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Diabetes-related complication rates have dropped dramatically, CDC says

Even as the disease rate climbs, the CDC reports a dramatic decline in amputations, heart attacks, renal failure and stroke.

Diabetes-related complication rates have dropped dramatically, CDC says
The rising increase in the total number of Americans diagnosed with diabetes suggest that the total burden, or absolute number of cases of complications, will probably continue to increase in the coming decades.

The rate of serious complications from diabetes, including heart attacks and limb amputations, has declined dramatically over the past 20 years, according to a new study from the Centers for Disease Control and Prevention (CDC) published Wednesday in the New England Journal of Medicine.

That’s obviously very welcomed news. For we are in the midst of a diabetes epidemic. The percentage of Americans with the blood-sugar disease has been climbing at a steady and alarming rate. Today, more than 20.7 million adults in the United States — almost 10 percent of all adults living in the country — have been diagnosed with diabetes. That’s more than triple the 6.5 million who had the disease in 1990, when the U.S. population was only about a third smaller.

The increase is almost entirely related to type 2 diabetes, the most common form of the disease and the one associated with obesity.

The new study shows “that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study, in a statement. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”

A focus on five complications

For their study, the CDC researchers used 1990-2010 data from four databases, including the National Health Interview Survey, which asks health-related questions of 57,000 U.S. adults each year. Here are the key findings:

  • The rate of heart attack, which has historically been the most common diabetes-related complication, fell 67.8 percent between 1990 and 2010. Heart attacks are now about as common as stroke among people with diabetes.
  • The rate of deaths from a hyperglycemic crisis (very high blood-sugar levels) declined 64.4 percent.
  • The rate of stroke fell 52.7 percent.
  • The rate of limb amputations dropped 51.4 percent. (Diabetes can cause nerve damage and poor circulation, which can make it difficult for wounds to heal, particularly on the feet or legs. The disease is the leading cause of lower-limb amputations in the United States.)
  • The rate of end-stage renal disease (chronic kidney failure) fell 28.3 percent.

The researchers did not have enough data to include trends in the incidence of diabetic retinopathy, the most common cause of adult-onset blindness in the United States, or in the incidence of hypoglycemia (abnormally low blood-sugar levels), a serious complication that can result from taking too much diabetes medication.

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The rate declines did not differ much by gender or race. Age was a factor, though. The greatest declines — except for kidney failure — were seen in people aged 75 or older.

The data also revealed that by 2010, the amputation rates were similar among older and younger adults, while the rates of death from a hyperglycemic crisis were higher among younger people.

Multiple reasons

The CDC researchers cite several possible reasons for the declines in the complications rates, including more effective medical treatments, improvements in the availability and delivery of health-care services, and greater efforts to raise awareness among people with diabetes about potential complications from the disease.

The researchers also stress that although the results of this new analysis are encouraging, they do not mean that the overall burden of diabetes-related complications is going to be letting up anytime soon.

The rising increase in the total number of Americans diagnosed with diabetes, coupled with the aging of the baby boomer generation (age, along with weight, is a primary risk factor for developing type 2 diabetes) suggest, say the researchers, “that the total burden, or absolute number of cases of complications, will probably continue to increase in the coming decades.”

You’ll find an abstract of the study on the NEJM website, but, unfortunately, the study itself — even though it was conducted by a publicly funded agency — is behind a paywall.