diabetes fact sheet

Source: National Center for Chronic Disease Prevention and Health Promotion

What is diabetes?

Diabetes mellitus is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.

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. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5 percent to 10 percent of all diagnosed cases of diabetes. Risk factors for type 1 diabetes may be autoimmune, genetic, or environmental. There is no known way to prevent type 1 diabetes. Several clinical trials of methods for the prevention of type 1 diabetes are currently in progress or are being planned.

Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes accounts for about 90 percent to 95 percent 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 it. Type 2 diabetes is associated with older age, obesity, a family history of diabetes, a 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 or other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications. Clinically-based reports and regional studies suggest that type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently, particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy. Gestational diabetes occurs more frequently 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. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5 to 10 percent of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next 5 to 10 years.

Other 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 percent of all diagnosed cases of diabetes.

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Treating Diabetes

To survive, people with type 1 diabetes must have insulin delivered by injections or a pump.
Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan 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.
Diabetes self-management education (DMSE) is an integral component of medical care.
Among adults with diagnosed diabetes, 16 percent take insulin only, 12 percent take both insulin and oral medication, 57 percent take oral medication only, and 15 percent do not take either insulin or oral medications.

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Pre-diabetes: Impaired glucose tolerance and impaired fasting glucose

Prediabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes.
People with pre-diabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some people have both IFG and IGT.
IFG is a condition in which the fasting blood glucose level is 100 to 125 milligrams per deciliter (mg/dL) after an overnight fast. The level is higher than normal but is not high enough to be classified as diabetes.
IGT is a condition in which the blood glucose level is 140 to 199 mg/dL after a 2-hour oral glucose tolerance test. This level is higher than normal but not high enough to be classified as diabetes.
In a cross-section sample of U.S. adults aged 40 to 74 years (tested from 1988 to 1994), 33.8 percent had IFG, 15.4 percent had IGT, and 40.1 percent had pre-diabetes (IGT or IFG or both). Applying these percentages to the entire U.S. population in 2000, an estimated 35 million adults aged 40 to 74 years had IFG, 16 million had IGT, and 41 million had pre-diabetes.
Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal.

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Complications of Diabetes in the United States

Heart disease and stroke

Heart disease and stroke account for about 65 percent of deaths in people with diabetes.
Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension.

Blindness

Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years.
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002.
In 2002 in the United Sates and Puerto Rico, 44,400 people with diabetes began treatment for end-stage kidney disease.
In 2002 in the United States and Puerto Rico,153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant.

Nervous system disease

About 60 to 70 percent 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.
Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

More than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes.
In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Dental disease

Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
Almost one-third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

Complications of pregnancy

Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies.
Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other complications

Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.
People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

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Prevention of Diabetes Complications

Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes and their health care providers can reduce the occurrence of these and other 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.

Glucose control

Studies in the United States and abroad 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 (e.g., from 8 to 7 percent) reduces the risk of microvascular complications (eye, kidney, and nerve disease) is reduced by 40 percent.

Blood pressure control

Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among persons with diabetes by 33 to 50 percent, and the risk of microvascular complications (eye, kidney, and nerve disease) by about 33 percent.
In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12 percent.

Control of blood lipids

Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20 to 50 percent.

Preventive care practices for eyes, kidneys, and feet

Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent.
Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.
Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent. Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure-lowering drugs.

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NIH Publication No. 06–3892
November 2005

General Information

What is diabetes?
Treating Diabetes
Pre-diabetes
Diabetes Complications
Prevention of Diabetes Complications

What is diabetes?

Types of diabetes

[Top]

Treating Diabetes

To survive, people with type 1 diabetes must have insulin delivered by injections or a pump.
Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan 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.
Diabetes self-management education (DMSE) is an integral component of medical care.
Among adults with diagnosed diabetes, 16 percent take insulin only, 12 percent take both insulin and oral medication, 57 percent take oral medication only, and 15 percent do not take either insulin or oral medications.

[Top]

Pre-diabetes: Impaired glucose tolerance and impaired fasting glucose

Prediabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes.

People with pre-diabetes have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some people have both IFG and IGT.

IFG is a condition in which the fasting blood glucose level is 100 to 125 milligrams per deciliter (mg/dL) after an overnight fast. The level is higher than normal but is not high enough to be classified as diabetes.

IGT is a condition in which the blood glucose level is 140 to 199 mg/dL after a 2-hour oral glucose tolerance test. This level is higher than normal but not high enough to be classified as diabetes.

In a cross-section sample of U.S. adults aged 40 to 74 years (tested from 1988 to 1994), 33.8 percent had IFG, 15.4 percent had IGT, and 40.1 percent had pre-diabetes (IGT or IFG or both). Applying these percentages to the entire U.S. population in 2000, an estimated 35 million adults aged 40 to 74 years had IFG, 16 million had IGT, and 41 million had pre-diabetes.

Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal.

[Top]

Complications of Diabetes in the United States

Heart disease and stroke

Heart disease and stroke account for about 65 percent of deaths in people with diabetes.
Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher among people with diabetes.

High blood pressure

About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension.

Blindness

Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years.
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

Kidney disease

Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002.
In 2002 in the United Sates and Puerto Rico, 44,400 people with diabetes began treatment for end-stage kidney disease.
In 2002 in the United States and Puerto Rico,153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant.

Nervous system disease

About 60 to 70 percent 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.
Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

More than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes.
In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes.

Dental disease

Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
Almost one-third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more.

Complications of pregnancy

Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies.
Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.

Other complications

Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.
People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

[Top]

Prevention of Diabetes Complications

Glucose control

Studies in the United States and abroad 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 (e.g., from 8 to 7 percent) reduces the risk of microvascular complications (eye, kidney, and nerve disease) is reduced by 40 percent.

Blood pressure control

Blood pressure control reduces the risk of cardiovascular disease (heart disease or stroke) among persons with diabetes by 33 to 50 percent, and the risk of microvascular complications (eye, kidney, and nerve disease) by about 33 percent.
In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12 percent.

Control of blood lipids

Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20 to 50 percent.

Preventive care practices for eyes, kidneys, and feet

Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent.
Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.
Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent. Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure-lowering drugs.

[Top]

NIH Publication No. 06–3892
November 2005

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