The Impact of Diabetes
Diabetes mellitus is one of the most common and serious chronic diseases in the United States. About 25.8 million Americans (8.3 percent of the population) have diabetes, 7 million of whom do not know they have the disease.
In 2010, 1.9 million new cases of diabetes were diagnosed in people 20 and older in the United States. The prevalence of diabetes has increased steadily in the last half of this century and will continue to rise with the aging U.S. population, the growth in minority populations most susceptible to Type 2 diabetes and the increasing prevalence of obesity among Americans.
In 2009, the Kentucky rate for diagnosed diabetes was the 4th highest in the nation at 11.4 percent, compared to a national median of 8.3 percent. This translates to an estimated 366,000 adults in Kentucky having diagnosed diabetes.
What Is Diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose (sugar) resulting from defects in insulin production, insulin action or both. Insulin is a hormone produced by the pancreas that is needed to convert sugar, starches and other foods into energy inside our cells. Diabetes can cause serious complications and premature death; but, people with diabetes can take steps to control the disease and lower their risk of developing complications.
The Different Types of Diabetes
Type 1 diabetes, formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, occurs when the body's immune system attacks and destroys its own insulin-producing beta cells in the pancreas.
- Type 1 diabetes develops most often in children or young adults but can occur at any age.
- It accounts for about 5 to 10 percent of diagnosed diabetes in the United States.
- Although risk factors are not well defined for type 1 diabetes, autoimmune, genetic and environmental factors are involved in its development.
Type 2 diabetes, formerly called noninsulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes, usually begins as insulin resistance, a disorder in which the body's cells do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body's needs so the glucose builds up in the blood while the cells become starved of energy (fuel or glucose).
- High blood glucose, over a period of years, can damage nerves and blood vessels and lead to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum disease and amputation.
- Being overweight and inactive increases the chances of developing type 2 diabetes.
- This form of diabetes usually develops in adults older than 40.
- However, type 2 diabetes increasingly occurs in children and adolescents.
- It is also associated with obesity, family history of diabetes, history of gestational diabetes or having a baby weighing nine pounds or more, impaired glucose metabolism, elevated blood pressure, abnormal cholesterol (lipid) levels and race or ethnicity (African American, Hispanic American, Asian American, Pacific Islander and Native American).
- About 90 percent of people with diabetes have type 2 diabetes.
Gestational diabetes is a form of glucose intolerance that develops or is discovered during pregnancy.
- It occurs more frequently among African Americans, Hispanic/Latino Americans and American Indians and is also more common among obese women and women with a family history of diabetes.
- Gestational diabetes requires treatment to keep the mother's blood glucose normal to avoid complications in the baby.
- This type usually disappears when the pregnancy is over, but women with gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes in the following five to 10 years.
Pre-Diabetes is indicated by higher-than-normal blood glucose levels, but not high enough to be considered diabetes. Before developing type 2 diabetes, individuals usually are diagnosed as having pre-diabetes.
- Pre-diabetes affects individuals who have been diagnosed with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). IFG occurs when the overnight fasting (no caloric intake for at least eight hours) blood glucose level is elevated (100 to 125 mg/dl). IGT occurs when the blood glucose level is elevated (140 to 199 mg/dl) after a two-hour oral glucose tolerance test.
- In the past, misleading terms such as "borderline" or "touch of sugar" may have been used to describe what is now called pre-diabetes.
- People with pre-diabetes are more likely to develop diabetes within 10 years and also are more likely to have a heart attack or stroke.
- However, studies suggest that people with pre-diabetes can prevent or delay diabetes with modest weight loss and increased physical activity.
An estimated 226,000 adult Kentuckians have pre-diabetes and are at very high risk for developing the disease.
What Are the Risk Factors For Developing Type 2 Diabetes and Pre-Diabetes?
- 45 years of age or older
- Overweight and obesity
- Family history (parent, brother, or sister with diabetes)
- Members of high-risk ethnic populations (African American, American Indian, Asian American, Hispanic/Latino or Pacific Islander)
- Diagnosed with gestational diabetes during pregnancy or delivered a baby weighing more than nine pounds
- High blood pressure (140/90 or higher)
- Abnormal cholesterol (lipid) levels (HDL 35 mg/dl or lower and/or triglyceride level 250 mg/dl or higher)
- Habitually physically inactive
- Presence of polycystic ovary syndrome
- Previous testing revealed impaired glucose tolerance or impaired fasting glucose
- Other clinical conditions associated with insulin resistance such as acanthosis nigricans (a skin disorder characterized by dark, thick, velvety skin found especially in folds of skin in the axilla, the groin and on the back of the neck)
- History of cardiovascular disease
If You Are At Risk, What Do You Do Next?
- Talk with your health care provider at your next visit.
- Testing to detect pre-diabetes and type 2 diabetes should be considered in adults of any age who are overweight or obese and who have 1 or more of the above additional risk factors.
- Testing should begin at age 45 years in those without these risk factors.
- If tests are normal, repeat testing should be done at least every 3 years.
Type 2 Diabetes Can Be Delayed or Prevented
It is important to find out early if you have Type 2 diabetes or are at risk for developing it. Early treatment can prevent or minimize some of the serious problems caused by high blood glucose.
As we age, the risk of developing diabetes increases. Don't wait. Ask your health care provider to help you make simple changes in your eating and physical activity habits. Modest weight loss (5 to 7 percent of your body weight) by eating a variety of low fat foods and reducing the number of calories you eat each day and regular, moderate-intensity physical activity (like 30 minutes of walking 5 days a week) can prevent or delay the development of diabetes.