Defining Diabetes With Data: 10 Things That Are Good to Know

Diabetes mellitus (DM) is the leading cause of kidney failure, nontraumatic lower limb amputations, and new cases of blindness among U S adults and a major cause of heart disease and stroke. DM also is the seventh leading cause of death in this country.

Patient care can be complex, requiring a variety of risk reduction strategies and ongoing patient self-management education.

To gain a better understanding of this national and global epidemic and its impact, consider the following key facts and figures:

1.DM affects 25.8 million persons in the United States, or 8.3% of the U S population. Among US residents aged 65 years and older, 26.9% had DM in 2010. About 1.9 million persons aged 20 years or older were newly diagnosed with DM. An estimated 79 million American adults aged 20 years or older have prediabetes.

2. DM caused 1.4 million deaths worldwide in 2011, up from 1 million deaths in 2000. The condition was the eighth leading cause of death in the world in 2011, up from tenth in 2000. The top causes of death were ischemic heart disease, stroke, lower respiratory tract infections, chronic obstructive lung disease, diarrhea, and HIV/AIDS.

3. About 90% to 95% of diagnosed cases in adults are type 2 DM. The diagnosis is increasing in children and adolescents.

4. A new DM management algorithm for primary care physicians and other health care professionals has been created to guide them in the treatment of patients with prediabetes and type 2 DM. A key recommendation is that a comprehensive care plan should consider obesity management as an integral part to effectively reduce morbidity, mortality, and disability in the majority of patients with type 2 DM who are obese.

5. The risk of DM is 40% less in persons who walk to work than in those who drive. However, exercise and lifestyle interventions are not always effective. An intensive intervention that focused on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 DM, although it did lead to other benefits, including more weight loss over 10 years and less kidney disease and retinopathy.

6. Treatment with higher-potency statins might be associated with an increased risk of new onset DM. Study findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease.

7. The availability of accurate blood glucose meters and test strips is critical to the success of DM self-management. A patient who administers additional insulin, based on a faulty test strip reading that indicates that his or her blood glucose level is high when it is actually low, runs the risk of acute hypoglycemia, possibly leading to an impaired cognitive state, coma, or death.

8. Psychological symptoms of depression in patients with DM are more specific to depression than their somatic counterparts. Specificity of the somatic symptoms of depression is increased when the somatic symptoms are severe, start concomitantly with depressed mood or anhedonia, are unrelated to DM, or appear out of proportion to what is expected. Initiate cognitive screening early because both DM and depression have been linked to earlier onset of dementia.

9. There is no direct relationship between the pathologic features of Alzheimer disease and DM. However, it is reasonable to conclude that out-of-control DM, strokes, and myocardial infarctions can increase the risk of dementia. Primary care physicians are advised to treat vascular risk factors aggressively.

10. Persons with obstructive sleep apnea (OSA) are at significantly increased risk for DM, and vice versa. OSA may disrupt normal glucose metabolism and increase insulin resistance. In patients with type 2 DM, treatment for sleep apnea may improve the sleep disorder and the DM.