Estimated total prevalence of diabetes in. people aged 20 years or older, by age group In people with diabetes, however, the. pancreas either produces …
Diabetes
Overview
National Diabetes Information Clearinghouse
Almost everyone knows someone who has diabetes An estimated 208 million people in the United States–70 percent of the population–have diabetes, a serious, lifelong condition Of those, 146 million have been diagnosed, and 62 million have not yet been diagnosed In 2005, about 15 million people aged 20 or older were diagnosed with diabetes For additional statistics, see the National Diabetes Statistics fact sheet online at wwwdiabetesniddknih gov/dm/pubs/statistics or call the National Diabetes Information Clearinghouse at 18008608747 to request a copy
What is diabetes?
Diabetes is a disorder of metabolism– the way our bodies use digested food for growth and energy Most of the food we eat is broken down into glucose, the form of sugar in the blood Glucose is the main source of fuel for the body After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy For glucose to get into cells, insulin must be present Insulin is a hormone produced by the pancreas, a large gland behind the stomach When we eat, the pancreas automatically produces the right amount of insulin to move
glucose from blood into our cells In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appro priately to the insulin that is produced Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine Thus, the body loses its main source of fuel even though the blood con tains large amounts of glucose
National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH
Estimated total prevalence of diabetes in people aged 20 years or older, by age group– United States, 2005
25 20
Percent
15 10 5 0
2039
4059 Age Group
60
Source: 19992002 National Health and Nutrition Examination Survey estimates of total prevalence both diagnosed and undiagnosed were projected to year 2005
What are the types of diabetes?
The three main types of diabetes are type 1 diabetes type 2 diabetes
US Department of Health and Human Services
gestational diabetes
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease An autoimmune disease results when the bodys system for fighting infection the immune system turns against a part of the body In diabetes, the immune system attacks
and destroys the insulin-producing beta cells in the pancreas The pancreas then produces little or no insulin A person who has type 1 diabetes must take insulin daily to live At present, scientists do not know exactly what causes the bodys immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States It develops most often in children and young adults but can appear at any age Symptoms of type 1 diabetes usually devel op over a short period, although beta cell destruction can begin years earlier Symp toms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue If not diagnosed and treated with insulin, a per son with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis
Type 2 Diabetes
The most common form of diabetes is type 2 diabetes About 90 to 95 percent of people with diabetes have type 2 This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of
gestational diabetes, physical inactivity, and certain ethnicities About 80 percent of people with type 2 diabetes are overweight Type 2 diabetes is increasingly being diagnosed in children and adolescents However, nationally representative data on prevalence of type 2 diabetes in youth are not available When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condi tion called insulin resistance After several years, insulin production decreases The result is the same as for type 1 diabetes– glucose builds up in the blood and the body cannot make efficient use of its main source of fuel The symptoms of type 2 diabetes develop gradually Their onset is not as sudden as in type 1 diabetes Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores Some people have no symptoms
2 Diabetes Overview
Gestational Diabetes
Some women develop gestational diabetes late in pregnancy Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 20 to
50 percent chance of developing type 2 diabetes within 5 to 10 years Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes About 3 to 8 percent of pregnant women in the United States develop gestational diabetes As with type 2 diabetes, gesta tional diabetes occurs more often in some ethnic groups and among women with a family history of diabetes Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin Women with gestational diabetes may not experi ence any symptoms
How is diabetes diagnosed?
The fasting blood glucose test is the pre ferred test for diagnosing diabetes in chil dren and nonpregnant adults It is most reliable when done in the morning How ever, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day: A blood glucose level of 126 milli grams per deciliter mg/dL or more after an 8-hour fast This test is called the fasting blood glucose test A blood glucose level of 200 mg/dL or more 2 hours after drinking a beverage containing 75 grams of glucose dis solved in water This test is called the oral glucose tolerance test
OGTT A random taken at any time of day blood glucose level of 200 mg/dL or more, along with the presence of diabetes symptoms Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower Blood glucose levels are measured before a woman drinks a beverage contain ing glucose Then levels are checked 1, 2, and 3 hours afterward If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has ges tational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL
3 Diabetes Overview
What is pre-diabetes?
People with pre-diabetes have blood glu cose levels that are higher than normal but not high enough for a diagnosis of diabetes This condition raises the risk of developing type 2 diabetes, heart disease, and stroke Pre-diabetes is also called impaired fasting glucose IFG or impaired glucose tolerance IGT, depending on the test used to diagnose it Some people have both IFG and IGT IFG is a condition in which the blood
glucose level is high 100 to 125 mg/dL after an overnight fast, but is not high enough to be classified as diabetes The former definition of IFG was 110 mg/dL to 125 mg/dL IGT is a condition in which the blood glucose level is high 140 to 199 mg/dL after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes Pre-diabetes is becoming more common in the United States, according to new esti mates provided by the US Department of Health and Human Services About 40 percent of US adults ages 40 to 74–or 41 million people–had pre-diabetes in 2000 New data suggest that at least 54 million US adults had pre-diabetes in 2002 Many people with pre-diabetes go on to develop type 2 diabetes within 10 years The good news is that if you have pre diabetes, you can do a lot to prevent or delay diabetes Studies have clearly shown that you can lower your risk of developing diabetes by losing 5 to 7 percent of your body weight through diet and increased
physical activity A major study of more than 3,000 people with IGT, a form of pre-diabetes, found that diet and exercise resulting in a 5 to 7 percent weight loss– about 10 to 14 pounds in a person who weighs 200
pounds–lowered the incidence of type 2 diabetes by nearly 60 percent Study participants lost weight by cutting fat and calories in their diet and by exercising most chose walking at least 30 minutes a day, 5 days a week
What are the scope and impact of diabetes?
Diabetes is widely recognized as one of the leading causes of death and disability in the United States In 2002, it was the sixth leading cause of death However, diabetes is likely to be underreported as the under lying cause of death on death certificates About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke Diabetes is associated with long-term complications that affect almost every part of the body The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes In 2002, diabetes cost the United States 132 billion Indirect costs, including dis ability payments, time lost from work, and premature death, totaled 40 billion; direct medical costs for diabetes care, including hospitalizations, medical care,
and treat ment supplies, totaled 92 billion
4 Diabetes Overview
Who gets diabetes?
Diabetes is not contagious People cannot catch it from each other However, cer tain factors can increase the risk of devel oping diabetes Type 1 diabetes occurs equally among males and females but is more common in whites than in non-whites Data from the World Health Organizations Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations However, some northern European coun tries, including Finland and Sweden, have high rates of type 1 diabetes The reasons for these differences are unknown Type 1 diabetes develops most often in children but can occur at any age Type 2 diabetes is more common in older people, especially in people who are over weight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanics/ Latinos On average, non-Hispanic African Americans are 18 times as likely to have diabetes as non-Hispanic whites of the same age Mexican Americans are 17 times as likely to have diabetes as nonHispanic whites of similar
age Data are not available for estimation of diabetes rates in other Hispanic/Latino groups American Indians have one of the highest rates of diabetes in the world On average, American Indians and Alaska Natives are 22 times as likely to have diabetes as nonHispanic whites of similar age Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limit ed, some groups, such as Native Hawaiians,
Estimated age-adjusted total prevalence of diabetes in people aged 20 years or older, by race/ethnicity–United States, 2005
American Indians/ Alaska Natives Non-Hispanic blacks Hispanic/Latino Americans Non-Hispanic whites 0 2 4 6 8 10 12 14 16 18 20 Percent
Source: For American Indians/Alaska Natives, the estimate of total prevalence was calculated using the estimate of diagnosed diabetes from the 2003 outpatient database of the Indian Health Service and the estimate of undiagnosed diabetes from the 19992002 National Health and Nutrition Examination Survey For the other groups, 19992002 NHANES estimates of total prevalence both diagnosed and undiagnosed were projected to year 2005
Asians, and other Pacific Islanders residing in Hawaii aged 20 or older are more
than twice as likely to have diabetes as white residents of Hawaii of similar age Diabetes prevalence in the United States is likely to increase for several reasons First, a large segment of the population is aging Also, Hispanics/Latinos and other minority groups at increased risk make up the fastest-growing segment of the US population Finally, Americans are increas ingly overweight and sedentary According to recent estimates from the Centers for Disease Control and Prevention CDC, diabetes will affect one in three people born in 2000 in the United States The CDC also projects the prevalence of diagnosed diabetes in the United States will increase 165 percent by 2050
5 Diabetes Overview
How is diabetes managed?
Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes The amount of insulin must be balanced with food intake and daily activities Blood glucose levels must be closely monitored through frequent blood
glucose checking People with dia betes also monitor blood glucose levels several times a year with a laboratory test called the A1C Results of the A1C test reflect average blood glucose over a 2- to 3-month period Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels Adults with diabetes are at high risk for cardiovascular disease CVD In fact, at least 65 percent of those with diabetes die from heart disease or stroke Managing diabetes is more than keeping blood glucose levels under control–it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications if needed By doing so, those with diabetes can lower their risk Aspirin
therapy, if recommended by the health care team, and smoking cessation can also help lower risk People with diabetes must take responsibil ity for their day-to-day care Much of the daily care involves keeping blood glucose levels from going too low or too high When blood glucose levels drop too low– a
condition known as hypoglycemia–a person can become nervous, shaky, and confused Judgment can be impaired, and if blood glucose falls too low, fainting can occur A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will moni tor their diabetes control Most people with diabetes get care from primary care physicians–internists, family practice doctors, or pediatricians Often, having a team of providers can improve diabetes care A team can include a primary care provider such as an
internist, a family practice doctor,
or a pediatrician
an endocrinologist a specialist in
diabetes care
a dietitian, a nurse, and other health care providers who are certified diabetes educators–experts in providing information about managing diabetes
6 Diabetes Overview
a podiatrist for foot care an ophthalmologist or an optometrist for eye care and other health care providers, such as cardiologists and other specialists In addi tion, the team for a pregnant woman with type 1, type 2, or gestational diabetes should include an
obstetrician who special izes in caring for women with diabetes The team can also include a pediatrician or a neonatologist with experience taking care of babies born to women with diabetes The goal of diabetes management is to keep levels of blood glucose, blood pres sure, and cholesterol as close to the normal range as safely possible A major study, the Diabetes Control and Complications Trial DCCT, sponsored by the National Insti tute of Diabetes and Digestive and Kidney Diseases NIDDK, showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes
This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes The study compared the effect of two treat ment approaches–intensive management and standard management–on the devel opment and progression of eye, kidney, nerve, and cardiovascular complications of diabetes Intensive treatment aimed to keep A1C levels as close to normal 6 per cent as possible Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications More recently, a follow-up
study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted more than 10 years after the trial ended The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes
7 Diabetes Overview
Hope Through Research
NIDDK conducts research in its own labo ratories and supports a great deal of basic and clinical research in medical centers and hospitals throughout the United States It also gathers and analyzes statistics about diabetes Other Institutes at the National Institutes of Health NIH conduct and support research on diabetes-related eye diseases, heart and vascular complications, autoimmunity, pregnancy, and dental problems Other Government agencies that sponsor diabetes programs are the CDC, the Indian Health Service, the Health Resources and Services Administration, the Department of Veterans Affairs, and the Department of Defense Many organizations outside the Govern ment support diabetes research and educa tion activities These
organizations include the American Diabetes Association ADA, the Juvenile Diabetes Research Foundation International 
JDRF, and the American Association of Diabetes Educators In recent years, advances in diabetes research have led to better ways of manag ing diabetes and treating its complications Major advances include development of quick-acting, long-
acting, and inhaled insulins
better ways to monitor blood glucose and for people with diabetes to check their own blood glucose levels
development of external insulin pumps that deliver insulin, replacing daily injections laser treatment for diabetic eye dis ease, reducing the risk of blindness successful kidney and pancreas trans plantation in people whose kidneys fail because of diabetes better ways of managing diabetes in pregnant women, improving their chances of a successful outcome new drugs to treat type 1 and type 2 diabetes and better ways to manage this form of diabetes through weight control evidence that intensive management of blood glucose reduces and may prevent development of diabetes complications demonstration that two types of antihypertensive drugs, ACE angiotensin-converting enzyme inhibitors and
ARBs angiotensin receptor blockers, are more effective than other antihypertensive drugs in reducing a decline in kidney function in people with diabetes advances in transplantation of islets clusters of cells that produce insulin and other hormones for type 1 diabetes evidence that people at high risk for type 2 diabetes can lower their chances of developing the disease through diet, weight loss, and physical activity
8 Diabetes Overview
What will the future bring?
Researchers continue to look for the cause or causes of diabetes and ways to manage, prevent, or cure the disorder Scientists are searching for genes that may be involved in type 1 or type 2 diabetes Some genetic markers for type 1 diabetes have been identified, and it is now possible to screen relatives of people with type 1 diabetes to determine whether they are at risk
TEDDY is funded by the NIDDK, the National Institute of Allergy and Infectious Diseases NIAID, the National Institute of Child Health and Human Development NICHD, the National Institute of Envi ronmental Health Sciences, the CDC, the JDRF, and the ADA For more informa tion, see wwwniddknihgov/patient/TEDDY/ TEDDYhtm
Type 1 Diabetes TrialNet
Type
1 Diabetes TrialNet is a network of experts and facilities dedicated to develop ing new approaches to the understanding, prevention, and treatment of type 1 diabetes Clinical centers are located in the United States, Canada, Europe, and Australia TrialNet studies are focusing on understanding the natural history of type 1 diabetes to determine its caus es and how the disease progresses preventing type 1 diabetes in those
at risk
developing ways to preserve the func tion of the insulin-producing cells in the pancreas in people recently diag nosed with type 1 diabetes For more information, see wwwDiabetesTrialNetorg or call 1800HALTDM1 18004258361 In many ways, the TrialNet studies build on the advances and insights gained from earlier research in type 1 diabetes For example, researchers learned a great deal about how to predict type 1 diabetes in atrisk people from the Diabetes Prevention Trial–Type 1 DPT1 This study showed
Type 1 Diabetes
A number of Federally-funded research studies and clinical trials are under way Studies focus on the prevention and causes of type 1 diabetes as well as experimental treatments such as islet transplantation
The Environmental Determinants
of Diabetes in the Young Consortium
The main mission of The Environmental Determinants of Diabetes in the Young TEDDY consortium, an international group of clinical centers, is to identify infectious agents, dietary factors, or other environmental factors including psychoso cial events that trigger type 1 diabetes in those who are genetically susceptible In addition, the consortium aims to create a central repository of data
and biological samples for use by
researchers
develop novel approaches to finding the causes of type 1 diabetes find ways to understand how the
disease starts and progresses
discover new methods to prevent,
delay, and reverse type 1 diabetes
9 Diabetes Overview
that people at risk of developing type 1 diabetes can be identified The DPT-1 researchers discovered ways to identify two populations at risk of developing type 1 diabetes within 5 years: those at high risk with at least a 50 percent chance and those with an intermediate risk having a 25 to 50 percent risk Then researchers explored possible ways of preventing type 1 diabetes in both groups TrialNet will iden tify people at risk who may be eligible for clinical trials In addition, TrialNet
will conduct trials to save beta cell function in those with new onset type 1 diabetes TrialNet is funded by the NIDDK, NICHD, and NIAID JDRF and ADA also support this effort
Islet Transplantation
Researchers are working on a way for peo ple with type 1 diabetes to live without daily insulin injections In an experimental pro cedure called islet transplantation, islets are taken from a donor pancreas and trans ferred into a person with type 1 diabetes Once implanted, the beta cells in these islets begin to make and release insulin Scientists have made many advances in islet transplantation in recent years Since reporting their findings in the June 2000 issue of the New England Journal of Medi cine, researchers at the University of Alberta in Edmonton, Alberta, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes Before use of the Edmonton pro tocol, during the 1990s, less than 10 percent of islet cell transplant recipients were able to control blood glucose levels for more than 1 year without insulin injections The Collaborative Islet Transplant Registry CITR, funded by NIDDK, was created in 2001
CITRs mission is to expedite progress and promote safety in islet trans plantation by collecting, analyzing, and com municating data on islet transplantation The CITR will study islet transplantation alone as well as islet transplantation follow ing kidney transplant The September 2005 CITR annual report noted that with use of the Edmonton protocol, after 1 year, 58 percent of those who had transplants no longer needed to inject insulin Of those who were still
The Immune Tolerance Network
TrialNet works closely with the Immune Tolerance Network, another international, collaborative consortium Its goal is to find safe and effective ways to induce long-term immune tolerance–prevention of an unwanted immune response by the body For example, type 1 diabetes might be pre vented if scientists could learn how to pre vent the immune system from mistakenly attacking the insulin-producing cells in the pancreas Effective immune tolerance could possibly prevent the bodys rejection of organ or tissue transplants prevent or treat autoimmune diseases prevent or treat allergies and asthma
10 Diabetes Overview
insulin-dependent 1 year after transplanta tion 33 percent of those followed by
the registry, requirements for insulin were decreased The average reduction in insulin requirements was 69 percent In summary, a total of 91 percent of those with transplants showed improvement fol lowing transplantation The success of the Edmonton protocol has been confirmed at other study sites, including the NIDDK The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections For an average-sized person 154 pounds, a typical transplant requires about 1 million islets, extracted from two donor pancreases Because good control of blood glucose can slow or prevent the progression of compli cations associated with diabetes, such as nerve or eye damage, a successful trans plant may reduce the risk of these compli cations However, transplanted islets lose their ability to function over time Also, a transplant recipient needs to take immuno suppressive drugs to stop the immune sys tem from rejecting the transplanted islets These drugs have significant side effects, and their long-term effects are still unknown Immediate side effects of
immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as
stomach upset or diarrhea Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infec tions Taking immunosuppressive drugs increases the risk of tumors and cancer as well Researchers are trying to find safer or less toxic immunosuppressants or new approaches that will allow successful transplantation without the use of immunosuppressive drugs The results of the Edmonton protocol are very encouraging, but more research is needed to develop safer and more effective immunosuppression and to enhance islet survival after transplantation Another obstacle to widespread use of islet transplantation is the severe shortage of islets Only about 6,000 pancreases a year become available for transplantation or for harvesting of islets However, researchers are pursuing alternative sources, such as creating islets from other types of cells New technologies could then be employed to grow islets in the laboratory
11 Diabetes Overview
Type 2 Diabetes
Diabetes Prevention Program
In 1996, NIDDK launched its Diabetes Prevention Program DPP The goal of this research effort was to learn
how to prevent or delay type 2 diabetes in people with impaired glucose tolerance IGT, a strong risk factor for type 2 diabetes The findings of the DPP, released in August 2001, showed that people at high risk for type 2 diabetes could sharply lower their chances of developing the disorder through diet and exercise In addition, treatment with the oral diabetes drug metformin also reduced diabetes risk, though less dramati cally Metformin lowers the amount of glucose released by the liver and also fights insulin resistance, a condition in which the body doesnt use insulin properly Participants randomly assigned to intensive lifestyle intervention reduced their risk of
getting type 2 diabetes by almost 60 per cent On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5 to 7 percent of their body weight Participants randomized to treatment with metformin reduced their risk of getting type 2 diabetes by 31 percent Of the 3,234 participants enrolled in the DPP, 45 percent were from minority groups that suffer disproportionately from type 2 diabetes: African Americans, Hispanics/ Latinos,
Asian Americans and Pacific Islanders, and American Indians The trial also recruited other groups known to be at higher risk for type 2 diabetes, including individuals aged 60 and older, women with a history of gestational diabetes, and peo ple with a first-degree relative with type 2 diabetes Participants are being followed to check for long-term effects of the inter ventions, including the effects on risk of CVD
12 Diabetes Overview
Type 2 Diabetes in Children and Teens
Two studies focusing on type 2 diabetes in children and teens are under way The TODAY Treatment Options for type 2 Diabetes in Adolescents and Youth study, a 13-site study sponsored by NIDDK, will compare treatments for type 2 diabetes in children and teens Participants will undergo one of three treatments: taking one diabetes medication
metformin
taking two diabetes medications
metformin and rosiglitazone,
another medication that fights
insulin resistance
taking metformin and participating in an intensive lifestyle change program designed to promote weight loss by cutting calories and increasing physical activity
The main goal of the study is to determine how well each type of treatment controls
blood glucose levels The study also will evaluate how long each type of treatment is effective The STOPP-T2D Studies to Treat or Prevent Pediatric Type 2 Diabetes study, sponsored by NIDDK with support from the ADA, is exploring methods to lower risk factors for type 2 diabetes and CVD in middle-school children grades 6 through 8 at eight sites A 3-year program will focus on the benefits of improving nutri tion, promoting physical activity, and making changes in behavior
13
Diabetes Overview
Preventing and Treating CVD in People with Type 2 Diabetes
CVD is the main killer of people with type 2 diabetes For this reason, the NIH is studying the best strategies to prevent and treat CVD in people with diabetes in three major studies These studies are all joint efforts of the NIDDK and the National Heart, Lung, and Blood Institute The Look AHEAD Action for Health in Diabetes trial is the largest clinical trial to date to examine the long-term health effects of voluntary weight loss This multi-center, randomized clinical trial is studying the effects of a lifestyle inter vention designed to achieve and maintain weight loss over the long term through decreased caloric intake and
increased exercise Look AHEAD will focus on the disorder most associated with being over weight or obese, type 2 diabetes, and on the outcome that causes the greatest morbidity and mortality in people with type 2 diabetes, CVD The Action to Control Cardiovascular Risk in Diabetes ACCORD trial, a multi-center, randomized trial, is studying three approaches to preventing major car diovascular events in individuals with type 2 diabetes ACCORD is designed to com pare current practice guidelines with more intensive glycemic control in 10,000 individ uals with type 2 diabetes, including those at especially high risk for CVD events because of age, evidence of subclinical atherosclero sis, or existing clinical CVD More inten sive control of blood pressure than is called
for in current guidelines and a medication to reduce triglyceride levels and raise HDL good cholesterol levels will also be stud ied in subgroups of these 10,000 volunteers Each treatment strategy will be accompa nied by standard advice regarding lifestyle choices, including diet, physical activity, and smoking cessation, appropriate for individuals with diabetes The primary outcome to be measured is the first occurrence
of a major CVD event, specifically heart attack, stroke, or cardio vascular death In addition, the study will investigate the impact of the treatment strategies on other cardiovascular out comes; total mortality; limb amputation; eye, kidney, or nerve disease; health-related quality of life; and cost-effectiveness The Bypass Angioplasty Revascularization Investigation 2 Diabetes BARI 2D trial, a 5-year, multi-center clinical trial, is com paring medical versus early surgical man agement of patients with type 2 diabetes who also have coronary artery disease and stable angina or ischemia At the same time, BARI 2D will study the effect of two different strategies to control blood glucose–providing insulin versus increas ing the sensitivity of the body to insulin– on the risk of cardiovascular mortality and morbidity A complete listing of clinical trials can be found at wwwClinicalTrialsgov
14 Diabetes Overview
For More Information Points to Remember
What is diabetes? a disorder of metabolism–the way the body uses or converts food for energy and growth What are the main types of diabetes? type 1 diabetes type 2 diabetes gestational diabetes What are the impacts of diabetes?
It affects 208 million people– 70 percent of the US population It is a leading cause of death and disability It costs 132 billion per year Who gets diabetes? people of any age people with a family history of
diabetes
others at high risk for type 2 dia betes: older people, overweight and sedentary people, African Americans, Alaska Natives, Ameri can Indians, Asian Americans, Native Hawaiians, some Pacific Islander Americans, and Hispanics/ Latinos To learn more about type 1, type 2, and gestational diabetes, as well as diabetes research, statistics, and education, contact: National Diabetes Education Program 1 Diabetes Way Bethesda, MD 208149692 Phone: 18004385383 Internet: wwwndepnihgov To find a clinical trial, check NIHs data base at wwwClinicalTrialsgov online To participate in studies about type 1 diabetes, contact: Type 1 Diabetes TrialNet Phone: 18004258361 Internet: wwwDiabetesTrialNetorg The following organizations also distribute materials and support programs for people with diabetes and their families and friends: American Diabetes Association National Service Center 1701 North Beauregard Street Alexandria, VA 22311 Phone: 18003422383 Internet: wwwdiabetesorg
Juvenile Diabetes Research Foundation International 120 Wall Street New York, NY 10005 Phone: 18005332873 Internet: wwwjdrforg
15 Diabetes Overview
National Diabetes Information Clearinghouse
1 Information Way Bethesda, MD 208923560 Phone: 18008608747 Fax: 7037384929 Email: ndic@infoniddknihgov Internet: wwwdiabetesniddknihgov The National Diabetes Information Clearinghouse NDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK The NIDDK is part of the National Institutes of Health under the US Department of Health and Human Services Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts
This publication is not copyrighted The Clearinghouse encourages users of this fact sheet to duplicate and distribute as many copies as desired This
fact sheet is also available at wwwdiabetesniddknihgov
US DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
NIH Publication No 063873 August 2006
Source:diabetes.niddk.nih.gov
