What is Diabetes?

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The specific roles of different cause of diabetes continue to be elusive, but it is clear that, along with genetics, obesity, diet, and lack of physical activity are important. ¹

• There are 20.8 million people in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed, 6.2 million people (or nearly one-third) are unaware that they have the disease. ¹
  
  
• 1.5 million new cases of diabetes were diagnosed in people aged 20 years or older in 2005. ¹
  
  
• 176,500, or 0.22% of all people under 20 years of age have diabetes. About one in every 400 to 600 children and adolescents has type 1 diabetes. ¹
  
  
• Two (2) million adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-diabetes. ¹
  
  
• 10.3 million, or 20.9% of all people age 60 years or older have diabetes. ¹
  
  
• Men: 10.9 million, or 10.5% of all men aged 20 years or older have diabetes although nearly one third of them do not know it.
  
  
• Women: 9.7 million, or 8.8% of all women aged 20 years or older have diabetes although nearly one third of them do not know it. The prevalence of diabetes is at least 2 to 4 times higher among non-Hispanic Black, Hispanic/Latino American, American Indian, and Asian/Pacific Islander women than among non-Hispanic white women
  
  
• Non-Hispanic whites: 13.1 million, or 8.7% of all non-Hispanic whites aged 20 years or older have diabetes.
  
  
• Non-Hispanic Blacks: 3.2 million, or 13.3% of all non-Hispanic blacks aged 20 years or older have diabetes. After adjusting for population age differences, non-Hispanic blacks are 1.8 times as likely to have diabetes as non-Hispanic whites.
  
  
• Hispanic/Latino Americans: After adjusting for population age differences, Mexican Americans, the largest Hispanic/Latino subgroup, are 1.7 times as likely to have diabetes as non-Hispanic whites. If the prevalence of diabetes among Mexican Americans was applied to the total Hispanic/Latino population, about 2.5 million (9.5%) Hispanic/Latino Americans aged 20 years or older would have diabetes. Sufficient data are not available to derive estimates of the total prevalence of diabetes (both diagnosed and undiagnosed diabetes) for other Hispanic/Latino groups. However, residents of Puerto Rico are 1.8 times as likely to have diagnosed diabetes as U.S. non-Hispanic whites.
  
  
• American Indians and Alaska Natives: 99,500, or 12.8% of American Indians and Alaska Natives aged 20 years or older who received care from IHS in 2003 had diagnosed diabetes. 118,000 (15.1%) American Indians and Alaska Natives aged 20 years or older have diabetes (both diagnosed and undiagnosed diabetes). Taking into account population age differences, American Indians and Alaska Natives are 2.2 times as likely to have diabetes as non-Hispanic whites.
  
  
• Asian Americans and Pacific Islanders: The total prevalence of diabetes (both diagnosed and undiagnosed diabetes) is not available for Asian Americans or Pacific Islanders. However, in Hawaii, Asians, Native Hawaiians, and other Pacific Islanders aged 20 years or older are more than 2 times as likely to have diagnosed diabetes as whites after adjusting for population age differences. Similarly, in California, Asians were 1.5 times as likely to have diagnosed diabetes as non-Hispanic whites. Other groups within these populations also have increased risk for diabetes.
  
  
• Each year in the United States, diabetes is diagnosed in about 800,000 people. ²
• Percent of noninstitutionalized adults 20 years and older with diabetes (diagnosed or undiagnosed): 9.4 (1999-2002)
• Percent of noninstitutionalized adults 20 years and older with diagnosed diabetes: 6.6 (1999-2002)
• Percent of noninstitutionalized adults 20 years and older with undiagnosed diabetes: 2.9 (1999-2002)
• Number of visits to office-based physicians for diabetes: 23.1 million ³
  
  
• Number of hospital outpatient department visits for diabetes: 2.6 million ⁴
  
  
• Average length of hospital stay: 4.7 days ⁵
  
  
• Number of current patients with diabetes as primary diagnosis:106,000 (2000) ⁵
  
  
• Percent of current patients with diabetes as primary diagnosis: 7.9 (2000) ⁶
  
  
• Average length of stay for discharges with diabetes as primary diagnosis: 357 days ⁷
• Number of diabetes deaths: 73,249
  
  
• Diabetes deaths per 100,000 population: 25.4 ⁸
  
  
• Cause of death rank: 6 ⁸
  
  

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¹ The American Diabetes Association Web site: www.diabetes.org
² Health, United States, 2005, table 55
³ National Ambulatory Medical Care Survey: 2003 Summary, table 13
⁴ National Hospital Ambulatory Medical Care Survey: 2003 Outpatient Department Summary, table 12
⁵ 2003 National Hospital Discharge Survey, tables 2, 4
⁶ National Home and Hospice Care Survey, table 12
⁸ Deaths: Final Data for 2002, tables 9, 10

So, what can be done about it?

There is much evidence to support the importance of behavioral and patient education approaches to helping individuals adopt diabetes self management.

• Diabetes self management includes ⁽¹⁾
• Helping individuals set goals for managing their disease -plans will be better implemented if individuals are involved in setting their own plans.
• Teaching people skills directly related to their disease, like monitoring blood sugar or following medication plans
• Teaching skills for eating a healthy diet and getting physical activity
• Skills for healthy coping with the stressors of daily life that may upset diabetes management and the additional stressors and challenges diabetes poses
• Self control and problem solving skills for pursuing ones goals and keeping temptations from upsetting plans
• Ongoing support for diabetes management and adjustment of management plans as circumstances change - it is 24/7 for "the rest of your life"
• Community resources for, e.g., physical activity and healthy diet, and help in identifying them.
• Continuity of quality clinical care to keep medical management plans up-to-date with a disease that naturally changes over time
  
  
• Meta-analyses have found that programs teaching and promoting diabetes self management improved patterns of disease management ⁽²⁾ and metabolic control among adults with Type 2 diabetes ⁽³⁾.
  
  
• Two major, multi-site clinical trials provide additional support for diabetes self management.
• The Diabetes Control and Complications Trial demonstrated that teaching patients self management skills for implementing intensive regimens to enhance glycemic control reduced complications of diabetes ^{(4, 5)}.
• The Diabetes Prevention Program demonstrated that self management to implement physical activity and modest weight loss (150 minutes per week, loss of 7% of body weight) among high risk individuals reduced conversion to type 2 diabetes by 58% relative to controls (6). (Similar findings were also achieved with lifestyle interventions in Japan ⁽⁷⁾ and Finland ⁽⁸⁾.)
  
  
• Multiple individual studies that have also documented benefits of diabetes self management have included group and individual self management interventions and have achieved improvements in self-efficacy, self-management behaviors, metabolic control, patient satisfaction, and quality of life ^(9-17), including among older Type 2 patients and ethnic minorities ^(18-20).

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1. Fisher EB, Brownson CA, O'Toole ML, Shetty G, Anwuri VV, Glasgow RE. Ecologic approaches to self management: The case of diabetes. American Journal of Public Health 2005;95(9):1523-1535.
2. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001;24:561-587.
3. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with Type 2 Diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care 2002;25:1159-1171.
4. The Diabetes Control and Complications Trial Research Group. 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;329:977-986.
5. The Diabetes Control and Complications Trial Research Group. Implementation of treatment protocols in the Diabetes Control and Complications Trial. Diabetes Care 1995;18(3):361-376.
6. Diabetes Prevention Program Research Group. Reduction of the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 2002;346:393-403.
7. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537-544.
8. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England Journal of Medicine 2001;344:1343-1350.
9. Anderson RM, Funnell MM, Barr PA, Dedrick RF, Davis WK. Learning to empower patients: Results of professional education program for diabetes educators. Diabetes Care 1991;14:584-590.
10. Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC. Patient empowerment. Results of a randomized controlled trial. Diabetes Care 1995;18:943-949.
11. Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank H. Patients' participation in medical care: Effects on blood sugar control and quality of life in diabetes. Journal of General Internal Medicine 1988;3:448-457.
12. Rubin RR, Peyrot M, Saudek CD. Effect of diabetes education on self-care, metabolic control, and emotional well-being. Diabetes Care 1989;12:673-679.
13. Rubin RR, Peyrot M, Saudek CD. The effect of a comprehensive diabetes education program incorporating coping skills training on emotional wellbeing and diabetes self-efficacy. The Diabetes Educator 1993;19:210-214.
14. Muhlhauser I, Berger M. Diabetes education and insulin therapy: When will they ever learn. Journal of Internal Medicine 1993;233:321-326.
15. Pieber TR, Brunner GA, Schnedl WJ, Schattenberg S, Kaufmann P, Krejs GJ. Evaluation of a structured outpatient group education program for intensive insulin therapy. Diabetes Care 1995;18:625-630.
16. Clement S. Diabetes self-management education. Diabetes Care 1995;18:1204-1214.
17. Aubert RE, Herman WH, Waters J, Moore W, Sutton D, Peterson BL, et al. Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial. Annals of Internal Medicine 1998;129(8):605-612.
18. Glasgow R, Toobert DJ, Hampson S. Participation in outpatient diabetes education programs: How many patients take part and how representative are they? Diabetes Educator 1991;5:376-380.
19. Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J. Improving self-care among older patients with type II diabetes: the 'Sixty Something...' Study. Patient Education and Counseling 1992;19:61-74.
20. Anderson RM, Herman WH, Davis JM, Friedman RP, Funnell MM, Neighbors HW. Barriers to improving diabetes care for black persons. Diabetes Care 1991;14:605-609.