Rates of five major diabetes-related complications have declined substantially in the last 20 years among U.S. adults with diabetes, according to a study by the Centers for Disease Control and Prevention, published in the current issue of the New England Journal of Medicine.
Rates of lower-limb amputation, end-stage kidney failure, heart attack, stroke, and deaths due to high blood sugar (hyperglycemia) all declined. Cardiovascular complications and deaths from high blood sugar decreased by more than 60 percent each, while the rates of both strokes and lower extremity amputations – including upper and lower legs, ankles, feet, and toes – declined by about half. Rates for end stage kidney failure fell by about 30 percent.
"These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes," said Edward Gregg, Ph.D., a senior epidemiologist in CDC's Division of Diabetes Translation and lead author of the study. "While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes."
Because the number of adults reporting diabetes during this time frame more than tripled – from 6.5 million to 20.7 million – these major diabetes complications continue to put a heavy burden on the U.S. health care system. Nearly 26 million Americans have diabetes and an additional 79 million have prediabetes and are at risk of developing the disease. Diabetes and its complications account for $176 billion in total medical costs each year.
CDC researchers used data from the National Health Interview Survey, National Hospital Discharge Survey, U.S. Renal Data System, and Vital Statistics, to examine trends in the occurrence of diabetes-related complications in the United States between 1990 and 2010.
Although all complications declined, the greatest declines in diabetes-related complications occurred for heart attack and stroke, particularly among people aged 75 years and older. The study authors attribute the declines in diabetes-related complications to increased availability of health care services, risk factor control, and increases in awareness of the potential complications of diabetes.