# DIABETES OVERVIEW FACT SHEET

Diabetes mellitus is one of the most common and serious chronic diseases
in the United States. About 16 million Americans have diabetes, 5.4
million of whom do not know they have the disease. Each year,
approximately 800,000 people are diagnosed with diabetes. The prevalence
of diabetes has increased steadily in the last half of this century and
will continue to rise with the aging U.S. population, the growth in
minority populations most susceptible to type 2 diabetes, and the
increasing prevalence of obesity among Americans.

# WHAT IS DIABETES?

Diabetes is a metabolic disease in which the body does not produce or
properly use insulin, a hormone that is needed to convert sugar,
starches, and other food into energy needed for daily life. Diabetes is
characterized by high levels of blood glucose (sugar).

# WHAT ARE THE DIFFERENT TYPES OF DIABETES?

There are three main types of diabetes:

-   Type 1 diabetes

-   Type 2 diabetes

-   Gestational diabetes

**Type 1 diabetes,** formerly called insulin-dependent diabetes mellitus
(IDDM) or juvenile-onset diabetes, is an autoimmune disease that results
when the body's immune system attacks and destroys its own
insulin-producing beta cells in the pancreas. People with type 1
diabetes need daily injections of insulin to live. Type 1 diabetes
develops most often in children or young adults and accounts for about 5
to 10 percent of diagnosed diabetes in the United States. Although risk
factors are not well defined for type 1 diabetes, autoimmune, genetic
and environmental factors are involved in its development.

**Type 2 diabetes,** formerly called noninsulin-dependent diabetes
mellitus (NIDDM) or adult-onset diabetes, is a disease that occurs when
the body makes enough insulin but cannot use it effectively. This form
of diabetes usually develops in adults over the age of 40. About 90 to
95 percent of people with diabetes have type 2; about 80 percent are
overweight. Type 2 diabetes is more common among people who are older;
obese; have a family history of diabetes; have had gestational diabetes;
and are of African American, Hispanic American, Asian American, Pacific
Islander, and Native American ethnicities.

**Gestational diabetes** develops or is discovered during pregnancy.
This type usually disappears when the pregnancy is over, but women who
have had gestational diabetes have a greater risk of developing type 2
diabetes later in their lives.

# WHAT IS THE SCOPE AND IMPACT OF DIABETES?

Diabetes is widely recognized as one of the leading causes of death and
disability in the United States. It was the seventh leading cause of
death listed on U.S. death certificates in 1995 and contributed to
187,800 deaths that same year.

Both type 1 and type 2 diabetes are associated with long-term
complications that threaten life and the quality of life. Diabetes is
the leading cause of adult blindness, end-stage renal disease, and
nontraumatic lower-extremity amputations (as a result of nerve disease).
People with diabetes are 2 to 4 times more likely to have coronary heart
disease and stroke than people without diabetes. In addition, poorly
controlled diabetes can complicate pregnancy, and birth defects are more
common in babies born to women with diabetes.

Diabetes costs the United States \$98.2 billion each year. Medical costs
for diabetes care \-- including hospitalizations, medical care and
treatment supplies \-- total \$44.1 billion. Indirect costs \--
including disability payments, time lost from work and premature death
\-- total \$54.1 billion.

**HOW IS DIABETES DIAGNOSED?**

Symptoms of type 1 diabetes usually develop over a short period of time,
although beta cell destruction can begin months, even 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 can lapse into a life-threatening coma.

The symptoms of type 2 diabetes develop gradually and are not as
noticeable as in type 1 diabetes. Symptoms include feeling tired or ill,
frequent urination (especially at night), unusual thirst, weight loss,
blurred vision, frequent infections, and slow-healing wounds and sores.

In 1997 the Expert Committee on the Diagnosis and Classification of
Diabetes published new guidelines for the diagnosis of diabetes. The
guidelines lowered the blood sugar values for diagnosis and recommended
use of the fasting plasma glucose test to diagnose diabetes, a simpler
and faster test than the commonly used oral glucose tolerance test.
Glucose levels greater than or equal to 126mg/dl with the fasting plasma
glucose test, or greater than or equal to 200 mg/dl with the oral
glucose tolerance test indicate a diagnosis of diabetes.^1^

**HOW IS DIABETES MANAGED?**

Diabetes is a self-managed disease because people with diabetes must
take responsibility for their day-to-day care. Much of the daily care
involves keeping blood glucose near normal levels at all times.

**Management of type 1 diabetes:** People with type 1 diabetes need
daily injections of insulin because their bodies no longer produce
insulin. Treatment requires a strict regimen that typically includes a
carefully calculated diet, planned physical activity, self-testing of
blood glucose, and multiple daily insulin injections.

**Management of type 2 diabetes:** Treatment for people with type 2
diabetes typically includes diet management, exercise, self-testing of
blood glucose, and, in some cases, oral medication and/or insulin.
Approximately 40 percent of people with type 2 diabetes require insulin
injections.

The goal of diabetes management is to keep blood glucose levels as close
to a normal range as safely possible, while avoiding blood glucose
levels that are too high (hyperglycemia) or too low (hypoglycemia). A
1993 study called the Diabetes Control and Complications Trial (DCCT),
conclusively showed that intensive glucose control delayed the onset and
progression of eye disease, kidney disease and nerve disease by "a range
of 35 to more than 70 percent." In fact, it demonstrated that *any*
sustained lowering of blood glucose helps, even if the person has a
history of poor control. This study was conducted by the National
Institute of Diabetes and Digestive and Kidney Diseases of the National
Institutes of Health.^2^

**WHAT ARE THE MAJOR DIABETES ADVANCES?**

In recent years, advances in diabetes research have led to better ways
to manage diabetes and treat its complications. Major advances include:

-   New forms of purified insulin that are less likely to cause allergic
    reactions and are nearly identical to the insulin naturally produced
    by the body.

-   Development of external and implantable insulin pumps that deliver
    appropriate amounts of insulin, replacing daily injections.

-   New oral medications to improve control of type 2 diabetes.

-   Better ways for patients, doctors and other health professionals to
    monitor blood glucose\-- notably, new devices for self-monitoring of
    blood glucose, which is performed by the patient, and the hemoglobin
    A1c (also called H-b-A-one-c) laboratory test, which measures blood
    glucose control during the previous 3-month period.

-   Effective treatment for diabetic eye disease.

-   Better ways to manage diabetic pregnancies, improving chances of
    successful outcomes.

-   Treatment strategies to reduce damage to the kidneys, eyes and
    nerves.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Adapted from *Diabetes Overview*. National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health, NIH
Publication No. 96-3873, October 1995.

^1^Report of the Executive Committee on the Diagnosis and Classification
of Diabetes Mellitus. *Diabetes Care*. 1997 July; 20 (7): 1183-97.

^2^The Effect of Intensive Treatment of Diabetes on the Development and
Progression of Long-Term Complications in Insulin-Dependent Diabetes
Mellitus. *The New England Journal of Medicine*. 1993 September 30; 329
(14): 977-86.