April 17, 2014
News Review From Harvard Medical School -- Related Health Problems Drop for Diabetics
Americans with diabetes are much less likely to develop further health problems than they were 20 years ago, a new study finds. But the actual number of people with diabetes has more than tripled. The study used data from several national surveys and databases. It found that the number of people with diabetes jumped from 6.5 million in 1990 to 20.7 million in 2010. About 95% of the cases were type 2 diabetes. This type is closely related to obesity. Diabetics are 6 times as likely to develop kidney disease as people without the disease. They are 10 times as likely to have an amputation. But rates of these and other health problems among diabetics have dropped dramatically since 1990, the study found. Heart attack rates declined nearly 70%. Deaths from extremely high blood sugar dropped 65%. Rates of amputation (leg or foot) and stroke fell about 50% each. The risk of end-stage kidney disease is down 28%. Researchers said better treatments have made a big difference in preventing these other health problems. Education on self-care also has helped, they said. The New England Journal of Medicine published the study. HealthDay News wrote about it April 16.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Diabetes has been in the news a lot in recent years. And nearly all of that news has been bad.
- The rising obesity rate has led to a dramatic increase in type 2 diabetes. This is the type that is strongly linked with excess weight. Type 2 diabetes accounts for 95% of diabetes cases.
- Once nearly unheard of, type 2 diabetes is being diagnosed in children at an alarming rate.
- Diabetes is an enormous source of suffering and early death. It places a burden not only on those with the disease, but on their loved ones as well.
- The estimated costs of caring for diabetes increased by more than 40% -- from $174 billion to $245 billion -- between 2007 and 2012.
Despite all of this, people in the United States with diabetes and their doctors have been taking better care of the disease in recent years. And that has some trends moving in the right direction.
A study just published in the New England Journal of Medicine explains this more positive trend. Researchers analyzed U.S. data on diabetes and some of the most important health problems (complications) it can cause. The study covered the last two decades and millions of people with the disease. Here's what it found:
- The number of people with diabetes more than tripled, from 6.5 million to 20.7 million. Meanwhile, the U.S. adult population increased by only 27%.
- The heart attack rate among people with diabetes decreased by 68%.
- Stroke rates decreased by 53%.
- Leg and foot amputations among diabetics decreased by 51%.
- Kidney disease requiring dialysis decreased by 28%.
The reductions were greater among people with diabetes than among people without the disease.
What accounts for these improvements? The study's authors suggest that it was a combination of:
- Better medical care of diabetes and the other health problems it can cause
- Better treatment of other conditions that increase heart and stroke risk, such as high blood pressure and high cholesterol
- Less smoking
- Improved coordination of care among health care professionals
- Education programs that promote better diabetes care
Still, the impact of these improvements was reduced by the rising number of people with diabetes. For example, the actual number of diabetics with stroke, amputation or severe kidney failure didn't change. That's because the falling rates of these problems were offset by the rising number of people with diabetes.
What Changes Can I Make Now?
If you've been diagnosed with diabetes, this new study shows how important it is to get good medical care. This includes taking steps to prevent further health problems and getting treatment for those that occur.
Here's what you can do:
- Keep track of your blood sugar levels.
- Take your sugar-lowering medicines exactly as prescribed.
- Don't smoke.
- Keep track of your blood pressure. If it's high, adjust your diet, lose weight and/or taking medicines to bring it down.
- Exercise regularly.
- Wear shoes that fit well, and examine your feet each day.
- Meet with a nutritionist, and stick with a heart-healthy, diabetic diet.
- Don't skip doctor visits. That includes your primary care doctor, foot specialist, eye doctor and any other specialists to whom you are referred.
Most people with diabetes also should take other medicines to help prevent heart attack, stroke and kidney disease. Ask your doctor whether you should take a baby aspirin, statin and/or angiotensin converting enzyme (ACE) inhibitor each day.
Keep track of all of your medicines, and update your doctors about any changes in your condition. These are two of the most important things you can do. Many people find it helpful to keep a folder with a summary of their medical problems, an updated list of medicines and their doctors' contact information. Bring the folder with you to each doctor visit.
Play an active role in your own care. For example, if you have kidney disease, make sure every doctor you see knows about it. Some medicines are dangerous when taken by a person with kidney disease. Or the dose may need to be adjusted. Speaking up can prevent problems.
Preventing diabetes is the best way to prevent the other health problems it can cause. Maintaining a healthy weight is the key toward reversing the rising rates of diabetes.
What Can I Expect Looking to the Future?
This latest research provides a clear and encouraging message to those with diabetes: careful medical care makes a difference. It should inspire everyone with diabetes to continue to do those things that we know will keep blood sugar in good control and reduce the rate of further problems.
But the advances shown by this latest research should not slow efforts to get at the real problem: obesity. You can expect to hear much more in the coming years about how to help people lose excess weight and avoid obesity. I hope you will also hear that the rate of new diabetes cases is dropping.