Well the bad news first–Diabetes is up with obesity, the good news is we are treating it more effectively.
Decreases in Diabetes-Related Complications, 1990–2010
Research · April 17, 2014
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Researchers examined the incidence of diabetes-related complications (lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis) in the United States from 1990 through 2010. Rates of all five complications declined between 1990 and 2010, with the largest declines in acute myocardial infarction and death from hyperglycemic crisis.
While these declines are substantial, the absolute number of complications associated with diabetes remains high due to the widespread prevalence of the disease.
– Moshe Ornstein, MD
Diabetes
M Sue Kirkman MD
ABSTRACT
BACKGROUND
Preventive care for adults with diabetes has improved substantially in recent decades. We examined trends in the incidence of diabetes-related complications in the United States from 1990 through 2010.
METHODS
We used data from the National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System, and the U.S. National Vital Statistics System to compare the incidences of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis between 1990 and 2010, with age standardized to the U.S. population in the year 2000.
RESULTS
Rates of all five complications declined between 1990 and 2010, with the largest relative declines in acute myocardial infarction (−67.8%; 95% confidence interval [CI], −76.2 to −59.3) and death from hyperglycemic crisis (−64.4%; 95% CI, −68.0 to −60.9), followed by stroke and amputations, which each declined by approximately half (−52.7% and −51.4%, respectively); the smallest decline was in end-stage renal disease (−28.3%; 95% CI, −34.6 to −21.6). The greatest absolute decline was in the number of cases of acute myocardial infarction (95.6 fewer cases per 10,000 persons; 95% CI, 76.6 to 114.6), and the smallest absolute decline was in the number of deaths from hyperglycemic crisis (−2.7; 95% CI, −2.4 to −3.0). Rate reductions were larger among adults with diabetes than among adults without diabetes, leading to a reduction in the relative risk of complications associated with diabetes. When expressed as rates for the overall population, in which a change in prevalence also affects complication rates, there was a decline in rates of acute myocardial infarction and death from hyperglycemic crisis (2.7 and 0.1 fewer cases per 10,000, respectively) but not in rates of amputation, stroke, or end-stage renal disease.
CONCLUSIONS
Rates of diabetes-related complications have declined substantially in the past two decades, but a large burden of disease persists because of the continued increase in the prevalence of diabetes.
The New England Journal of Medicine
Changes in Diabetes-Related Complications in the United States, 1990–2010
N. Engl. J. Med 2014 Apr 17;370(16)1514-1523, EW Gregg, Y Li, J Wang, NR Burrows, MK Ali, D Rolka, DE Williams, L Geiss