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Overall diabetes complication rate drops

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(Bloomberg) — Improved preventive care for diabetes in the United States may have cut the likelihood that the condition will lead to complications such as heart attacks and strokes, government researchers report.

But the researchers note that the number of Americans diagnosed with diabetes continues to rise.

Diagnosed diabetes cases tripled to 20.7 million in 2010, from 6.5 million in 1990, according to research from the Centers for Disease Control and Prevention (CDC) published yesterday in the New England Journal of Medicine.

Because of the increase in the number of diagnosed cases, the total number of diabetes complication cases increased, even though the likelihood that someone diagnosed with diabetes would suffer a complication fell, according to Linda Geiss, one of the study authors.

“We need to make some progress in preventing Type 2 diabetes in order to help decrease these numbers,” Geiss, head of diabetes surveillance at the CDC in Atlanta, said in a telephone interview.

Diabetes, which is caused when the body doesn’t use insulin properly or doesn’t make the hormone, is the seventh-leading cause of death in the U.S. Insulin is a hormone secreted by the pancreas that helps the body control blood sugar. Type 2 accounts for 90 percent to 95 percent of U.S. cases.

About 79 million Americans are at risk for developing diabetes, according to the CDC. Diabetes and the associated complications cost $176 billion in medical expenses each year.

But the CDC researchers found the overall rate of heart attack among all known diabetics declined 68 percent between 1990 and 2010. The stroke rate fell 53 percent, and the amputation rate fell 51 percent.

Rates of deaths from high blood sugar and end-stage kidney failure also fell during the 20 years.

The largest decline in many of the complications was seen in those ages 75 and older.

Researchers used data from the National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System and Vital Statistics to look at diabetes-related complications in the U.S. during the 20 years.

The CDC has said that 25.8 million Americans have diabetes, including 7 million who haven’t been diagnosed. The researchers who wrote the report issued yesterday focused on those who know they have the condition.

Doctors may be diagnosing a higher percentage of moderate and mild cases of diabetes because of an increased emphasis on diabetes screening. The additional people diagnosed with moderate and mild diabetes may be less likely to suffer from severe complications than other people with diabetes who get comparable preventive care.

The CDC researchers have no direct evidence about whether or not aggressive diabetes screening has changed the mix of people who describe themselves as having diabetes.

“The degree to which earlier detection is actually occurring is unclear,” the researchers write in the report.

The researchers tried to adjust for any major screening-related shifts in the types of people who say they have diabetes by looking to see what would happen if people with newly diagnosed diabetes were excluded from the results. Even the researchers made that adjustment, they found big decreases in diabetes-related complication rates, CDC officials say.

Geiss said the decline in the overall complication rates among people who know they have diabetes may reflect better medical management of people with diabetes, better self-management by those with the disease, better treatment of blood pressure and cholesterol and earlier screening for issues like kidney disease and foot ulcers.

“While the decline in complications is good news, they are still high and will stay with us unless we can make substantial progress in preventing Type 2 diabetes,” Edward Gregg, the lead study author and a senior epidemiologist in the CDC’s Division of Diabetes Translation, said in a statement.

Elizabeth Seaquist, president of medicine and science at the American Diabetes Association, said more studies are needed to better understand what’s being done right in the medical community to help lower diabetes complications and what more must be done to reduce the number of people who have or at risk of developing the disease.

“Diabetes is still a huge epidemic in this country and these complications are very serious and certainly not going away,” Seaquist, a professor of medicine at the University of Minnesota in Minneapolis said in a telephone interview. “We need to understand where clinical care has led to improvements. It may give us some suggestions on where we need to further our future efforts.”

Allison Bell contributed to this report.

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