations
In 2006, over 65,000 nontraumatic lower-limb amputations were performed in people with diabetes.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

7. The risk of periodontal disease is two to three times higher in adults with diabetes About one-third of people with diabetes have severe periodontal disease

8. Diabetes Complications
60% to 70% of people with diabetes have mild to severe nervous system damage
Almost 30% of people with diabetes aged 40 years and older have impaired sensation in the feet
People with diabetes are twice as likely to have depression
National Diabetes Fact Sheet, CDC, 2011.
Diabetes affects many parts of the body, other complications of diabetes include:
The risk of periodontal (gum) disease is 2 to 3 times greater in adults with diabetes
About one-third of people with diabetes have severe periodontal disease - severe periodontal disease consists of loss of attachment (5 or more millimeters) of the gums to the teeth.
60% to 70% of adults with diabetes have mild to severe nervous system damage
Almost 30% of people with diabetes aged 40 years and older have impaired sensation in the feet (i.e., at least one area that lacks feeling)
People with diabetes are twice as likely to have depression as people without diabetes.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. 8

9. Common Types of Diabetes
Type 1 diabetes in adults
5% of diagnosed cases of diabetes
Type 2 diabetes in adults
90% to 95% of diagnosed cases of diabetes
National Diabetes Fact Sheet, CDC, 2011.
Type 1 diabetes is an auto-immune disease that 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. People with type 1 diabetes must take insulin every day either by injection or pump.
Type 1 diabetes accounts for 5% all diagnosed cases of diabetes in adults. Type 1 is more often diagnosed in children and young adults, although the disease can occur at any age. There is no known way to prevent type 1 diabetes.
Type 2 diabetes usually begins as insulin resistance—a disorder in which cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Insulin resistance and abnormal beta cell function may occur long before type 2 diabetes is diagnosed.
Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes in adults. It is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians and other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications. Although still rare, type 2 diabetes is being diagnosed more frequently in children and adolescents.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

10. Common Types of Diabetes
Gestational Diabetes (GDM)
diagnosed during pregnancy
5% to 10% of women with GDM are found to have diabetes, usually type 2, immediately following pregnancy
35% to 60% of women with GDM will develop diabetes in the next 10 to 20 years
affects at least 7% of pregnancies
National Diabetes Fact Sheet, CDC, 2011.
Gestational diabetes mellitus is a form of glucose intolerance diagnosed in some women during pregnancy.
5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2, immediately following pregnancy. Women who have had gestational diabetes have an increased lifelong risk – a 35 to 60% chance—of developing diabetes in the next 10 to 20 years after pregnancy. Their offspring from the pregnancies affected by GDM are at higher risk for obesity and type 2 diabetes compared to other children.
Gestational diabetes affects at least 7% and possibly as many as 18% of pregnancies in the U.S. Using new diagnostic criteria and international multiple center study of GDM found 18% of pregnancies were affected by GDM (Reference: Coustan, DR, Lowe, LP, Letzger, BE, Dyer, AR. The Hyperglycemia and Adverse Pregnancy Outcomes Study: paving the way for new diagnostic criteria for gestational diabetes. Am. J. Obstet. Gyncol. 2010; 202(6) 654 e1-6.)
Gestational diabetes is more common 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.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

11. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1994
Methodology
The percent of U.S. adults who are obese or who have diagnosed diabetes was determined by using data from the Behavioral Risk Factor Surveillance System (BRFSS, available at An ongoing, yearly, state-based telephone survey of the non-institutionalized adult population in each state, the BRFSS provides state-specific information on behavioral risk factors for disease and on preventive health practices. Respondents who reported that a physician told them they had diabetes (other than during pregnancy) were considered to have diagnosed diabetes. Self reported weight and height were used to calculate body mass index (BMI): weight in kilograms divided by the square of height in meters. A BMI greater than or equal to 30 was considered to be obese. Rates were age-adjusted using the 2000 U.S. Standard Population.

12. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1995

13. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1996

14. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1997

15. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1998

16. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
1999

17. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2000

18. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2001

19. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2002

20. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2003

21. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2004

22. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2005

23. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2006

24. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2007

25. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2008

26. Age-adjusted Percentage of U.S. Adults Who Were Obese or
Who Had Diagnosed Diabetes
2009

27. Age-adjusted Percentage of U. S
Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes
This slide is from the National Diabetes Surveillance System. These maps clearly show that the trend in diagnosed diabetes follows the obesity trend.
Centers for Disease Control and Prevention: National Diabetes Surveillance System

28. Millions of years
27 years

29. U.S. Diabetes Prevalence All Ages, 2010
25.8 million people have diabetes
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people
National Diabetes Fact Sheet, CDC, 2011.
25.8 million people have diabetes (8.3% of the U.S. population)
Of these 18.8 are diagnosed, and 7.0 million are undiagnosed. This means that one out of every four people with diabetes doesn’t know they have the disease.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

30. Estimated percentage of people aged 20 years or older with diagnosed and undiagnosed diabetes, by age group, United States,
Source: 2005–2008 National Health and Nutrition Examination Survey
3.7 percent of all people 20 through 44 years have diabetes.
13.7 percent all people 45 through 64 years have diabetes.
26.9 percent of all people 65 years and older have diabetes – that is about one out of every four older adults!
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

31. Diabetes Incidence
A total of 1.9 million new cases of diabetes were diagnosed in 2010 in the United States among people aged 20 years and older.
National Diabetes Fact Sheet, CDC, 2011.
1.9 million new cases of diabetes were diagnosed in people aged 20 or older in 2010.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

32. American Indians and Alaska Natives & Diabetes
About 16.1% aged 20 and older who are served by Indian Health Services have diagnosed diabetes
Rates vary:
5.5% of Alaska Native adults have diabetes
33.5% of American Indian adults in southern Arizona have diabetes
National Diabetes Fact Sheet, CDC, 2011.
About 16.1% of American Indians and Alaska Natives aged 20 years or older who received care from the Indian Health Service (IHS) in 2003 have diagnosed diabetes.
Rates of diabetes vary among the American Indians and Alaska Natives:
5.5% among Alaska Native adults
33.5% among American Indian adults in Southern Arizona
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

33. African Americans & Diabetes
4.9 million; 18.7% of all African Americans aged 20 and older have diagnosed and undiagnosed diabetes
Compared to non-Hispanic whites, the risk of diagnosed diabetes is 77% higher among African Americans
National Diabetes Fact Sheet, CDC, 2011.
4.9 million or 18.7% of all non-Hispanic blacks aged 20 years or older have diagnosed and undiagnosed diabetes.
Compared to non-Hispanic white adults, the risk of diagnosed diabetes is 77% higher among non-Hispanic blacks.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

34. Hispanics/Latinos & Diabetes
11.8% of all Hispanics/Latinos aged 20 years and over have diagnosed diabetes
Rates vary among groups:
Cubans & Central and South Americans 7.6%
Mexican Americans 13.3%
Puerto Ricans 13.8%
National Diabetes Fact Sheet, CDC, 2011.
11.8% of all Hispanic/Latino Americans aged 20 years or older have diabetes.
Rates vary:
Mexican Americans 13.3%
Cubans and Central and South Americans 7.6%
Puerto Ricans 13.8%
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

35. Asian Americans and Pacific Islanders & Diabetes
8.4% of all Asian Americans have diagnosed diabetes
Prevalence data for diabetes among Pacific Islanders is limited
National Diabetes Fact Sheet, CDC, 2011.
8.4% of all Asian Americans have diagnosed diabetes
The prevalence of diabetes is not available for Pacific Islanders. It is important to note that the absence of data for Pacific Islanders does not mean they are not affected by diabetes.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

36. Every 24 Hours… 5225 new cases of diabetes are diagnosed
180 non-traumatic lower limb amputations are performed
133 people begin treatment for end-stage renal disease
634 people die of diabetes or diabetes is a contributing cause of death
National Diabetes Fact Sheet, CDC, 2011.
The following are rough approximations to help emphasize what diabetes prevalence numbers mean to people with diabetes each and every day.
Approximately,
5225 new cases of diabetes diagnosed
180 people with diabetes will have an amputation
133 people with diabetes will begin treatment for end-stage renal disease
634 people die from diabetes or diabetes is a contributing cause of death
Approximations were determined using information from the following reference:
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

37. Preventing Diabetes Complications
Blood glucose control
Blood pressure control
Blood lipid control
Preventive care practices for eyes, kidneys, feet, teeth, and gums
National Diabetes Fact Sheet, CDC, 2011.
People with diabetes and their health care providers can reduce the occurrence of diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner.
Studies have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results (i.e., from 8.0% to 7.0%) reduces the risk of microvascular complications—such as eye, kidney, and nerve diseases—by 40%.
Blood pressure control reduces the risk of heart disease or stroke among persons with diabetes by 33% to 50%, and the risk of microvascular complications by about 33%. In general, each 10 mm Hg drop in systolic blood pressure, the risk of any complication of diabetes is reduced by 12%!
Improved blood lipids – improved control of LDL cholesterol can reduce cardiovascular complications by 20% to 50%.
Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.
Comprehensive foot care programs can reduce amputation rates by 45% to 85%.
Detecting and Treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30% to 70%.
Reference
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

41. Questions? Renee Crichlow MD, FAAFP
North Memorial Family Medicine Residency Program
“Where Excellence Meets Caring”