New survey results show huge burden of diabetes

January 27, 2009

Study Includes sensitive test of blood glucose abnormalities

In the United States, nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed, according to epidemiologists from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), whose study includes newly available data from an Oral Glucose Tolerance Test (OGTT). Diabetes is especially common in the elderly: nearly one-third of those age 65 and older have the disease. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range. The researchers report these findings in the February 2009 issue of Diabetes Care, which posted a pre-print version of the article online at http://diabetes.org/diabetescare.

The study compared the results of two national surveys that included a fasting blood glucose (FBG) test and 2-hour glucose reading from an OGTT. The OGTT gives more information about blood glucose abnormalities than the FBG test, which measures blood glucose after an overnight fast. The FBG test is easier and less costly than the OGTT, but the 2-hour test is more sensitive in identifying diabetes and pre-diabetes, especially in older people. Two-hour glucose readings that are high but not yet diabetic indicate a greater risk of cardiovascular disease and of developing diabetes than a high, but not yet diabetic, fasting glucose level.

"We're facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes," said lead author Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the NIH. "For years, diabetes prevalence estimates have been based mainly on data that included a fasting glucose test but not an OGTT. The 2005-2006 National Health and Nutrition Examination Survey, or NHANES, is the first national survey in 15 years to include the OGTT. The addition of the OGTT gives us greater confidence that we're seeing the true burden of diabetes and pre-diabetes in a representative sample of the U.S. population."

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. It is the most common cause of blindness, kidney failure, and amputations in adults and a leading cause of heart disease and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases and virtually all cases of undiagnosed diabetes. Pre-diabetes, which causes no symptoms, substantially raises the risk of a heart attack or stroke and of developing type 2 diabetes.

In its analysis, the team also found that:

* The rate of diagnosed diabetes increased between the surveys, but the prevalence of undiagnosed diabetes and pre-diabetes remained relatively stable.
* Minority groups continue to bear a disproportionate burden. The prevalence of diabetes, both diagnosed and undiagnosed, in non-Hispanic blacks and Mexican- Americans is about 70 to 80 percent higher than that of non-Hispanic whites.
* Diabetes prevalence was virtually the same in men and women, as was the proportion of undiagnosed cases.
* Pre-diabetes is more common in men than in women (36 percent compared to 23 percent).
* Diabetes is rare in youth ages 12 to 19 years, but about 16 percent have pre-diabetes.

"These findings have grave implications for our health care system, which is already struggling to provide care for millions of diabetes patients, many of whom belong to vulnerable groups, such as the elderly or minorities," said Griffin P. Rodgers, M.D., director of the NIDDK. "Of paramount importance is the need to curb the obesity epidemic, which is the main factor driving the rise in type 2 diabetes."

The study is based on 2005-2006 data from the NHANES conducted by the CDC's National Center for Health Statistics. The survey involved 7,267 people, who represented a national sample of persons age 12 years and older. Participants were interviewed in their homes and received a physical exam. A subsample had a blood sugar reading taken after an overnight fast as well as the OGTT, sometimes called a 2-hour glucose challenge. The OGTT measures blood glucose 2 hours after a person drinks a premeasured sugary beverage. The findings were then compared to those of the last NHANES survey that included the OGTT, which was conducted from 1988 to 1994.

"These findings of yet another increase in diabetes prevalence are a reminder that a full-scale public health response is in order. Re-directing the trends in diabetes will require changing the nutritional and physical activity habits of people at risk, and also creative and substantial efforts by health systems and communities," said Ed Gregg, Ph.D., epidemiology and statistics branch chief in CDC's Division of Diabetes Translation.

"It's important to know if you have diabetes or pre-diabetes, because there's so much you can do to preserve your health," said Joanne Gallivan, M.S., R.D., director of the National Diabetes Education Program (NDEP) for the NIH. "You should talk to your health care professional about your risk. If your blood glucose is high but not high enough to be diagnosed as diabetes, losing a modest amount of weight and increasing physical activity will greatly lower your risk of getting type 2 diabetes. If you already have diabetes, controlling your blood glucose, blood pressure, and cholesterol will prevent or delay the complications of diabetes."

People over age 45 should be tested for pre-diabetes or diabetes. Those younger than 45 who are overweight and have another risk factor should ask their health care provider about testing. People are at greater risk of developing pre-diabetes and type 2 diabetes if they:

* are age 45 or older
* have a family history of diabetes
* are overweight
* are inactive (exercise less than three times a week)
* are members of a high-risk ethnic population (e.g., African American, Hispanic/Latino American, American Indian and Alaska Native, Asian American, Pacific Islander)
* have high blood pressure: 140/90 mm/Hg or higher
* have an HDL cholesterol less than 35 mg/dL or a triglyceride level 250 mg/dL or higher
* have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds
* have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system
* have acanthosis nigricans (dark, thickened skin around neck or armpits)
* have a history of disease of the blood vessels to the heart, brain, or legs
* have had higher-than-normal blood glucose levels on previous testing.

NIH/National Institute of Diabetes and Digestive and Kidney Diseases

---

---

	Diabetes Diet: The 101 Best Diabetic Foods by Millwood Media Stuck in a meal rut and tired of the same old foods? If you’re someone who is dealing with diabetes, there’s no question that you must be paying attention to what you eat each day. The foods you put into your body are going to have a very strong influence on not only how well you feel, but on how well you handle this condition altogether. By making smart food choices, you can maintain control over your diabetes and live the lifestyle that you want to lead. The following 101 foods will do just that. We’ve selected the top picks that you should include in your diet plan regularly so you no longer have to wonder what to eat. This list is meant to encourage you to broaden your eating choices. This prevents the boredom that many experience...
	The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed by Gretchen Becker (Author), Allison B. Goldfine (Foreword) After Gretchen Becker was diagnosed with type 2 diabetes in 1996, she educated herself on every aspect of this chronic condition — by reading medical and scientific books and journals, talking with doctors and listening to her own body. In 2001, she marshaled everything she had learned as a "patient-expert" into the first edition of this book, which she has now completely updated and revised. The First Year®—Type 2 Diabetes uniquely guides you step-by-step through your first year with diabetes, walking you through everything you need to learn and do each day of your first week after diagnosis, each subsequent week of the first month, and each subsequent month of the crucial first year. In clear, concise, accessible language, Becker covers a wide range of practical, medical, and...
	Diabetes For Dummies®, Mini Edition by For Dummies Treat diabetes successfully and lead a full lifeWant to know how to manage diabetes? You'll learn about all the advances in monitoring glucose, the latest medications, and how to develop a diet and exercise plan to stay healthy. And if you need to use insulin, this book explains your options.Open the book and find:Ways to reduce your diabetes riskExplanations of the different types of diabetesNutritional advice for maintaining a healthy weightExplanations of the available treatment optionsStrategies for getting the daily exercise you need
	Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes without Drugs by Neal D. Barnard (Author) Until Dr. Barnard’s scientific breakthrough, most health professionals believed that once you developed diabetes, you were stuck with it—and could anticipate one complication after another, from worsening eyesight and nerve symptoms to heart and kidney problems. But as this groundbreaking work reveals, this simply is not true. In a series of studies—the most recent funded by the National Institutes of Health—Dr. Barnard has shown that it is possible to repair insulin function and reverse type 2 diabetes. By following his scientifically proven, life-changing program, diabetics can control blood sugar three times more effectively than with the standard diet; and cut back on and in some cases eliminate medications while reducing the risk of diabetes complications. "The long overdue...
	What Do I Eat Now?: A Step-by-Step Guide to Eating Right with Type 2 Diabetes by M.S. Patti Geil (Author), R.D. Tami A. Ross R.D. (Author) The DIY approach to a diabetes diet! What Do I Eat Now? is the single best resource for people with diabetes to learn how to eat right and eat healthy with diabetes. Each chapter explains a vital concept of diabetes nutrition in easy-to-understand language. “Tell Me What to Eat” meal plans and recipes at the end of each chapter get readers started on a lifetime of healthy eating. Don’t waste time trying to figure everything out from scratch when What Do I Eat Now? gives readers a step-by-step plan for understanding how to eat right. Learn as you go by cooking healthy, nutritious, and flavorful diabetic meals!
	The Starvation Treatment of Diabetes by Rena Sarah (Author) This anthology is a thorough introduction to classic literature for those who have not yet experienced these literary masterworks. For those who have known and loved these works in the past, this is an invitation to reunite with old friends in a fresh new format. From Shakespeare’s finesse to Oscar Wilde’s wit, this unique collection brings together works as diverse and influential as The Pilgrim’s Progress and Othello. As an anthology that invites readers to immerse themselves in the masterpieces of the literary giants, it is must-have addition to any library.
	Diabetes For Dummies by Alan L. Rubin MD (Author) Covers the latest glucose meters and insulin treatments The straight facts on treating diabetes successfully and living a full lifeWant to know how to manage diabetes? Leading diabetes expert Dr. Alan Rubin gives you reassuring, authoritative guidance in putting together a state-of-the-art treatment program. You'll learn about all the advances in monitoring glucose, the latest medications, and how to develop a diet and exercise plan to stay healthy. You'll also see how to overcome insurance and on-the-job obstacles.Discover how to:Reduce your diabetes riskUnderstand the different types of diabetesManage diabetes in children and the elderlyPrevent long-term complicationsGet the support you need
	Blood Sugar 101: What They Don't Tell You About Diabetes by Jenny Ruhl (Author) Based on the award winning Bloodsugar101.com web site, this book explains what peer-reviewed research published in top medical journals has to say about: + What is a normal blood sugar?   + How does diabetes develop? + What really causes diabetes? + What blood sugar levels cause complications? + Must you deteriorate? + What diet is right for you? + How can you make that diet work? + What medications are safe? + What supplements lower blood sugar? Written in clear and understandable language, this book provides all the tools needed to understand how blood sugar works and achieve blood sugar health. "...this book should be read by all diabetics because of the valuable material that cannot be found elsewhere."...
	American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts (American Diabetes Association Comlete Guide to Diabetes) by American Diabetes Association (Author) The American Diabetes Association—the nation's leading health organization supporting diabetes research, information, and advocacy—has completely revised this comprehensive home reference to provide all the information a person needs to live an active, healthy life with diabetes. Now in its fifth edition, this extensive resource contains information on the best self-care techniques and the latest medical advances. For people with diabetes, this extraordinary guide will answer any question. Topics include the latest on self-care for type 1, type 2, and gestational diabetes; new types of insulin and medications; strategies for avoiding diabetes complications; expanded sections on meal planning and nutrition; and tips on working with the health care system and insurance...
	Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars by Richard K. Bernstein (Author) Originally published in 1997, DR. BERNSTEIN'S DIABETES SOLUTION is a unique resource that covers both adult- and childhood-onset diabetes, explains step-by-step how to normalize blood sugar levels and prevent or reverse complications, and offers detailed guidelines for establishing a treatment plan. Readers will find fifty gourmet recipes, in addition to a comprehensive discussion of diet, obesity, and new drugs to curb carbohydrate craving and overeating. Now in its fourth edition, the book presents up-to-the-minute information on insulin resistance, blood-testing devices, measuring blood sugar, new types of insulin, gastroparesis and other issues, as well as updated diet guidelines. DR. BERNSTEIN'S DIABETES SOLUTION is the one book every diabetic must own.