Diabetes Information Sheet

What is diabetes?

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood.

Diabetes is the seventh leading cause of death in the United States and the sixth leading cause of death in Maryland. This is likely an underestimate because diabetes also contributes to deaths from heart disease, stroke and kidney disease. In addition, diabetes causes other complications including heart failure, blindness and lower-extremity amputations. However, people with diabetes, working together with their support network and their health care providers, can take steps to control the disease and lower the risk of complications.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:

• Frequent urination
• Excessive thirst
• Unexplained weight loss
• Extreme hunger
• Sudden vision changes
• Tingling or numbness in hands or feet
• Feeling very tired much of the time
• Very dry skin
• Sores that are slow to heal
• More infections than usual

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.

What are the types of diabetes?

Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be called diabetes. Studies have shown that by losing weight and increasing physical activity people can prevent or delay pre-diabetes from progressing to diabetes.

Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, may account for about 5% of all diagnosed cases of diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age

Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently.

Gestational diabetes is a type of diabetes diagnosed during pregnancy. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 10% of all pregnancies but usually disappears when a pregnancy is over.

Other specific types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 5% of all diagnosed cases of diabetes.

What is the prevalence of diabetes?

Some astonishing facts on the prevalence of diabetes:

• Diabetes affects 25.8 million or 8.3% of the U.S. population.
• Among U.S. residents aged 65 years and older, 10.9, or 26.9%, had diabetes in 2010.
• Among African Americans, 18.7% aged 20 and older had diabetes.
• About 215,000 Americans younger than age 20 had diabetes (type 1 or type 2) in the U.S. in 2010.
• About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 in the U.S.
• In 2005 - 2008, 35% of U.S. adults aged 20 years or older had prediabetes (50% of adults aged 65 years or older). Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults aged 20 years or older with prediabetes.

For Maryland-specific data, please see the "Chronic Disease in Maryland: Facts and Figures".

What are the risk factors for diabetes?

Risk factors for type 1 diabetes may be autoimmune, genetic, or environmental. There is no known way to prevent type 1 diabetes. Several clinical trials for preventing type 1 diabetes are currently in progress or are being planned.

Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.

Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes have a 35% to 60% chance of developing type 2 diabetes in the next 10-20 years.

Other specific types of diabetes, which may account for 1% to 5% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

How is diabetes diagnosed?

The following tests are used for diagnosis:

A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least 8 hours. A value greater than 126 mg/dL is considered diagnostic of diabetes.

An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least 8 hours and 2 hours after the person drinks a glucose-containing beverage. A value greater than 200 mg/dL is considered diagnostic of diabetes.

A random plasma glucose test, also called a casual plasma glucose test, measures blood glucose without regard to when the person being tested last ate. A value greater than 200 mg/dL in association with symptoms of hyperglycemia is considered diagnostic of diabetes.

Hemoglobin A1c serves as a marker for average blood glucose levels over the previous 3 months prior to the measurement. A value greater than 6.5% is considered diagnostic of diabetes. Measurement of hemoglobin A1c is also the standard for monitoring long-term glycemic control.

Test results indicating that a person has diabetes should be confirmed with a second test on a different day.

People with fasting glucose levels from 100 to 125 mg/dL are considered to have impaired fasting glucose. Patients with plasma glucose between 140 mg/dL and 200 mg/dL two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Impaired fasting glucose and impaired glucose tolerance are indicators of prediabetes.

What is the treatment for diabetes?

Diet, insulin, and oral medication to lower blood glucose levels are the foundation of diabetes treatment and management. Patient education and self-care practices are also important aspects of disease management that help people with diabetes lead normal lives.
To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.

Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight, and taking oral medication. Medications for each individual with diabetes will often change during the course of the disease. Some people with type 2 diabetes may also need insulin to control their blood glucose.

Self-management education or training is a key step in improving health outcomes and quality of life. It focuses on self-care behaviors, such as healthy eating, being active, and monitoring blood sugar. It is a collaborative process in which diabetes educators help people with or at risk for diabetes gain the knowledge and problem-solving and coping skills needed to successfully self-manage the disease and its related conditions.

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.
Many people with diabetes also need to take medications to control their cholesterol and blood pressure.

Can diabetes be prevented?

Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop type 1 diabetes, but prevention remains elusive.

A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. The Diabetes Prevention Program (DPP), a large prevention study of people at high risk for diabetes, showed that lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by 58% during a 3-year period. The reduction was even greater, 71%, among adults aged 60 years or older. Treatment with the drug metformin reduced the risk by 31% overall and was most effective in younger (aged 25 - 44 years) and in heavier (body mass index >35) adults. Prevention or delay of type 2 diabetes with either lifestyle or metformin intervention was effective in all racial and ethnic groups studied and has been shown to persist for at least 10 years. Interventions to prevent or delay type 2 diabetes in individuals with prediabetes can be feasible and cost-effective. Research has found that lifestyle interventions are more cost-effective than medications.

The information presented here was adapted from the diabetes website of the Centers for Disease Control and Prevention.

Resources

Centers for Disease Control and Prevention
National Diabetes Education Program
American Diabetes Association