Diabetes news: Both good and bad

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According to a recent article in the New England Journal of Medicine, there is both good and bad news about diabetes. The bad news is that the occurrence of diabetes tripled between1990 and 2010 in the United States. We shouldn t be surprised at this, since obesity prevalence a major risk factor for diabetes has also increased. The good news, however, is that the rate of the major complications of diabetes has dropped significantly over that same period of time.

Dr. Edward W. Gregg and colleagues from the CDC and the Rollins School of Public Health at Emory University examined data from nationally representative registries and hospitalization databases to assess both the prevalence of diabetes and the rates of five major complications of the disease over the two decades between 1990 and 2010. They used data from adults over the age of 20. The major complications they assessed included: Lower-extremity amputations; acute myocardial infarction (heart attacks); stroke; end-stage renal disease (ESRD); and death from hyperglycemic crisis (very high blood sugar leading to coma and death if uncontrolled).

The researchers found that, in spite of the great increase in the prevalence of diabetes over the time period studied, there were impressive declines in the rates of these complications. The rate of amputation decreased by 51 percent, of myocardial infarction by 67 percent, of stroke by 53 percent, of ESRD by 28 percent, and of hyperglycemic crisis by 64 percent. These substantial decreases were all statistically significant. In general, persons who were 75 years old or older had the greatest declines in diabetes-related complications.

In their analysis the authors noted These findings probably reflect a combination of advances in acute clinical care, improvements in the performance of the health care system, and health promotion efforts directed at patients with diabetes. However, they also warned that the encouraging decreases in the rates of the complications for adults with diabetes don t mean there will be reductions in the overall burden of these problems. Because of the large increase in the number of cases of diabetes as the population has grown and aged, we will likely see a continued increase in the total burden of these complications which will certainly affect our health care system.

ACSH s Dr. Ruth Kava commented While it s good news that the rate of complications of diabetes has been decreasing, it is still very important to emphasize prevention especially with respect to the burden of obesity in this country.