Diabetes

Goal

Reduce the disease and economic burden of diabetes mellitus (DM) and improve the quality of life for all persons who have, or are at risk for, DM.

Overview

DM occurs when the body cannot produce or respond appropriately to insulin. Insulin is a hormone that the body needs to absorb and use glucose (sugar) as fuel for the body's cells. Without a properly functioning insulin signaling system, blood glucose levels become elevated and other metabolic abnormalities occur, leading to the development of serious, disabling complications.
Many forms of diabetes exist. The 3 common types of DM are:

  • Type 2 diabetes, which results from a combination of resistance to the action of insulin and insufficient insulin production.
  • Type 1 diabetes, which results when the body loses its ability to produce insulin.
  • Gestational diabetes, a common complication of pregnancy. Gestational diabetes can lead to perinatal complications in mother and child and substantially increases the likelihood of cesarean section. Gestational diabetes is also a risk factor for subsequent development of type 2 diabetes after pregnancy.

Effective therapy can prevent or delay diabetic complications.1,2 However, almost 25 percent of Americans with DM are undiagnosed, and another 57 million Americans have blood glucose levels that greatly increase their risk of developing DM in the next several years.3 Few people receive effective preventative care, which makes DM an immense and complex public health challenge.

Why is Diabetes Important?

DM affects an estimated 23.6 million people in the United States and is the 7th leading cause of death.3 DM:

  • Lowers life expectancy by up to 15 years.
  • Increases the risk of heart disease by 2 to 4 times.
  • Is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. 3,4

In addition to these human costs, the estimated total financial cost of DM in the United States in 2007 was $174 billion, which includes the costs of medical care, disability, and premature death.3 The rate of DM continues to increase both in the United States5,6 and throughout the world. Due to the steady rise in the number of persons with DM, and possibly earlier onset of type 2 DM, there is growing concern about:

  • The possibility of substantial increases in diabetes-related complications.
  • The possibility that the increase in the number of persons with DM and the complexity of their care might overwhelm existing health care systems.
  • The need to take advantage of recent discoveries on the individual and societal benefits of improved diabetes management and prevention by bringing life-saving discoveries into wider practice.
  • The clear need to complement improved diabetes management strategies with efforts in primary prevention among those at risk for developing DM.

Additional Resources

HP2020's National Objectives for Diabetes
HHDW Reports on Diabetes

References

  1. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
  2. Knowler WC, Fowler SE, Hamman RF, et al; Diabetes Prevention Program Research Group. Ten-year followup of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.
  3. Centers for Disease Control and Prevention (CDC). National diabetes fact sheet: General information and national estimates on diabetes in the United States, 2007. Atlanta: CDC; 2008.
  4. Portuese E, Orchard T. Mortality in insulin-dependent diabetes. In Diabetes in America, pp. 221-32. Bethesda, MD: National Institutes of Health, National Diabetes Data Group; 1995.
  5. Geiss LS, Pan L, Cadwell B, et al. Changes in incidence of diabetes in US adults, 1997–2003. Am J Prev Med. 2006;30:371-7.
  6. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the US population in 1988–1994 and 2005–2006. Diabetes Care. 2009;32:287-94.