Diabetes in america 2nd edition publication date

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Ask the Reimbursement Expert. Entrepreneurial Diabetes Educator. Kenny, Ronald E. Aubert, and Linda S. Cowie and Mark S. Cowie and Maureen I. Dorman, Bridget J. McCarthy, Leslie A. Geiss, William H. Herman, and Philip J. Nelson, William C. Minority women, women who are obese, women with a family history of diabetes, and women who have had gestational diabetes in a previous pregnancy are at higher risk than other women for developing gestational diabetes.

Strict glycemic control and management of women with gestational diabetes is necessary to prevent birth complications in the developing infant.

Prediabetes is a precursor condition to diabetes in which a person has elevated blood glucose levels but does not meet diagnostic criteria for diabetes. People with prediabetes can have impaired fasting glucose or impaired glucose tolerance, or both. This finding clearly indicates that there is a large population that is at risk for developing diabetes within a relatively short time frame.

In , an estimated 1. Although these sources provide accurate self-reported data about diabetes for the United States, they have been limited to reporting the prevalence of diagnosed diabetes because they assess whether a person has been told by a physician or health care professional that he or she has diabetes.

This limitation, then, does not allow for measurement of undiagnosed diabetes ie, those people who have diabetes but have not yet been diagnosed by a physician. The National Health and Nutrition Examination Surveys NHANES are the only nationally representative surveys that have taken blood samples in addition to survey questions and, therefore, can estimate both diagnosed and undiagnosed diabetes. Of these, Diabetes mellitus is now approaching epidemic proportions.

In , the age-adjusted prevalence rate was 2. The overall prevalence of diagnosed diabetes increases with age and the rate of increase over time has been largest in people over 65 years of age.

Age-adjusted prevalence rates for diagnosed diabetes have consistently been higher among African Americans and Hispanics compared with whites. African-American women have the highest prevalence of diabetes compared with other racial or ethnic and gender groups. In , the age-adjusted prevalence rate for diagnosed diabetes was 8. Although the pathogenesis of diabetes is complex, a number of factors that increase the risk for the disease have been identified.

Risk factors for type 1 diabetes include family history, race with whites at higher risk than other racial or ethnic groups , and certain viral infections during childhood. Risk factors for type 2 diabetes are more diverse; some are modifiable, and others are not. Nonmodifiable risk factors for type 2 diabetes include age, race or ethnicity, family history genetic predisposition , history of gestational diabetes, and low birth weight.

Diabetes incidence and prevalence increases with age. In , the Centers for Disease Control and Prevention reported that the prevalence of diabetes among people aged 20 years or older was African Americans are more likely to develop diabetes than whites.

Little difference exists by sex. Genetic factors also play a role, but nongenetic or lifestyle risk factors such as diet and physical activity appear to be the primary culprits. Modifiable or lifestyle risk factors include increased body mass index BMI , physical inactivity, poor nutrition, hypertension, smoking, and alcohol use, among others. Consistent findings from various studies show that lower levels of physical activity increase a person's risk for diabetes.

Total caloric intake, as well as specific components of diet such as refined carbohydrates and fats, have been linked to diabetes development. Moderate alcohol use may reduce the risk for developing diabetes, 10 but smoking has been shown to be an independent risk factor for diabetes. Psychosocial factors such as depression, increased stress, lower social support, and poor mental health status also are associated with an increased risk for the development of diabetes.

In , diabetes was the sixth leading cause of death, 2 with 73, death certificates listing diabetes as the underlying cause of death and an additional , death certificates listing diabetes as a contributing cause of death. Diabetes is likely to be underreported as a cause of death due to the many complications associated with diabetes that ultimately cause death. Overall, the risk of death among people with diabetes is almost twice that of people of similar age who do not have diabetes. From death certificate data, it appears that age-adjusted death rates for African Americans and Hispanic Americans are similar to the rates of whites.

There is general agreement about the distribution of causes of death in type 2 diabetes. The risk for cardiovascular disease mortality is 2 to 4 times higher in people with diabetes than in people who do not have diabetes. There are several risk factors that increase the risk for dying in people with diabetes.

In a large intervention trial, men with diabetes were more likely to die as a result of cardiovascular disease when they had the conventional risk factors of elevated serum cholesterol, elevated systolic blood pressure, and cigarette smoking.

Diabetes can affect many different organ systems in the body and, over time, can lead to serious complications. Complications from diabetes can be classified as microvascular or macrovascular. Microvascular complications include nervous system damage neuropathy , renal system damage nephropathy and eye damage retinopathy. Peripheral vascular disease may lead to bruises or injuries that do not heal, gangrene, and, ultimately, amputation.

Figure 2 shows the prevalence of the most common diabetes complications among people with type 2 diabetes. Other complications include dental disease, reduced resistance to infections such as influenza and pneumonia, and macrosomia and other birth complications among pregnant women with diabetes.

Although the types of complications are similar for type 1 and type 2 diabetes patients, the frequency or timing of occurrence can vary. The types and prevalence of the most common diabetes complications are discussed further in more detail with specific attention to differences between complications of type 1 versus type 2 diabetes. In addition, as described above, mortality rates due to heart disease are 2 to 4 times higher among people with diabetes compared with those without diabetes.

People with diabetes also are 2 to 4 times more likely to develop stroke than people without diabetes. The role of hyperglycemia in cardiovascular complications among persons with diabetes is not clear. Risk factors for cardiovascular disease among people with diabetes are similar to those for people without diabetes and include hypertension, hypercholesterolemia, and smoking.

It appears, however, that the presence of even one of these risk factors leads to poorer outcomes among people with diabetes compared with those without diabetes. It appears, however, that these decreases have slowed since the late s. Peripheral arterial disease PAD, also referred to as peripheral vascular disease [PVD] , is caused by the narrowing of blood vessels that carry blood to the arms, legs, stomach, and kidneys.

In people with diabetes, the risk for PAD is increased by age, duration of diabetes, and presence of neuropathy. Other factors associated with cardiovascular disease, such as C-reactive protein levels and homocysteine levels, also are associated with an increased risk for PAD.

Data on PAD trends come from hospital discharge data from the National Center for Health Statistics and indicate that the hospital discharge rates for PAD as the primary diagnosis have decreased steadily since The age-adjusted hospital discharge rate for PAD peaked at 7.

In addition, discharge rates for PAD were higher in men than in women and increased with increasing age. Diabetic retinopathy is the most common microvascular complication among people with diabetes and results in more than 10, new cases of blindness per year.

In addition, retinopathy is associated with prolonged hyperglycemia, it is slow to develop, and there is some evidence that it can begin to develop as early as 7 years before clinical diagnosis of type 2 diabetes. Prevalence rates in women with diabetes have been falling throughout this time period, whereas rates in men with diabetes have stayed fairly constant since There appears to be no difference between racial groups in the prevalence of visual impairment during the period — Duration of diabetes is the most significant predictor of visual impairment among people with type 2 diabetes.

Annual dilated eye examinations are recommended for all patients with diabetes. Diabetic nephropathy is defined as persistent proteinuria more than mg of protein or mg of albumin per 24 hours in patients without urinary tract infection or other diseases causing the proteinuria. In patients with type 1 diabetes, development of clinical nephropathy is a relatively late event; however, in patients with type 2 diabetes, diabetic proteinuria may be present at diagnosis. The incidence of diabetic nephropathy in patients with type 2 diabetes is low during the first 10 to 15 years of diabetes duration, after which it increases rapidly to a maximum at about 18 years of duration, and then declines.

The etiology of diabetic nephropathy is poorly understood. Several risk factors are involved, some of which are modifiable and others are not. Metabolic regulation is one of the key modifiable risk factors for development of diabetic nephropathy. In people with either type 1 or type 2 diabetes, strict metabolic control leads to a significant reduction in the risk of developing microalbinuria and the risk of progression to persistent proteinuria.

Increasing blood pressure and hypertension also are associated with an increased risk of progression of diabetic renal disease. Other risk factors, including cigarette smoking, obesity, anemia, and genetic factors, also have been suggested. People with type 2 diabetes and diabetic nephropathy are at increased risk for developing many other diabetic complications.

The renal-retinal syndrome has been known for years and refers to the presence of both types of diseases at the same time. People with diabetes and nephropathy also are more likely to develop coronary heart disease and stroke compared with patients with diabetes without nephropathy. People with diabetes and nephropathy also are more likely to die from macrovascular disease, as described above.

Overall, the incidence of nephropathy has declined in recent decades, due to improvements in the management of people with diabetes to promote tight control of glycemia as well as improved control of hypertension.

For example, comparison of 4 cohorts of patients with type 1 diabetes whose disease was diagnosed between and showed that the cumulative incidence of diabetic nephropathy over the following 20 years were lowest in the most recently diagnosed cohorts.

Chronic sensorimotor distal symmetric polyneuropthy is the most common form of DPN. The typical presentation of polyneuropathy is a gradual onset of sensory impairment, including burning and numbness in the feet. The onset is so gradual that the disease may go undetected for years. Diabetic peripheral neuropathy leads to a number of impairments and functional limitations.

Individuals with DPN are at high risk for foot ulceration and subsequent lower-extremity amputation. Also see the articles in this issue by Mueller et al, 64 Sinacore et al, 65 and Hilton et al 66 about neuropathic skin, bone, and muscle in people with diabetes mellitus. Data from the National Center for Health Statistics indicate that the hospital discharge rates for DPN have steadily increased from to The age-adjusted hospital discharge rate for DPN increased from 4. Discharge rates were higher in men than in women and higher for people younger than 45 years of age compared with those who were 45 years of age and older.

Nontraumatic lower-extremity amputations LEAs are a devastating complication of diabetes. People with diabetes are 10 to 20 times more likely to have LEAs than those without diabetes. The annual number of diabetes-related hospital discharges with LEA increased from about 33, in to 84, in In , there were about 75, diabetes-related hospital discharges with LEAs. After reaching a peak in , LEA rates decreased slightly.

In , the age-adjusted LEA rate was 4. There are several risk factors for LEA, including increasing age, being male, being African American, having peripheral neuropathy, and having chronic ulcers. There is still controversy concerning the benefit of primary minor amputation versus primary major amputation. The advantage of primary minor amputation is that there is a lower risk for new major amputation and better rehabilitation potential.