Diabetes

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Introduction

Because type 2 diabetes is most common, it is worth reviewing some risk factors.

Type 2 Diabetes Risk Factors:

Low activity level

Excessive body fat

Hypertension

Hyperlipidemia

Family history or history of gestational diabetes

Age: >45 years old

Race/ethnicity: higher rates in African, Asian, Hispanic, American Indian, Pacific Islander descent

These include items that can be controlled, such as lack of physical activity, obesity and specifically excessive body fat, hypertension, and hyperlipidemia, as well as other things that cannot, such as:

•Family history, specifically a first degree relative with type 2 diabetes

•Age over 45 years

•And race/ethnicity as noted above.(1,5)

There are several complications of diabetes, including some life-threatening complications.(4,5)

Heart disease is common with diabetes and was noted on the death certificates of more than 2/3 of people over 65. Heart disease death and stroke rates may be 2 to 4-fold higher in people with diabetes.

Hypertension is another common diagnosis in people with diabetes with up to 75% of adults with both diagnoses.

Diabetes is the leading cause of new cases of blindness in adults, with diabetic retinopathy associated with between 12,000-24,000 new cases each year.

Diabetes is also the leading cause of kidney failure accounting for nearly 45% of new cases in 2005.

Around 2/3 of people with diabetes have mild to severe nerve damage, which can manifest as numbness or pain in the extremities, delayed digestion of food, carpal tunnel syndrome, and erectile dysfunction. This can lead to amputation with the majority of lower-limb amputees occurring in people with diabetes.

There is a 2-fold risk for dental disease in diabetes with almost 1/3 having severe periodontal disease.

Poorly controlled blood sugars can lead to birth defects in 5-10% of pregnancies and even spontaneous abortions in 15-20% of pregnancies.

The costs of caring for diabetes in the United States is significant.

In 2017, direct and indirect costs were estimated at $404 billion. Direct medical costs were estimated at $237 billion. These costs were estimated to be more than 2 times higher in patients diagnosed with diabetes compared to medical care costs for patients without diabetes. Indirect costs, such as disability, work loss, and premature mortality were estimated at $58 billion per year. Adding in $31.7 billion for people with undiagnosed diabetes, $43.4 billion for adults with pre-diabetes, and $1.6 billion for gestational diabetes brings the estimated total costs to $403.7 billion in 2017.(6)

Rick Fields-Gardner