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Diabetes Overview
Almost everyone knows someone who has diabetes. An estimated 18.2 million people in the United States — 6.3 percent of the population — have diabetes, a serious, lifelong condition. Of those, 13 million have been diagnosed, and about 5.2 million people have not yet been diagnosed. Each year, about 1.3 million people aged 20 or older are diagnosed with diabetes.What Is Diabetes? Diabetes is a disorder of metabolism — the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose. What Are the Types Of Diabetes? The three main types of diabetes are:
Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live. At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that autoimmune, genetic and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 percent to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults, but can appear at any age. Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis. Type 2 Diabetes The most common form of diabetes is type 2 diabetes. About 90 percent to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight. Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes — glucose builds up in the blood and the body cannot make efficient use of its main source of fuel. The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some people have no symptoms. Gestational Diabetes Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 percent to 50 percent chance of developing type 2 diabetes within five to 10 years. What Are the Tests for Diagnosing Diabetes? The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:
What Are the Other Forms of Impaired Glucose Metabolism (Also Called Pre-Diabetes)? People with pre-diabetes, a state between "normal" and "diabetes," are at risk for developing diabetes, heart attacks and strokes. However, studies suggest that weight loss and increased physical activity can prevent or delay diabetes. There are two forms of pre-diabetes. Impaired Fasting Glucose A person has impaired fasting glucose (IFG) when fasting plasma glucose is 100 to 125 mg/dL. This level is higher than normal but less than the level indicating a diagnosis of diabetes. Impaired Glucose Tolerance Impaired glucose tolerance (IGT) means that blood glucose during the oral glucose tolerance test is higher than normal but not high enough for a diagnosis of diabetes. IGT is diagnosed when the glucose level is 140 to 199 mg/dL two hours after a person drinks a liquid containing 75 grams of glucose. About 35 million people ages 40 to 74 have impaired fasting glucose and 16 million have impaired glucose tolerance. Because some people have both conditions, the total number of U.S. adults ages 40 to 74 with pre-diabetes comes to about 41 million. These recent estimates were calculated using data from the 1988-1994 National Health and Nutrition Examination Survey and projected to the 2000 U.S. population. What Are the Scope and Impact of Diabetes? Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2000, it was the sixth leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke. Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. In 2002, diabetes cost the United States $132 billion. Indirect costs — including disability payments, time lost from work and premature death — totaled $40 billion; direct medical costs for diabetes care — including hospitalizations, medical care and treatment supplies — totaled $92 billion. Who Gets Diabetes? Diabetes is not contagious. People cannot "catch" it from each other. However, certain factors can increase the risk of developing diabetes. Type 1 diabetes occurs equally among males and females, but is more common in whites than in nonwhites. Data from the World Health Organization's Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown. Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanic Americans. On average, non-Hispanic African Americans are 1.6 times as likely to have diabetes as non-Hispanic whites of the same age. Hispanic Americans are 1.5 times as likely to have diabetes as non-Hispanic whites of similar age. American Indians have one of the highest rates of diabetes in the world. On average, American Indians and Alaska Natives are 2.3 times as likely to have diabetes as non-Hispanic whites of similar age. Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limited, some groups, such as Native Hawaiians and Japanese and Filipino residents of Hawaii aged 20 or older, are about twice as likely to have diabetes as white residents of Hawaii of similar age. The prevalence of diabetes in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanic Americans and other minority groups make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates, the prevalence of diabetes in the United States is predicted to reach 8.9 percent of the population by 2025. How Is Diabetes Managed? Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment. Today, healthy eating, physical activity and taking insulin via injection or an insulin pump are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. Healthy eating, physical activity and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin or both to control their blood glucose levels. People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low — a condition known as hypoglycemia — a person can become nervous, shaky and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur. A person also can become ill if blood glucose levels rise too high, a condition known as hyperglycemia. People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. An endocrinologist is a doctor who often specializes in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to learn the skills needed for day-to-day diabetes management. Hope Through Research In recent years, advances in diabetes research have led to better ways of managing diabetes and treating its complications. Major advances include:
National Diabetes Education Program 1 Diabetes Way Bethesda, MD 20892-3600 1-800-438-5383 www.ndep.nih.gov American Diabetes Association National Service Center 1701 North Beauregard Street Alexandria, VA 22311 1-800-342-2383 or (703) 549-1500 www.diabetes.org Juvenile Diabetes Research Foundation International 120 Wall Street, 19th Floor New York, NY 10005 1-800-533-2873 or (212) 785-9500 www.jdrf.org Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health Updated: April 2004 | |
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