Improvement in national diabetes outcomes

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The Centers for Disease Control and Prevention (CDC) reported on Wednesday major changes are being seen in what is still the fastest growing chronic epidemic nationally diabetes. The study evaluated four federal data sets from the National Health Interview Survey, the National Hospital Discharge Survey, the United States Renal Data, and Vital Statistics. The analyzed data stretched over a 20 year period of time, 1990 to 2010, and gave a broad picture of changes in diabetes outcomes (while both type 1 and type 2 diabetes were studied, the overwhelming majority of diabetics suffer from type 2, formerly called adult onset or non-insulin-dependent, which is closely related to obesity). The report, published in the New England Journal of Medicine, detailed dramatic declines in the rates of diabetes complications including heart attacks, strokes, kidney failure, and amputations (for some reason, eye complications, a common and feared complication, were not included in this study). Dr. David M. Nathan, director of the Diabetes Center at Massachusetts General Hospital, reacts This is the first really credible, reliable data that demonstrates that all of the efforts at reducing risk have paid off, given that diabetes is the chronic epidemic of this millennium, this is a very important finding.

The most notable gains were seen in the declining rates of heart attacks and deaths caused by high blood sugar. Both diabetic complications fell by over 60 percent over the twenty-year period. Federal researchers mentioned that the sharp decline in heart attacks also aligns with declines of heart attacks in the general population. However, the decrease among the diabetic population still remains noteworthy, as individuals without diabetes observed a 31 percent decline since 1990, while those with the disease saw a 68 percent decline. The director of the Clinical Diabetes Center at the Montefiore Medical Center, Dr. Joel Zonszein credits the progress in managing heart complications to shifts in diabetes treatment. He states, Doctors are putting more emphasis on controlling blood pressure and cholesterol major risk factors for heart disease and strokes than on lowering blood sugar. Indeed, since heart disease is a leading contributing factor of death in patients with diabetes, this change in treatment was necessary and seems to be effective.

Overall the declines in diabetic complications began to appear around 1995, and have steadily decreased over the observed time period due to a multifaceted shift in care and treatment. Physicians now manage disease risks better, patient education has became a priority, and significant advances have been made in tracking the course disease in patients. Authors of the NYTimes article, Sabrina Tavernese and Denise Grady summarize, Improved blood sugar control has made a difference, especially in reducing the rate of amputations and end-stage kidney disease. Declines in smoking and the rising use of statins to lower cholesterol and of other medications to control blood pressure contributed to the declines in heart attacks and strokes.

Though these recent findings are impressive, diabetes continues to rise among our population, which warrants critical attention. Dr. Nathans adds, There s nothing else in the world that s increasing as fast as the rate of diabetes. As a society, we are still facing an enormous burden. The mounting threat of the disease must be tamed with patient education and appropriate prevention, as 79 million Americans are currently pre-diabetic. Tavernese and Grady draw attention to salient advice from Dr. Zonszein, Really, we have two worlds, explaining that educated patients tend to manage diabetes well. Then we have the other world, which is far more likely to ignore diabetes until its devastating complications set in, maybe because of social issues, language issues, access to health care, economic issues.