Journal Wrap: Major Diabetes-Related Complications Are on the Decline
A new study, sponsored by the Centers for Disease Control and Prevention, offers some sweet news for US adults with diabetes: the rates of five major diabetes-related complications have declined substantially in the last 20 years. Gregg et al. used data from the National Health Interview Survey, National Hospital Discharge Survey, US Renal Data System, and National Vital Statistics System from 1990 through 2010 to determine the incidence of lower-extremity amputation, end-stage renal disease (ESRD), acute myocardial infarction (AMI), stroke, and death from hyperglycemic crisis.
Over the 20-year period, rates of all five complications dropped (all p < 0.001), with the following percent changes between 1990 and 2010:
- AMI: 67.8%
- death from hyperglycemic crisis: 64.4%
- stroke: 52.7%
- amputations: 51.4%
- ESRD: 28.3%
Rates of absolute decline were highest in AMI (95.6 fewer cases per 10,000 persons) and smallest in the number of deaths from hyperglycemic crisis (2.7 fewer cases per 10,000 persons; FIGURE). When expressed as rates for the overall population, in which the changing prevalence rate of diabetes was permitted to influence the rates of complications, there was a decline in rates of AMI and death from hyperglycemic crisis (2.7 and 0.1 fewer cases per 10,000, respectively), but not in rates of amputation, stroke, or ESRD.
In the past 2 decades, the investigators wrote, preventive care for adults with diabetes has improved substantially, and, as the results from this study showed, increases in availability of health care services, risk factor control, and awareness of diabetes' potential complications have led to a move in the right direction. However, some distasteful news tempers the good: during the study's timeframe, the number of adults reporting diabetes more than tripled—from 6.5 to 20.7 million—meaning that a large burden of disease persists, and will likely continue to increase in the coming decades without a concerted effort to curb its growing incidence and prevalence.
Gregg EW, Li Y, Wang J, et al. N Engl J Med. 2014;370:1514-23.
Keywords: Centers for Disease Control and Prevention, U.S., Prevalence, Incidence, Myocardial Infarction, Stroke, Diabetes Complications, Kidney Failure, Chronic, Risk Factors, Health Care Surveys, Awareness
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