Diabetes
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What is diabetes?
Diabetes is a disorder of metabolism?the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.
After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.
When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.
The three main types of diabetes are type 1, type 2, and gestational diabetes.
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body?s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.
At present, scientists do not know exactly what causes the body?s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults but can appear at any age.
Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.
Type 2 Diabetes
The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. About 80 percent of people with type 2 diabetes are overweight.
Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.
When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes?glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.
Gestational Diabetes
Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.
About 3 to 8 percent of pregnant women in the United States develop gestational diabetes. As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms.
How is diabetes diagnosed?
The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:
* A blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an 8-hour fast. This test is called the fasting blood glucose test.
* A blood glucose level of 200 mg/dL or more 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).
* A random (taken at any time of day) blood glucose level of 200 mg/dL or more, along with the presence of diabetes symptoms.
Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.
What is pre-diabetes?
People with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.
Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some people have both IFG and IGT.
* IFG is a condition in which the blood glucose level is high (100 to 125 mg/dL) after an overnight fast, but is not high enough to be classified as diabetes. (The former definition of IFG was 110 mg/dL to 125 mg/dL.)
* IGT is a condition in which the blood glucose level is high (140 to 199 mg/dL) after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes.
Pre-diabetes is becoming more common in the United States, according to new estimates provided by the U.S. Department of Health and Human Services. About 40 percent of U.S. adults ages 40 to 74?or 41 million people?had pre-diabetes in 2000. New data suggest that at least 54 million U.S. adults had pre-diabetes in 2002. Many people with pre-diabetes go on to develop type 2 diabetes within 10 years.
The good news is that if you have pre-diabetes, you can do a lot to prevent or delay diabetes. Studies have clearly shown that you can lower your risk of developing diabetes by losing 5 to 7 percent of your body weight through diet and increased physical activity. A major study of more than 3,000 people with IGT, a form of pre-diabetes, found that diet and exercise resulting in a 5 to 7 percent weight loss?about 10 to 14 pounds in a person who weighs 200 pounds?lowered the incidence of type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week.
What are the scope and impact of diabetes?
Diabetes is widely recognized as one of the leading causes of death and disability in the United States. Diabetes, however, is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke.
Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.
What was the total prevalence of diabetes in the United States for all ages in 2005?
Total: 20.8 million people?7 percent of the population?have diabetes.
Diagnosed: 14.6 million people
Undiagnosed: 6.2 million people
Who gets diabetes?
Diabetes is not contagious. People cannot 'catch' it from each other. However, certain factors can increase the risk of developing diabetes.
Type 1 diabetes occurs equally among males and females but is more common in whites than in non-whites. Data from the World Health Organization?s Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown. Type 1 diabetes develops most often in children but can occur at any age.
Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanics/Latinos. On average, non-Hispanic African Americans are 1.8 times as likely to have diabetes as non-Hispanic whites of the same age. Mexican Americans are 1.7 times as likely to have diabetes as non-Hispanic whites of similar age. (Data are not available for estimation of diabetes rates in other Hispanic/Latino groups.) American Indians have one of the highest rates of diabetes in the world. On average, American Indians and Alaska Natives are 2.2 times as likely to have diabetes as non-Hispanic whites of similar age. Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limited, some groups, such as Native Hawaiians, Asians, and other Pacific Islanders residing in Hawaii (aged 20 or older) are more than twice as likely to have diabetes as white residents of Hawaii of similar age.
Diabetes prevalence in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanics/Latinos and other minority groups at increased risk make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates from the Centers for Disease Control and Prevention (CDC), diabetes will affect one in three people born in 2000 in the United States. The CDC also projects the prevalence of diagnosed diabetes in the United States will increase 165 percent by 2050.
How is diabetes managed?
Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.
Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period.
Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.
Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control?it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications (if needed). By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by the health care team, and smoking cessation can also help lower risk.
People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low?a condition known as hypoglycemia?a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.
A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.
People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians?internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include:
* a primary care provider such as an internist, a family practice doctor, or a pediatrician
* an endocrinologist (a specialist in diabetes care)
* a dietitian, a nurse, and other health care providers who are certified diabetes educators?experts in providing information about managing diabetes
* a podiatrist (for foot care)
* an ophthalmologist or an optometrist (for eye care)
and other health care providers, such as cardiologists and other specialists. In addition, the team for a pregnant woman with type 1, type 2, or gestational diabetes should include an obstetrician who specializes in caring for women with diabetes. The team can also include a pediatrician or a neonatologist with experience taking care of babies born to women with diabetes.
The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.
This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches?intensive management and standard management?on the development and progression of eye, kidney, nerve, and cardiovascular complications of diabetes. Intensive treatment aimed to keep A1C levels as close to normal (6 percent) as possible. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a follow-up study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted more than 10 years after the trial ended.
The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.
What exactly is type 2 diabetes?
Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.
People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body?s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.
Can type 2 diabetes be prevented?
Research has demonstrated that people at risk for type 2 diabetes can prevent or delay developing type 2 diabetes by losing a little weight. The results of the Diabetes Prevention Program (DPP) showed that moderate diet changes and physical activity can delay and prevent type 2 diabetes. Participants in this Federally funded study of 3,234 people at high risk for diabetes experienced a 5- to 7-percent weight loss. For example, a 5- to 7-percent weight loss for a 200-pound person would be 10 to 14 pounds.
Study participants were overweight and had higher than normal levels of blood glucose, a condition called pre-diabetes, also called impaired glucose tolerance. Both pre-diabetes and obesity are strong risk factors for type 2 diabetes. Because of the high risk for diabetes among some minority groups, about half of the DPP participants were African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino.
DPP participants also included others at high risk for developing type 2 diabetes, such as women with a history of gestational diabetes and individuals aged 60 and older.
The DPP tested two approaches to preventing diabetes: lifestyle change?a program of healthy eating and exercise?and the diabetes drug metformin. People in the lifestyle change group exercised about 30 minutes a day 5 days a week, usually by walking, and lowered their intake of fat and calories. Those who took the diabetes drug metformin received information on exercise and diet. A third group only received information on exercise and diet.
The results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. In the first year of the study, people lost an average of 15 pounds. Lifestyle change was even more effective in those aged 60 and older. They reduced their risk by 71 percent. People receiving metformin reduced their risk by 31 percent.
What are the signs and symptoms of type 2 diabetes?
More than 6 million people in the United States have type 2 diabetes and do not know it. Many have no signs or symptoms. Symptoms can also be so mild that you might not even notice them. Some people have symptoms but do not suspect diabetes.
Symptoms include
* increased thirst
* increased hunger
* fatigue
* increased urination, especially at night
* weight loss
* blurred vision
* sores that do not heal
Many people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. If you find out early that you have diabetes, then you can get treatment to prevent damage to the body.
What does having pre-diabetes mean?
Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. It also means you are at risk for getting type 2 diabetes and heart disease. However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years.
How can I reduce my risk of diabetes?
You can do a lot to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and losing a little weight can help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy.
Total Prevalence of Diabetes Among People Aged 20 Years or Older, United States, 2005
Age 20 years or older: 20.6 million; 9.6 percent of all people in this age group have diabetes.
Age 60 years or older: 10.3 million; 20.9 percent of all people in this age group have diabetes.
Men: 10.9 million; 10.5 percent of all men aged 20 years or older have diabetes.
Women: 9.7 million; 8.8 percent of all women aged 20 years or older have diabetes.
Source: National Institutes of Health
Adhering to healthy lifestyle habits associated with reduced lifetime risk of heart failure
2009 AUG 4 - (NewsRx.com) -- Men who exercised regularly, drank moderately, did not smoke, who were not overweight and had a diet that included cereal and fruits and vegetables had a lower lifetime risk of heart failure, according to a study in the July 22/29 issue of JAMA. With an annual incidence of 550,000, heart failure remains a major public health issue and is the leading cause of hospitalization among older adults in the United States. Despite improved medical and surgical management, death after onset of heart failure remains high, ranging from 20 percent to 50 percent. The lifetime risk of heart failure at age 40 years is approximately 1 in 5 in the general population; however, it has been unclear whether adherence to healthy lifestyle factors, such as regular exercise and not smoking, could lead to a reduction in lifetime risk of heart failure, according to background information in the article. "A demonstration of beneficial influence of healthy lifestyle habits on the lifetime risk has potential clinical and public health implications." Luc Djousse, M.D., Sc.D., M.P.H., of Brigham and Women's Hospital, Harvard Medical School and Boston Veterans Affairs Healthcare System, Boston, and colleagues assessed the association between modifiable lifestyle factors and the remaining lifetime risk of heart failure in a large group of men. The study included data from 20,900 men (average age at the start of the study, 53.6 years) from the Physicians' Health Study I (1982-2008) who were apparently healthy at baseline. Six modifiable lifestyle factors were assessed: body weight, smoking, exercise, alcohol intake, consumption of breakfast cereals and consumption of fruits and vegetables. During an average follow-up of 22.4 years, 1,200 new cases of heart failure (5.7 percent) and 4,999 confirmed deaths (23.9 percent) occurred in the study. Compared with participants adhering to no healthy lifestyle factors, those adhering to 4 or more factors tended to be older and had a lower prevalence of hypertension and diabetes mellitus. Analysis indicated that overall, the lifetime risk of heart failure was 13.8 percent at age 40 years and remained constant through age 70; at age 80 years, the lifetime risk for heart failure was 10.6 percent. The remaining lifetime risk of heart failure was approximately 2 percent to 4 percent higher in men with hypertension than in those without hypertension. The researchers found that normal body weight, never smoking, regular exercise, moderate alcohol intake, and consumption of breakfast cereal and fruits and vegetables were individually associated with a lower lifetime risk of heart failure compared to a corresponding undesirable behavior. There was an inverse and graded association between the number of healthy lifestyle factors and lifetime risk of heart failure. "For example, the lifetime risk for heart failure was approximately 1 in 5 (21.2 percent) in men adhering to none of the desirable lifestyle factors, compared to 1 in 10 (10.1 percent) in those adhering to 4 or more healthy lifestyle factors," the authors write. When restricted to body weight, smoking, and exercise, the association between lifestyle factors and lifetime risk of heart failure persisted in the overall population as well as in men with and without hypertension. "Our estimate of lifetime risk of heart failure could help public health officials allocate resources for the prevention and management of this condition. Our findings of a low lifetime risk in men who adhere to modifiable lifestyle factors emphasize the need for incorporation of these behaviors in prevention strategies against heart failure at both the individual and the population level," the authors write. (JAMA. 2009;302[4]:385-393. Available pre-embargo to the media at www.jamamedia.org) Keywords: Bariatrics, Cardiology, Heart Failure, Obesity, Public Health, JAMA and Archives Journals. This article was prepared by Cardiovascular Business Week editors from staff and other reports. Copyright 2009, Cardiovascular Business Week via NewsRx.com.
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