Over the past two decades preventive care for adults diagnosed with diabetes has substantially improved, and although rates of diabetes-related complications have declined substantially, a large burden of disease persists because of the continued increase in the prevalence of diabetes, according to a report published April 16 in the New England Journal of Medicine.

The study, led by Edward Gregg, PhD, the Division of Diabetes Translation, Centers for Disease Control and Prevention, examined the recurring trends in the incidence of diabetes-related complications in the U.S. from 1990-2010, and utilized 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. Gregg and his colleagues compared the incidences of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis.

Results showed that between 1990 and 2010 the number of adults that reported a diagnosis of diabetes more than tripled, from 6.5 million to 20.7 million. Despite such a rise the rates of all five complications declined in the same span of time, with the largest relative decline in acute myocardial infarction (-67.8 percent; 95 percent confidence interval [CI], -76.2 to -59.3) and death from hyperglycemic crisis (-64.4 percent; 95 percent CI, -68.0 to -60.9), followed by stroke and amputations, which each declined by approximately half (-52.7 percent and -51.4 percent, respectively). The smallest decrease was in end-stage renal disease (-28.3 percent; 95 percent 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 people; 95 percent CI, 76.6 to 114.6), and the smallest absolute decline was in the number of deaths from hyperglycemic crisis (-2.7; 95 percent CI, -2.4 to -3.0). The results also found that rate reductions were larger among adults with diabetes than among adults without diabetes, showing a reduction in the relative risk of complications associated with the condition.

The authors note that these findings reflect a combination of advances in acute clinical care, improvements in the performance of the health care system, health promotion efforts directed at patients with diabetes, and an increased emphasis on the integrated management of care for patients with chronic diseases, including enhancements in team-based care, patient education, and clinical decision-making support. Such changes, paralleled by enhanced management of risk and detection are all likely to be of significant influence.

Ultimately, while the results of the report are encouraging in the rate reduction of morbidity and hyperglycemia-related mortality in the U.S. adult population, it does not signify any imminent reductions in the overall burden of diabetes-related complications. The annual numbers of amputations, cases of end-stage renal disease, and strokes continue to increase because of the large increase in the number of prevalent cases of diabetes. The authors conclude that given that the baby-boom generation is shifting into an age range characterized by a high incidence of diabetes and related morbidity, the total burden of cases will only continue to increase in the coming decades.

Keywords: Centers for Disease Control and Prevention, U.S., Prevalence, Risk, Myocardial Infarction, Stroke, Hyperglycemia, Diabetes Complications, Health Promotion, Morbidity, Kidney Failure, Chronic, Health Care Surveys