Total Prevalence of Diabetes in the United States, All Ages, 2005
Total: 20.8 million people—7.0 percent of the population—have
diabetes.
Diagnosed: 14.6 million people
Undiagnosed: 6.2 million people
Prevalence of Diagnosed Diabetes in People Aged 20 Years or Younger, United
States, 2005
About 176,500 people aged 20 years or younger have diabetes. This group
represents 0.22 percent of all people in this age group.
About one in every 400 to 600 children and adolescents has type 1
diabetes.
Although type 2 diabetes can occur among youth, the nationally representative
data that would be needed to monitor diabetes trends in youth by type are not
available. Clinically based reports and regional studies suggest that type 2
diabetes, although still rare, is being diagnosed more frequently in children
and adolescents, particularly in American Indians, African Americans, and
Hispanic/Latino Americans.
Note:
CDC’s
National Health Interview Survey (NHIS) is the only source of national data on
diabetes in children and adolescents. Because diabetes is relatively rare in
this age group and the NHIS sample size is small, prevalence estimates for
diabetes in youth vary considerably from year to year, to reduce this
variability, prevalence estimates in this report are based on 5 years of NHIS
data instead of 3, resulting in a lower estimate of diabetes in youth than the
estimate for 2003. CDC and the National Institutes of Health are funding a
5-year study, SEARCH for Diabetes in Youth, which is examining the incidence and
prevalence of diabetes in youth in six geographical regions of the United
States. When completed, the SEARCH study will provide more reliable estimates of
diabetes in youth.
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.
Total Prevalence of Diabetes by Race/Ethnicity Among People Aged 20 Years or
Older, United States, 2005
Non-Hispanic whites: 13.1 million; 8.7 percent of all non-Hispanic
whites aged 20 years or older have diabetes.
Non-Hispanic blacks: 3.2 million; 13.3 percent of all non-Hispanic
blacks aged 20 years or older have diabetes. After adjusting for population age
differences, non-Hispanic blacks are 1.8 times as likely to have diabetes as
non-Hispanic whites of similar age.
Hispanic/Latino Americans: After adjusting for population age
differences, Mexican Americans, the largest Hispanic/Latino subgroup, are 1.7
times as likely to have diabetes as non-Hispanic whites. If the prevalence of
diabetes among Mexican Americans was applied to the total Hispanic/Latino
population, about 2.5 million (9.5 percent) Hispanic/Latino Americans aged 20
years or older would have diabetes. Sufficient data are not available to derive
estimates of the total prevalence of diabetes (both diagnosed and undiagnosed
diabetes) for other Hispanic/Latino groups. However, residents of Puerto Rico
are 1.8 times as likely to have diagnosed diabetes as non-Hispanic whites in the
United Sates.
American Indians and Alaska Natives who receive care from the Indian
Health Service (IHS): 99,500; 12.8 percent of American Indians and Alaska
Natives aged 20 years or older who received care from the Indian Health Service
(IHS) in 2003 had diagnosed diabetes. Applying the rate of undiagnosed diabetes
in the total U.S. population to the American Indians and Alaska Natives who
receive care from IHS gives an estimate of 118,000 (15.1 percent) American
Indians and Alaska Natives aged 20 years or older with diabetes (both diagnosed
and undiagnosed diabetes). After adjusting for population age differences, the
total prevalence of diabetes in this group is lowest among Alaska Natives (8.1
percent) and highest among American Indians in the southern United States (26.7
percent) and in southern Arizona (27.6 percent). Taking into account population
age differences, American Indians and Alaska Natives are 2.2 times as likely to
have diabetes as non-Hispanic whites.
Asian Americans and Native Hawaiian or other Pacific Islanders: The
total prevalence of diabetes (both diagnosed and undiagnosed diabetes) is not
available for Asian Americans or Pacific Islanders. In Hawaii, however, Asians,
Native Hawaiians, and other Pacific Islanders aged 20 years or older are more
than 2 times as likely to have diagnosed diabetes as whites after adjusting for
population age differences. Similarly in California, Asians were 1.5 times as
likely to have diagnosed diabetes as non-Hispanic whites. Other groups within
these populations also have increased risk for diabetes.
Deaths Among People with Diabetes, United States, 2002
Diabetes was the sixth leading cause of death listed on U.S. death
certificates in 2002. This ranking is based on the 73,249 death certificates in
which diabetes was listed as the underlying cause of death. According to death
certificate reports, diabetes contributed to a total of 224,092 deaths.
Diabetes is likely to be underreported as a cause of death. Studies have
found that only about 35 to 40 percent of decedents with diabetes have diabetes
listed anywhere on the death certificate and only about 10 to15 percent had it
listed as the underlying cause of death.
Overall, the risk for death among people with diabetes is about twice that
of people without diabetes of similar age.
Complications of Diabetes in the United States
Heart disease and stroke
Heart disease and stroke account for about 65 percent of deaths in people
with diabetes.
Adults with diabetes have heart disease death rates about 2 to 4 times
higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher among people with diabetes.
High blood pressure
About 73 percent of adults with diabetes have blood pressure greater than or
equal to 130/80 mm Hg or use prescription medications for
hypertension.
Blindness
Diabetes is the leading cause of new cases of blindness among adults aged 20
to 74 years.
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each
year.
Kidney disease
Diabetes is the leading cause of kidney failure, accounting for 44 percent
of new cases in 2002.
In 2002 in the United Sates and Puerto Rico, 44,400 people with diabetes
began treatment for end-stage kidney disease.
In 2002 in the United States and Puerto Rico,153,730 people with end-stage
kidney disease due to diabetes were living on chronic dialysis or with a kidney
transplant.
Nervous system disease
About 60 to 70 percent of people with diabetes have mild to severe forms of
nervous system damage. The results of such damage include impaired sensation or
pain in the feet or hands, slowed digestion of food in the stomach, carpal
tunnel syndrome, and other nerve problems.
Almost 30 percent of people with diabetes aged 40 years or older have
impaired sensation in the feet (i.e., at least one area that lacks
feeling).
Severe forms of diabetic nerve disease are a major contributing cause of
lower-extremity amputations.
Amputations
More than 60 percent of nontraumatic lower-limb amputations occur among
people with diabetes.
In 2002, about 82,000 nontraumatic lower-limb amputations were performed in
people with diabetes.
Dental disease
Periodontal (gum) disease is more common in people with diabetes. Among
young adults, those with diabetes have about twice the risk of those without
diabetes.
Almost one-third of people with diabetes have severe periodontal diseases
with loss of attachment of the gums to the teeth measuring 5 millimeters or
more.
Complications of pregnancy
Poorly controlled diabetes before conception and during the first trimester
of pregnancy can cause major birth defects in 5 to 10 percent of pregnancies and
spontaneous abortions in 15 to 20 percent of pregnancies.
Poorly controlled diabetes during the second and third trimesters of
pregnancy can result in excessively large babies, posing a risk to both mother
and child.
Other complications
Uncontrolled diabetes often leads to biochemical imbalances that can cause
acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar
(nonketotic) coma.
People with diabetes are more susceptible to many other illnesses and, once
they acquire these illnesses, often have worse prognoses. For example, they are
more likely to die with pneumonia or influenza than people who do not have
diabetes.
Prevention of Diabetes Complications
Diabetes can affect many parts of the body and can lead to serious
complications such as blindness, kidney damage, and lower-limb amputations.
Working together, people with diabetes and their health care providers can
reduce the occurrence of these and other diabetes complications by controlling
the levels of blood glucose, blood pressure, and blood lipids and by receiving
other preventive care practices in a timely manner.
Glucose control
Studies in the United States and abroad have found that improved glycemic
control benefits people with either type 1 or type 2 diabetes. In general, every
percentage point drop in A1C blood test results (e.g., from 8 to 7 percent)
reduces the risk of microvascular complications (eye, kidney, and nerve disease)
is reduced by 40 percent.
Blood pressure control
Blood pressure control reduces the risk of cardiovascular disease (heart
disease or stroke) among persons with diabetes by 33 to 50 percent, and the risk
of microvascular complications (eye, kidney, and nerve disease) by about 33
percent.
In general, for every 10 mm Hg reduction in systolic blood pressure, the
risk for any complication related to diabetes is reduced by 12
percent.
Control of blood lipids
Improved control of cholesterol or blood lipids (for example, HDL, LDL, and
triglycerides) can reduce cardiovascular complications by 20 to 50
percent.
Preventive care practices for eyes, kidneys, and feet
Detecting and treating diabetic eye disease with laser therapy can reduce
the development of severe vision loss by an estimated 50 to 60 percent.
Comprehensive foot care programs can reduce amputation rates by 45 to 85
percent.
Detecting and treating early diabetic kidney disease by lowering blood
pressure can reduce the decline in kidney function by 30 to 70 percent.
Treatment with ACE inhibitors and angiotensin receptor blockers (ARBs) are more
effective in reducing the decline in kidney function than other blood
pressure-lowering drugs.
Cost of diabetes in the United States, 2002
Total (direct and indirect): $132 billion
Direct medical costs: $92 billion
Indirect costs: $40 billion (disability, work loss, premature
mortality)
These data are based on a study conducted by the Lewin
Group, Inc., for the American Diabetes Association and are 2002 estimates of
both the direct costs (cost of medical care and services) and indirect costs
(costs of short-term and permanent disability and of premature death)
attributable to diabetes. This study uses a specific cost-of-disease methodology
to estimate the health care costs that are due to diabetes.
Treating Diabetes
To survive, people with type 1 diabetes must have insulin delivered by
injections or a pump.
Many people with type 2 diabetes can control their blood glucose by
following a healthy meal plan and exercise program, losing excess weight, and
taking oral medication.
Many people with diabetes also need to take medications to control their
cholesterol and blood pressure.
Diabetes self-management education (DMSE) is an integral component of
medical care.
Among adults with diagnosed diabetes, 16 percent take insulin only, 12
percent take both insulin and oral medication, 57 percent take oral medication
only, and 15 percent do not take either insulin or oral medications.
Pre-diabetes: Impaired glucose tolerance and impaired fasting glucose
Prediabetes is a condition that raises the risk of developing type 2
diabetes, heart disease, and stroke. People with prediabetes have blood glucose
levels higher than normal but not high enough to be classified as diabetes.
People with pre-diabetes have impaired fasting glucose (IFG) or impaired
glucose tolerance (IGT). Some people have both IFG and IGT.
IFG is a condition in which the fasting blood glucose level is 100 to 125
milligrams per deciliter (mg/dL) after an overnight fast. The level is higher
than normal but is not high enough to be classified as diabetes.
IGT is a condition in which the blood glucose level is 140 to 199 mg/dL
after a 2-hour oral glucose tolerance test. This level is higher than normal but
not high enough to be classified as diabetes.
In a cross-section sample of U.S. adults aged 40 to 74 years (tested from
1988 to 1994), 33.8 percent had IFG, 15.4 percent had IGT, and 40.1 percent had
pre-diabetes (IGT or IFG or both). Applying these percentages to the entire U.S.
population in 2000, an estimated 35 million adults aged 40 to 74 years had IFG,
16 million had IGT, and 41 million had pre-diabetes (there is overlap between
the IFG and IGT groups).
Progression to diabetes among those with pre-diabetes is not inevitable.
Studies have shown that people with pre-diabetes who lose weight and increase
their physical activity can prevent or delay diabetes and even return their
blood glucose levels to normal.
