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Wellness Wise

November is the American Diabetes Month

There are three main types of diabetes: type 1, type 2, and gestational diabetes. You may have a health risk factor for type 2 diabetes if you are overweight, are over 45 years of age, or habitually inactive, if you have metabolic syndrome (insulin resistance), high blood pressure, abnormal cholesterol levels, a history of gestational diabetes, polycystic ovary disease, habitually inactive, or have a history of vascular disease (such as stroke or have a family history of diabetes).

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 group of diseases marked by high levels of blood glucose, also called blood sugar, resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications.

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

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 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 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 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

Other types of diabetes result from specific genetic conditions, such as maturity-onset diabetes of youth; surgery; medications; infections; pancreatic disease; and other illnesses. Such types of diabetes account for 1 to 5 percent of all diagnosed cases.

Treating Diabetes

Diabetes can lead to serious complications, such as blindness, kidney damage, cardiovascular disease, and lower-limb amputations, but people with diabetes can lower the occurrence of these and other diabetes complications by controlling blood glucose, blood pressure, and blood lipids.

pie chart

Pre-diabetes: Impaired Glucose Tolerance and Impaired Fasting Glucose

Pre-diabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes. People with pre-diabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke.

Prevalence of Impaired Fasting Glucose in People Younger than 20 Years of Age, United States

Prevalence of Impaired Fasting Glucose in People Aged 20 Years or Older, United States, 2007

Prevention or Delay of Diabetes

National Estimates on Diabetes

Estimation Methods

The estimates on diabetes in this fact sheet were derived from various data systems of the Centers for Disease Control and Prevention (CDC), the outpatient database of the Indian Health Service (IHS), the U.S. Renal Data System of the National Institutes of Health (NIH), the U.S. Census Bureau, and published studies. Estimates of the total number of persons with diabetes and the prevalence of diabetes in 2007 were derived using 2003–2006 National Health and Nutrition Examination Survey (NHANES), 2004–2006 National Health Interview Survey (NHIS), 2005 IHS data, and 2007 resident population estimates. Many of the estimated numbers and percentages of people with diabetes were derived by applying diabetes prevalence estimates from health surveys of the civilian, noninstitutionalized population to the most recent 2007 resident population estimates. These estimates have some variability due to the limits of the measurements and estimation procedures. The procedures assumed that age-race-sex-specific percentages of adults with diabetes—diagnosed and undiagnosed—in 2007 are the same as they were in earlier time periods—for example, 2003 to 2006—and that the age-race-sex-specific percentages of adults with diabetes in the resident population are identical to those in the civilian, noninstitutionalized population. Deviations from these assumptions may result in over- or under-estimated numbers and percentages. For further information on the methods for deriving total, diagnosed, and undiagnosed prevalence of diabetes from NHANES data, see www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a1.htm.

Prevalence of Diagnosed and Undiagnosed Diabetes in the United States, All Ages, 2007

Total: 23.6 million people—7.8 percent of the population—have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Prevalence of Diagnosed and Undiagnosed Diabetes among People Aged 20 Years or Older, United States, 2007

Age 20 years or older: 23.5 million, or 10.7 percent, of all people in this age group have diabetes.

Age 60 years or older: 12.2 million, or 23.1 percent, of all people in this age group have diabetes.

Men: 12.0 million, or 11.2 percent, of all men aged 20 years or older have diabetes.

Women: 11.5 million, or 10.2 percent, of all women aged 20 years or older have diabetes.

Non-Hispanic whites: 14.9 million, or 9.8 percent, of all non-Hispanic whites aged 20 years or older have diabetes.

Non-Hispanic blacks: 3.7 million, or 14.7 percent, of all non-Hispanic blacks aged 20 years or older have diabetes.
graph
Source: 20042006 National Health Interview Survey estimates projected to year 2007.

Prevalence of Diagnosed Diabetes in People Younger than 20 Years of Age, United States, 2007

Race and Ethnic Differences in Prevalence of Diagnosed Diabetes

Sufficient data are not available to derive prevalence estimates of both diagnosed and undiagnosed diabetes for all minority populations. For example, national survey data cannot provide reliable estimates for the Native Hawaiian and other Pacific Islander population. However, national estimates of diagnosed diabetes for certain minority groups are available from national survey data and from the IHS user population database, which includes data for approximately 1.4 million American Indians and Alaska Natives in the United States who receive health care from the IHS. Because most minority populations are younger and tend to develop diabetes at earlier ages than the non-Hispanic white population, it is important to control for population age differences when making race and ethnic comparisons.

Incidence of Diagnosed Diabetes among People Aged 20 Years or Older, United States, 2007

A total of 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older in 2007.
graph
Source: SEARCH for Diabetes in Youth Study.
NHW=Non-Hispanic whites; AA=African Americans; H=Hispanics;
API=Asians/Pacific Islanders; AI=American Indians

Incidence of Diagnosed Diabetes in People Younger than 20 Years of Age, United States, 2002 to 2003

SEARCH for Diabetes in Youth is a multicenter study funded by the CDC and the NIH to examine diabetes—type 1 and type 2—among children and adolescents in the United States. SEARCH findings for the communities studied include:

Deaths among People with Diabetes, United States, 2006

Complications of Diabetes in the United States

Heart Disease and Stroke

High Blood Pressure

Blindness

Kidney Disease

Nervous System Disease

Amputations

Dental Disease

Complications of Pregnancy

Other Complications

Preventing Diabetes Complications

Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes, their support network, and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids and by receiving other preventive care practices in a timely manner.

Glucose Control

Blood Pressure Control

Control of Blood Lipids

Preventive Care Practices for Eyes, Feet, and Kidneys

Estimated Diabetes Costs in the United States in 2007

Total—direct and indirect: $174 billion

Direct medical costs: $116 billion

Indirect costs: $58 billion—disability, work loss, premature mortality

Resources

  1. Visit http://bcbstx.com/ut/
  2. Log onto Blue Access
  3. Select Personal Health Manager
  4. From there you can go to: Ask A Nurse and/or Clinical Tools

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This information is provided by The University of Texas System, Office of Employee Benefits and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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