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Cardiovascular Disease Decreasing Among Adults with Diabetes

Separate Report Finds People with Diabetes Doing a Better Job of Checking Blood Sugar

October 27, 2007 -- Two CDC studies say adults with diabetes report they are doing better at the vital job of monitoring their blood sugar, and fewer say they’ve developed cardiovascular disease.

Among people aged 35 years and older with diagnosed diabetes, the prevalence of cardiovascular disease decreased by over 11 percent over an eight year period, according to, " Trends in Prevalence of Self–Reported Cardiovascular Disease Among Adults with Diabetes Aged 35 Years and Older, United States, 1997 – 2005," published in CDC’s Morbidity and Mortality Weekly Report (MMWR). The report’s authors note the decrease may be due in part to declining rates of cardiovascular disease risk factors such as smoking, high cholesterol and high blood pressure, and to increased use of preventive treatments such as daily aspirin.

Self–reported cardiovascular disease among black adults with diabetes decreased by more than 25 percent between 1997 and 2005. Blacks tend to have higher diabetes rates than whites and Hispanics, the other racial/ethnic groups included in the report.

The report, which analyzed self-reported data from the National Health Interview Survey (NHIS), also notes a 14 percent decrease in self–reported cardiovascular disease among adults aged 35–64 years with diabetes, the age range in which the majority of all new diagnosed cases of diabetes among adults occur. During 1997 to 2005, prevalence of self–reported cardiovascular disease in this age group decreased from 31.1 percent in 1997 to 26.7 percent in 2005.

" Cardiovascular disease is not only the leading cause of death for Americans, it is also the greatest killer of adults with diabetes," said Nilka Burrows, CDC’s Division of Diabetes Translation and the lead author of the report. " While the trends in this report are very encouraging, it is important that we continue to take steps to help prevent and control diabetes, which will also aid in the fight against cardiovascular disease."

About 65 percent of deaths in people with diabetes are caused by heart disease and stroke. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.

A second MMWR report, " Self-Monitoring of Blood Glucose Among Adults with Diabetes – United States, 1997 – 2006," found significant increases in daily monitoring of blood glucose levels among adults with diabetes. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), researchers found that adults with diabetes who checked their blood glucose levels at least once a day increased by over 22 percent between 1997 and 2006.

In 2006, over 63 percent of respondents checked their blood glucose at least once daily. This surpassed the national health objective of 61 percent, as outlined in Healthy People 2010, a government framework for achieving specific health objectives by the year 2010.

Blood glucose is the main sugar that the body makes from the food we eat. Blood glucose control is critical for managing diabetes and preventing diabetes-related complications such as heart disease, foot and leg amputation, and retinopathy, which can lead to blindness.

" People are taking better advantage of a tool that can aid in making critical decisions about how to treat their diabetes," said Liping Pan, lead author of the report. " Continued education about diabetes self-management can help ensure that people have the knowledge to continue – or start – taking steps to prevent or control diabetes."

CDC, through its Division of Diabetes Translation, funds diabetes prevention and control programs in all 50 states, as well as the District of Columbia and seven U.S. territories and island jurisdictions. The National Diabetes Education Program, co–sponsored by CDC and NIH, provides diabetes education to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of diabetes.

Rare Diabetes Foot Complication Becoming More Common

October 23, 2007 — At first, Kim Schraeder didn’t worry about the swelling in her left foot. After all, it was pulling double-duty while her other foot recovered from surgery.

“I have a high threshold for pain,” she says. “It hurt to walk on it, but I didn’t think it was serious.”

Just a year earlier, doctors diagnosed the 48-year-old mother of four with diabetes. The recent surgery on her right foot corrected a bunion to prevent reoccurring diabetic ulcers. As Schraeder’s bunion recovery moved forward, her left foot moved outwards. Her ankle bent inwards. The foot grew so swollen none of her shoes fit. The skin was warm and red. Schraeder started to worry.

During a follow-up visit with her foot and ankle surgeon, she spoke up. Her doctor took one look and said, “We have a problem.”

Schraeder was diagnosed with a rare diabetic complication called Charcot foot. It is estimated to affect less than one percent of people with diabetes. Now doctors with the American College of Foot and Ankle Surgeons (ACFAS) say Charcot foot’s prevalence appears to be growing as more Americans get diabetes.

Some worry that few patients – or their diabetes care providers – seem to know about this complication or its warning signs.

Charcot foot is a sudden softening of the foot’s bones caused by severe neuropathy, or nerve damage, a common diabetic foot complication. It can trigger an avalanche of problems, including joint loss, fractures, collapse of the arch, massive deformity, ulcers, amputation, and even death. As the disorder progresses, the bottom of the foot can become convex, bulging like the hull of a ship. Since most people with Charcot cannot feel pain in their lower extremities, they continue walking on the foot, causing further injury.

Charcot cannot be reversed, but its destructive effects can be stopped if the complication is detected early.

The symptoms of Charcot foot appear suddenly. They include warm and red skin, swelling and pain. A person with diabetes who has a red, hot, swollen foot or ankle requires emergency medical care because these can also be symptoms of deep vein thrombosis or an infection.

Doctors say Charcot’s ambiguous symptoms can lead to misdiagnosis. Since patients don’t feel pain, doctors may presume the swelling is due to infection and prescribe antibiotics. Meanwhile the patient continues walking on a foot that is collapsing.

“More people with diabetes, their families and their care providers need to know about Charcot foot,” says J. T. Marcoux. DPM, FACFAS, one of only a handful of Massachusetts foot and ankle surgeons who performs Charcot foot reconstructions. “When I diagnose a patient with this complication, I telephone their primary care doctor and educate them about it as well.”

Schraeder says no one told her about Charcot. “It was not even in my vocabulary,” she says. “If someone had educated me, I think I would have been more aware that I had a major problem.”

But educating patients and their care providers is only half the battle. Keith Jacobson, DPM, FACFAS is the Houston foot and ankle surgeon who diagnosed and reconstructed Schraeder’s Charcot foot. He and Marcoux say there’s little they can do when patients are apathetic or in “diabetic denial.”

“I’ve had patients who are literally blind, on dialysis and neuropathic who refuse to admit they have diabetes,” says Jacobson. “I have seen horrific deformities with this condition.”

Marcoux tells of a middle-aged woman he diagnosed with Charcot. Typically the first order of business is to immobilize the foot by putting the patient in a boot or cast, and to keep the patient off the foot by using crutches or a wheelchair. Marcoux says his patient was “in massive denial” about her Charcot diagnosis.

“I tried to get her off the foot, but she wouldn’t do it” he says, “Six months later she came in with a bone infection and a gaping hole in her foot.”

Foot and ankle surgeons expect to see more patients like that as diabetes rates soar.

Today, Schraeder is back to walking on both feet. Three months after her Charcot diagnosis, she underwent reconstructive surgery. Her recovery included spending three months in a “halo” external fixator where a series of pins and screws are placed into the bones and connected to clamps and rods outside the skin. She then wore a custom shoe boot for nearly a year.

The experience taught her four children to appreciate their mother a lot more, since all the cooking, cleaning, and laundry fell on their shoulders.

“They’re all like hawks now,” she says. “If I’m sitting here with bare feet, they’ll look to make sure they’re not red, hot and swollen.”