Changes in Diabetes-Related Complications in the United States, 1990–2010

Study Questions:

What are the trends in the incidence of diabetes-related complications in the United States from 1990 through 2010?

Methods:

The investigators used data from the National Health Interview Survey, the National Hospital Discharge Survey, the US Renal Data System, and the US 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 US 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, 76.6-114.6), 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:

The authors concluded that the 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.

Perspective:

This analysis of nationally representative data showed large reductions in the incidence of a broad spectrum of diabetes-related complications between 1990 and 2010 in the US population of adults with diabetes. The magnitude of reduction was greatest for cardiovascular disease, particularly acute myocardial infarction, which has historically been the most common diabetes-related complication. Reductions in rates were smallest for end-stage renal disease, which actually increased among older adults. 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 incidence has doubled in the past 15 years and the prevalence has tripled as mortality has declined. The total burden, or absolute number of cases of complications, will probably continue to increase in the coming decades, and every effort needs to be made to reduce the incidence and prevalence of diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: Stroke, Myocardial Infarction, Risk Factors, Metabolic Syndrome X, Incidence, Diabetes Complications, Cardiovascular Diseases, Health Care Surveys, Population Groups, United States, Diabetes Mellitus, Renal Insufficiency, Chronic


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