An American Epidemic

Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m 2 ) Diabetes No Data 26.0% No Data 9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at

26 million with Diabetes 79 million with Pre-Diabetes

Epidemic of Diabetes Diabetes affects almost 26 million Americans (8.3%), one quarter of whom don’t know they have it. Another 79 million Americans have pre-diabetes, which raises their risk of developing type 2 diabetes, heart disease, and stroke. About 1.9 million new cases of diabetes were diagnosed in people aged 20 or older in

Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958–2010 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at

Narayan et al, JAMA, 2003 Estimated lifetime risk of developing diabetes for individuals born in the United States in 2000

Source: 2005–2008 National Health and Nutrition Examination Survey.

The Diabetes Epidemic Aging of America Diverse ethnic groups, various incidence and prevalence of diabetes Earlier diagnosis and reclassification Pre-diabetes: “Borderline Diabetes” or a “touch of sugar” = real condition that needs to be treated By 2050, 1 in every 3 adult Americans will have diabetes if current trends continue

Estimated Cost of Diabetes in U.S. (ADA 2007) Total: $174 billion Indirect costs include increased absenteeism ($2.6 billion) and reduced productivity while at work ($20.0 billion) for the employed population Reduced productivity for those not in the labor force ($0.8 billion) Unemployment from disease-related disability ($7.9 billion) Lost productive capacity due to early mortality ($26.9 billion)

Diabetes 101: What is Diabetes Not just a “sugar” problem Interaction of food, insulin, other hormones (glucagon) Physical activity/Obesity Pancreatic function Genetics Other commonly associated conditions: hypertension, lipid problems The complications, not just the diagnosis of diabetes, cause the problems Diabetes is common, serious BUT treatable

Diabetes means: 2 x the risk of high blood pressure 2 to 4 x the risk of heart disease 2 to 4 x the risk of stroke #1 cause of adult blindness #1 cause of kidney failure Causes more than 60% of non-traumatic lower-limb amputations each year NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2010.

Complications Eyes Kidneys Nerves Cardiovascular disease and stroke Randomly controlled studies show that these complications can be prevented or controlled with good blood sugar control but this might involve multiple shots etc More shots does not mean “worse diabetes”!

Symptoms Frequent urination Excessive thirst Extreme hunger or constant eating Unexplained weight loss Presence of glucose in the urine Tiredness or fatigue Changes in vision Numbness or tingling in the extremities Slow-healing wounds or sores Abnormally high frequency of infection Many people have no symptoms

Types of Diabetes Type 1: traditionally age <20, no endogenous insulin, may be any age, about10-20% of people with diabetes, Rx = insulin Type 2: traditionally >40, multiple problems with insulin secretion and action, may be any age, about 80-90% of people with diabetes, Rx may include oral agents and/or insulin or newer agents (incretins, GLP1 ) Pre-diabetes Gestational Diabetes

Physiologic Serum Insulin Secretion Profile Polonsky KS et al, N Engl J Med Plasma Insulin (  U/mL) Plasma Insulin (  U/mL) Time 4:008:0012:0016:0020:0024:0028:0032:00 Breakfast Lunch Dinner

Who Is At Risk? Age 45 or older Overweight Inactive Ethnic or minority population Family history of diabetes Excess abdominal fat High blood pressure Pre-diabetes High blood fats Darkening of the skin Polycystic ovary syndrome History of Gestational Diabetes or large baby

Why Control Diabetes? Do Any Interventions Work? Bottom Line: Does better glucose control translate to better outcomes or better health in the individual? Yes! For every 1% drop in A1c the risk of microvascular complications (eye, kidney, and nerve damage) can be reduced by up to 40%.