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Diabetics faring better these days reports new study

A new study has found that diabetes-related complications have decreased significantly during the past two decades
A new study has found that diabetes-related complications have decreased significantly during the past two decades
Robin Wulffson, MD

Diabetics are at increased for many medical conditions including cardiovascular disease, loss of vision, and peripheral artery disease that results in amputations. A new study has found that diabetes-related complications have decreased significantly during the past two decades. The findings were published by the Centers for Disease Control and Prevention (CDC) on April 17 in The New England Journal of Medicine.

The study authors note that, in recent decades, preventive care for adults with diabetes has improved significantly. To clarify the degree of improvement, they reviewed trends in the incidence of diabetes-related complications in the US from 1990 through 2010. They accessed data from the National Health Interview Survey, the National Hospital Discharge Survey, the US Renal Data System, and the US National Vital Statistics System to compare the incidences of the following diabetic complications: lower-extremity amputation, end-stage renal (kidney) disease, acute myocardial infarction (heart attack), stroke, and death from hyperglycemic crisis (extremely high blood sugar). They reviewed data from 1990 through 2010 and standardized the data to the United States population in the year 2000.

The investigators found that the rates of all five complications decreased during the study period; the largest relative declines were found in acute myocardial infarction (−67.8% decrease) and death from hyperglycemic crisis (−64.4% decrease); stroke decreased by –52.7% and amputations decreased by −51.4%. (Relative decline is the percentage difference between 1990 and 2010.) The smallest relative decline was found with end-stage renal disease (−28.3%; 95% CI, −34.6 to −21.6). The largest absolute decline was found in the number of acute myocardial infarction cases (95.6 fewer cases per 10,000 persons); the smallest absolute decline was found in the number of deaths from hyperglycemic crisis (−2.7). (Absolute decline refers to the difference in actual number of cases.) The rate reductions were greater among adults with diabetes than among adults without diabetes; thus, resulting in a reduction in the relative risk of diabetes-related complications. When the data was expressed as rates for the overall population, in which a change in prevalence also affects complication rates, the investigators found a decrease in the rates of acute myocardial infarction and death from hyperglycemic crisis but not in rates of amputation, stroke, or end-stage renal disease.

The authors concluded that the rates of diabetes-related complications have declined significantly during the past two decades; however, a large burden of disease persists because of the continued increase in the prevalence of diabetes.

There are three types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is thought to be an autoimmune disease that destroys insulin-producing cells in the pancreas. It requires insulin injections for control. Type 2 diabetes is much more common in individuals who are overweight, do not exercise, and/or have an unhealthy diet. Gestational diabetes appears during pregnancy and usually resolves afterward; however, women have gestational diabetes are at increased risk for type 2 diabetes later in life.

The basic treatment for diabetes is to maintain blood sugar (glucose) in a healthy range. Emphasis is on control of blood sugar by monitoring the levels, regular physical activity, meal planning, and routine healthcare. Treatment of diabetes is an ongoing process of management and education that includes not only the person with diabetes, but also healthcare professionals and family members. Often, type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone. However, over time, these measures are not enough and either oral or injected medications and/or insulin must be used. Treatment often includes: proper diet; weight control; an appropriate exercise program; and regular foot inspections.

Regular monitoring of the hemoglobin A1c levels is necessary for good diabetes control. The hemoglobin A1c test shows the average amount of sugar in the blood over the last three months. The result will indicate if the blood sugar level is under control. The frequency of HbA1c testing will be determined by your doctor. It is recommended that testing occur at least twice a year if the blood sugar level is in the target range and stable, and more frequently if the blood sugar level is unstable.

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