DM Statistics

8/8/2019 DM Statistics

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National Diabetes

Statistics, 2007National Diabetes Information Clearinghouse

U.S. Departmentof Health andHuman Services

NATIONALINSTITUTESOF HEALTH

General InformationWhat is diabetes?Diabetes is a group o diseases marked by

high levels o blood glucose, also calledblood sugar, resulting rom deects in insulinproduction, insulin action, or both. Diabetescan lead to serious complications and premature death, but people with diabetes can takesteps to control the disease and lower the risko complications.

Types of DiabetesType 1 diabetes was previously calledinsulin-dependent diabetes mellitus (IDDM)or juvenile-onset diabetes. Type 1 diabetes

develops when the bodys immune systemdestroys pancreatic beta cells, the only cellsin the body that make the hormone insulinthat regulates blood glucose. To survive,people with type 1 diabetes must have insulindelivered by injection or a pump. This ormo diabetes usually strikes children and youngadults, although disease onset can occur atany age. In adults, type 1 diabetes accountsor 5 to 10 percent o all diagnosed cases odiabetes. Risk actors or type 1 diabetesmay be autoimmune, genetic, or environ

mental. No known way to prevent type 1diabetes exists. Several clinical trials or theprevention o type 1 diabetes are currently inprogress or are being planned.

Type 2 diabetes was previously callednon-insulin-dependent diabetes mellitus(NIDDM) or adult-onset diabetes. In adults,

type 2 diabetes accounts or about 90 to95 percent o all diagnosed cases o diabetes. It usually begins as insulin resistance, adisorder in which the cells do not use insulin

properly. As the need or insulin rises, thepancreas gradually loses its ability to produce it. Type 2 diabetes is associated witholder age, obesity, amily history o diabetes,history o gestational diabetes, impairedglucose metabolism, physical inactivity,and race/ethnicity. Arican Americans,Hispanic/Latino Americans, American Indians, and some Asian Americans and NativeHawaiians or other Pacic Islanders are atparticularly high risk or type 2 diabetes andits complications. Type 2 diabetes in children

and adolescents, although still rare, is beingdiagnosed more requently among AmericanIndians, Arican Americans, Hispanic/Latino

Americans, and Asians/Pacic Islanders.

Gestational diabetes is a orm o glucoseintolerance diagnosed during pregnancy.Gestational diabetes occurs more requentlyamong Arican Americans, Hispanic/Latino

Americans, and American Indians. It isalso more common among obese womenand women with a amily history o diabe

tes. During pregnancy, gestational diabetesrequires treatment to normalize maternalblood glucose levels to avoid complicationsin the inant. Immediately ater pregnancy,5 to 10 percent o women with gestationaldiabetes are ound to have diabetes, usuallytype 2. Women who have had gestationaldiabetes have a 40 to 60 percent chance odeveloping diabetes in the next 5 to 10 years.


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40

50

/y

Type 1

Other types o diabetes result rom specicgenetic conditions, such as maturity-onsetdiabetes o youth; surgery; medications;inections; pancreatic disease; and otherillnesses. Such types o diabetes account or1 to 5 percent o all diagnosed cases.

Treating DiabetesDiabetes can lead to serious complications,such as blindness, kidney damage, cardiovascular disease, and lower-limb amputations,but people with diabetes can lower the occur

rence o these and other diabetes complications by controlling blood glucose, bloodpressure, and blood lipids.

Many people with type 2 diabetes cancontrol their blood glucose by ollowinga healthy meal plan and exercise program, losing excess weight, and takingoral medication. Some people withtype 2 diabetes may also need insulin tocontrol their blood glucose.

To survive, people with type 1 diabetesmust have insulin delivered by injectionor a pump.

Among adults with diagnosed diabetestype 1 or type 214 percent take insulinonly, 13 percent take both insulin andoral medication, 57 percent take oralmedication only, and 16 percent donot take either insulin or oral medication. Medications or each individual

with diabetes will oten change over thecourse o the disease.

Many people with diabetes also need totake medications to control their cholesterol and blood pressure.

Sel-management education or training is a key step in improving healthoutcomes and quality o lie. It ocuseson sel-care behaviors, such as healthyeating, being active, and monitoringblood glucose. It is a collaborativeprocess in which diabetes educatorshelp people with or at risk or diabetesgain the knowledge and problem-solvingand coping skills needed to successullysel-manage the disease and its relatedconditions.

57%

16%

14%

13%

Insulin only

Insulin and oral medication

No medication

Oral medication only

Treatment with insulin or oralmedication among adults with

diagnosed diabetes, United States,20042006

Source: 20042006 National Health Interview Survey.

National Diabetes Statistics, 20072


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Pre-diabetes: Impaired GlucoseTolerance and Impaired FastingGlucosePre-diabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classied asdiabetes. People with pre-diabetes have anincreased risk o developing type 2 diabetes,heart disease, and stroke.

People with pre-diabetes have impairedasting glucose (IFG) or impairedglucose tolerance (IGT). Some peoplehave both IFG and IGT.

IFG is a condition in which the astingblood glucose level is 100 to 125 milligrams per deciliter (mg/dL) ater anovernight ast. This level is higher thannormal but not high enough to be classied as diabetes.

IGT is a condition in which the bloodglucose level is 140 to 199 mg/dL ater a2-hour oral glucose tolerance test. Thislevel is higher than normal but not highenough to be classied as diabetes.

In 1988 to 1994, among U.S. adults ages40 to 74 years, 33.8 percent had IFG,15.4 percent had IGT, and 40.1 percenthad pre-diabetesIGT or IFG or both.More recent data or IFG, but not IGT,are available and are presented below.

Prevalence of Impaired FastingGlucose in People Younger than

20 Years of Age, United States In 1999 to 2000, 7.0 percent o U.S. ado

lescents ages 12 to 19 years had IFG.

Prevalence of Impaired FastingGlucose in People Ages 20 Yearsor Older, United States, 2007 In 2003 to 2006, 25.9 percent o U.S.

adults ages 20 years or older had IFG35.4 percent o adults ages 60 years orolder. Applying this percentage to theentire U.S. population in 2007 yields anestimated 57 million American adultsages 20 years or older with IFG, suggesting that at least 57 million American

adults had pre-diabetes in 2007.Ater adjusting or population age and

sex dierences, IFG prevalence amongU.S. adults ages 20 years or older in2003 to 2006 was 21.1 percent or non-Hispanic blacks, 25.1 percent or non-Hispanic whites, and 26.1 percent orMexican Americans.

Prevention or Delay of Diabetes Progression to diabetes among those

with pre-diabetes is not inevitable.Studies have shown that people withpre-diabetes who lose weight andincrease their physical activity can pre

vent or delay diabetes and even returntheir blood glucose levels to normal.

In the Diabetes Prevention Program, alarge prevention study o people at highrisk or diabetes, liestyle interventionreduced the development o diabetes by58 percent over 3 years. The reduction

was even greater, 71 percent, among

adults ages 60 years or older.

Interventions to prevent or delaytype 2 diabetes in individuals withpre-diabetes can be easible and cost-eective. Research has ound thatliestyle interventions are more cost-eective than medications.

3 National Diabetes Statistics, 2007


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National Estimates onDiabetesEstimation MethodsThe estimates on diabetes in this act sheetwere derived rom various data systems othe Centers or Disease Control and Prevention (CDC), the outpatient database othe Indian Health Service (IHS), the U.S.Renal Data System o the National Institutes o Health (NIH), the U.S. CensusBureau, and published studies. Estimates

o the total number o people with diabetes and the prevalence o diabetes in 2007were derived using 20032006 NationalHealth and Nutrition Examination Survey(NHANES), 20042006 National HealthInterview Survey (NHIS), 2005 IHS data,and 2007 resident population estimates.Many o the estimated numbers and percentages o people with diabetes werederived by applying diabetes prevalenceestimates rom health surveys o the civilian,

noninstitutionalized population to the mostrecent 2007 resident population estimates.These estimates have some variability dueto the limits o the measurements andestimation procedures. The proceduresassumed that age-race-sex-specifc percentages o adults with diabetesdiagnosedand undiagnosedin 2007 are the sameas they were in earlier time periodsorexample, 2003 to 2006and that the agerace-sex-specifc percentages o adults withdiabetes in the resident population are

identical to those in the civilian, noninstitutionalized population. Deviations romthese assumptions may result in over- orunder-estimated numbers and percentages.For urther inormation on the methods orderiving total, diagnosed, and undiagnosedprevalence o diabetes rom NHANES data,seewww.cdc.gov/mmwr/preview/mmwrhtml/mm5235a1.htm.

Prevalence of Diagnosed andUndiagnosed Diabetes in theUnited States, All Ages, 2007

Total: 23.6 million people7.8 percento the populationhave diabetes.

Diagnosed: 17.9 million people Undiagnosed: 5.7 million people

Prevalence of Diagnosed andUndiagnosed Diabetes amongPeople Ages 20 Years or Older,

United States, 2007Ages 20 years or older: 23.5 million, or

10.7 percent, o all people in this agegroup have diabetes.

Ages 60 years or older: 12.2 million, or23.1 percent, o all people in this agegroup have diabetes.

Men: 12 million, or 11.2 percent, o all men ages 20 years or older have diabetes.

Women: 11.5 million, or 10.2 percent, o

all women ages 20 years or older havediabetes.

Non-Hispanic whites: 14.9 million, or9.8 percent, o all non-Hispanic whitesages 20 years or older have diabetes.

Non-Hispanic blacks: 3.7 million, or14.7 percent, o all non-Hispanic blacksages 20 years or older have diabetes.

National Diabetes Statistics, 20074


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0

200,000

400,000

600,000

800,000

1,000,000819,000

281,000

536,000Nmb

2039 4059 60+Age Group

Type 2

Estimated prevalence of diagnosedand undiagnosed diabetes in people

ages 20 years or older, by agegroup, United States, 2007

25 23.120

cent

15Per

10.810

52.6

02039 4059 60+

Age Group

Source: 20032006 National Health and NutritionExamination Survey estimates o total prevalence

(both diagnosed and undiagnosed) were projected toyear 2007.

Prevalence of DiagnosedDiabetes in People Younger than20 Years of Age, United States,2007About 186,300 people younger than

20 years have diabetestype 1 ortype 2. This represents 0.2 percent o

all people in this age group. Estimateso undiagnosed diabetes are unavailableor this age group.


Race and Ethnic Differencesin Prevalence of DiagnosedDiabetesSufcient data are not available to deriveprevalence estimates o both diagnosed andundiagnosed diabetes or all minority populations. For example, national survey data cannot provide reliable estimates or the NativeHawaiian and other Pacifc Islander population. However, national estimates o diagnosed diabetes or certain minority groups

are available rom national survey data androm the IHS user population database, whichincludes data or approximately 1.4 million

American Indians and Alaska Natives in theUnited States who receive health care romthe IHS. Because most minority populationsare younger and tend to develop diabetesat earlier ages than the non-Hispanic whitepopulation, it is important to control orpopulation age dierences when making raceand ethnic comparisons.

Data rom the 2005 IHS user population database indicate that 14.2 percento the American Indians and AlaskaNatives ages 20 years or older whoreceived care rom IHS had diagnoseddiabetes. Ater adjusting or populationage dierences, 16.5 percent o the totaladult population served by IHS haddiagnosed diabetes, with rates varyingby region rom 6 percent among AlaskaNative adults to 29.3 percent among

American Indian adults in southern

Arizona.Ater adjusting or population age di

erences, 2004 to 2006 national surveydata or people ages 20 years or olderindicate that 6.6 percent o non-Hispanic

whites, 7.5 percent o Asian Americans, 10.4 percent o Hispanics, and11.8 percent o non-Hispanic blacks haddiagnosed diabetes. Among Hispanics, rates were 8.2 percent or Cubans,11.9 percent or Mexican Americans,

and 12.6 percent or Puerto Ricans.


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059 60+

23.8

H API AI

0

200,000

400,000

600,000

800,000

1,000,000

819,000

281,000

536,000

N

umber

2039 4059 60+

Age Group

Estimated number of new cases ofdiagnosed diabetes in people ages

20 years or older, by age group,United States, 2007

Source: 20042006 National Health Interview Surveyestimates projected to year 2007.

Incidence of Diagnosed Diabetesamong People Ages 20 Years orOlder, United States, 2007

A total o 1.6 million new cases o diabeteswere diagnosed in people ages 20 years orolder in 2007.

Incidence of Diagnosed Diabetesin People Younger than 20 Yearsof Age, United States, 2002 to2003SEARCH or Diabetes in Youth is a multicenter study unded by the CDC andthe NIH to examine diabetestype 1 andtype 2among children and adolescents inthe United States. SEARCH ndings or thecommunities studied include:

Based on 2002 to 2003 data, 15,000youth in the United States were newlydiagnosed with type 1 diabetes annuallyand about 3,700 youth were newly diagnosed with type 2 diabetes annually.

The rate o new cases among youthwas 19 per 100,000 each year or type 1diabetes and 5.3 per 100,000 or type 2diabetes.

Non-Hispanic white youth had the highest rate o new cases o type 1 diabetes.

Type 2 diabetes was extremely rareamong youth younger than 10 years oage. While still inrequent, rates weregreater among youth ages 10 to 19 yearscompared with younger children, withhigher rates among U.S. minority populations compared with non-Hispanic

whites.

Among non-Hispanic white youth ages10 to 19 years, the rate o new caseso type 1 diabetes was higher than

or type 2 diabetes. For Asian/PacicIslander and American Indian youthages 10 to 19 years, the opposite wastruethe rate o new cases o type 2

was greater than the rate or type 1 diabetes. Among Arican American andHispanic youth ages 10 to 19 years, therates o new cases o type 1 and type 2diabetes were similar.



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0

5

1013%

2039 4059 60+Age Group

2.6

.

Insulin onlyInsulin and oral medication

No medicationOral medication only

Rate of new cases of type 1 and type 2 diabetesamong youth ages < 20 years, by race/ethnicity, 20022003

0

10

20

30

40

50

Rate(per100,0

00/year)

Type 1 Type 2


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Complications of Diabetes in theUnited StatesHeart Disease and Stroke In 2004, heart disease was noted on

68 percent o diabetes-related deathcerticates among people ages 65 yearsor older.

In 2004, stroke was noted on 16 percento diabetes-related death certicatesamong people ages 65 years or older.

Adults with diabetes have heart diseasedeath rates about two to our timeshigher than adults without diabetes.

The risk or stroke is two to our timeshigher among people with diabetes.

High Blood Pressure In 2003 to 2004, 75 percent o adults

with sel-reported diabetes had bloodpressure greater than or equal to130/80 millimeters o mercury (mm Hg)or used prescription medications or

hypertension.Blindness Diabetes is the leading cause o new

cases o blindness among adults ages20 to 74 years.

Diabetic retinopathy causes 12,000 to24,000 new cases o blindness each year.

Kidney Disease Diabetes is the leading cause o kidney

ailure, accounting or 44 percent onew cases in 2005.

In 2005, 46,739 people with diabetesbegan treatment or end-stage kidneydisease in the United States and PuertoRico.

In 2005, a total o 178,689 people withend-stage kidney disease due to diabetes were living on chronic dialysis or

with a kidney transplant in the UnitedStates and Puerto Rico.

Nervous System DiseaseAbout 60 to 70 percent o people with

diabetes have mild to severe orms onervous system damage. The results osuch damage include impaired sensation or pain in the eet or hands, sloweddigestion o ood in the stomach, carpaltunnel syndrome, erectile dysunction,or other nerve problems.

Almost 30 percent o people with diabetes ages 40 years or older have impairedsensation in the eetor example, atleast one area that lacks eeling.

Severe orms o diabetic nerve diseaseare a major contributing cause o lower-extremity amputations.

Amputations More than 60 percent o nontraumatic

lower-limb amputations occur in peoplewith diabetes.

In 2004, about 71,000 nontraumaticlower-limb amputations were perormed

in people with diabetes.Dental Disease Periodontal, or gum, disease is more

common in people with diabetes.Among young adults, those with diabetes have about twice the risk o those

without diabetes.

People with poorly controlled diabetesA1C greater than 9 percentwerenearly three times more likely to havesevere periodontitis than those without

diabetes.

Almost one-third o people with diabetes have severe periodontal disease withloss o attachment o the gums to theteeth measuring 5 millimeters or more.



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Complications of Pregnancy Poorly controlled diabetes beore con

ception and during the rst trimestero pregnancy among women with type 1diabetes can cause major birth deectsin 5 to 10 percent o pregnancies andspontaneous abortions in 15 to 20 percent o pregnancies.

Poorly controlled diabetes during thesecond and third trimesters o pregnancy can result in excessively largebabies, posing a risk to both mother andchild.

Other Complications Uncontrolled diabetes oten leads to

biochemical imbalances that can causeacute lie-threatening events, such asdiabetic ketoacidosis and hyperosmolar,or nonketotic, coma.

People with diabetes are more susceptible to many other illnesses and, oncethey acquire these illnesses, oten have

worse prognoses. For example, they aremore likely to die with pneumonia orinfuenza than people who do not havediabetes.

People with diabetes ages 60 years orolder are two to three times more likelyto report an inability to walk a quartero a mile, climb stairs, do housework, oruse a mobility aid compared with people

without diabetes in the same age group.

Preventing DiabetesComplicationsDiabetes can aect many parts o the bodyand can lead to serious complications suchas blindness, kidney damage, and lower-limbamputations. Working together, people withdiabetes, their support network, and theirhealth care providers can reduce the occurrence o these and other diabetes complications by controlling the levels o bloodglucose, blood pressure, and blood lipids and

by receiving other preventive care practicesin a timely manner.

Glucose Control Studies in the United States and abroad

have ound that improved glycemic control benets people with either type 1or type 2 diabetes. In general, everypercentage point drop in A1C bloodtest resultsor example, rom 8 to7 percentcan reduce the risk o micro

vascular complicationseye, kidney,and nerve diseasesby 40 percent.

In people with type 1 diabetes, intensiveinsulin therapy has long-term benecialeects on the risk o cardiovasculardisease.

Blood Pressure Control Blood pressure control reduces the risk

o cardiovascular diseaseheart diseaseor strokeamong people with diabetes by 33 to 50 percent, and the risko microvascular complicationseye,

kidney, and nerve diseasesby approximately 33 percent.

In general, or every 10 mm Hg reduction in systolic blood pressure, the riskor any complication related to diabetesis reduced by 12 percent.



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Control of Blood Lipids Improved control o LDL cholesterol

can reduce cardiovascular complicationsby 20 to 50 percent.

Preventive Care Practices for Eyes,Feet, and Kidneys Detecting and treating diabetic eye dis

ease with laser therapy can reduce thedevelopment o severe vision loss by anestimated 50 to 60 percent.

Comprehensive oot care programscan reduce amputation rates by 45 to85 percent.

Detecting and treating early diabetickidney disease by lowering blood pressure can reduce the decline in kidneyunction by 30 to 70 percent. Treatment

with angiotensin-converting enzyme(ACE) inhibitors and angiotensin receptor blockers (ARBs) are more eectivein reducing the decline in kidney unction than other blood pressure lowering

drugs. In addition to lowering blood pressure,

ARBs reduce proteinuria, a risk actor or developing kidney disease, by35 percentsimilar to the reductionachieved by ACE inhibitors.

Estimated Diabetes Costs in theUnited States in 2007Totaldirect and indirect: $174 billion

Direct medical costs: $116 billion

Ater adjusting or population ageand sex dierences, average medicalexpenditures among people with diagnosed diabetes were 2.3 times higherthan what expenditures would be in theabsence o diabetes.

Indirect costs: $58 billiondisability, work loss, premature mortality

AcknowledgmentsThe ollowing organizations collaborated incompiling the inormation or this act sheet:

Agency or Healthcare Research andQuality

www.ahrq.gov/browse/diabetes.htm

American Association o Diabetes Educators

www.diabeteseducator.org

American Diabetes Associationwww.diabetes.org

Centers or Disease Control and Prevention

www.cdc.gov/diabeteswww.cdc.gov/nchs

Centers or Medicare and Medicaid Services

www.cms.hhs.gov

U.S. Department o Veterans Aairswww.va.gov/health/diabetes

Health Resources and Services Administrationwww.hrsa.gov

Indian Health Service www.ihs.gov/MedicalPrograms/Diabetes/index.asp

Juvenile Diabetes Research FoundationInternational

www.jdr.org

National Diabetes Education Program(NDEP), a joint program o the NIHand the CDC

www.ndep.nih.govwww.cdc.gov/diabetes/ndep/index.htm

National Diabetes Inormation Clearinghouse

www.diabetes.niddk.nih.gov



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National Institute o Diabetes andDigestive and Kidney Diseases o theNIH

www.niddk.nih.gov

U.S. Department o Health and HumanServices, Oce o Minority Health

www.omhrc.gov

NoteThis publication is not subject to copyrightrestrictions; please duplicate and distributecopies as desired.

CitationNational Institute o Diabetes and Digestiveand Kidney Diseases. National Diabetes Statistics, 2007 act sheet. Bethesda, MD: U.S.Department o Health and Human Services,National Institutes o Health, 2008.

Data Sources, References,and Methods for Estimates

of DiabetesTreating Diabetes

1. 20042006 National Health Interview Survey (NHIS), National Center or Health Statistics, Centers or Disease Control and Prevention. Available at:

www.cdc.gov/nchs/nhis.htm.

Methods: The percent distribution o thetype o treatment among civilian, noninstitutionalized adults ages 18 years or older

with diagnosed diabetes was calculated using

treatment questions rom the 20042006NHIS.

Pre-diabetes: Impaired GlucoseTolerance (IGT) and ImpairedFasting Glucose (IFG)

1. The Expert Committee on the Diagnosis and Classication o Diabetes Mellitus. Report o the Expert Committeeon the Diagnosis and Classicationo Diabetes Mellitus. Diabetes Care.1997;20:11831197.

2. Coutinho M, Gerstein HC, Wang Y,Yusu S. The relationship between glucose and incident cardiovascular events.

A metaregression analysis o publisheddata rom 20 studies o 95,783 individuals ollowed or 12.4 years. DiabetesCare. 1999; 22:233240.

3. Meigs JB, Nathan DM, DAgostino RBSr, Wilson PW; Framingham OspringStudy. Fasting and postchallenge glycemia and cardiovascular disease risk: theFramingham Ospring Study. DiabetesCare. 2002;10:18451850.

4. Smith NL, Barzilay JI, Shaer D, SavagePJ, Heckbert SR, Kuller LH, KronmalRA, Resnick HE, Psaty BM. Fastingand 2-hour postchallenge serum glucosemeasures and risk o incident cardiovascular events in the elderly: the Cardiovascular Health Study. Archives o

Internal Medicine. 2002;162:209216.

5. Harris MI, Flegal KM, Cowie CC,Eberhardt MS, Goldstein DE, LittleRR, Wiedmeyer HM, Byrd-Holt DD.

Prevalence o diabetes, impaired astingglucose, and impaired glucose tolerance in U.S. adults. The Third NationalHealth and Nutrition Examination Sur

vey (NHANES III) 19881994. DiabetesCare. 1998;21(4):518524.

6. NHANES III 19881994, NationalCenter or Health Statistics, Centers orDisease Control and Prevention. Available at: www.cdc.gov/nchs/nhanes.htm.



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Methods: The prevalences o IGT, IFG,and pre-diabetes in the civilian noninstitutionalized population were estimated using19881994 NHANES III data. Peoplepreviously diagnosed with diabetes and those

with undiagnosed diabetesi.e., without ahistory o diabetes but with a asting plasmaglucose o 126 or morewere excluded romthe prevalence counts o IGT, IFG, and prediabetes. People were classied as havingIGT i they had 2-hour plasma glucose valueso 140 to 199 mg/dL ater an oral glucose

tolerance test. They were classied as havingIFG i they had asting plasma glucose valueso 100 to 125 mg/dLregardless o their2-hour plasma glucose values. Those withIGT or IFG or both were classied as havingpre-diabetes.

Prevalence of IFG in PeopleYounger than 20 Years of Age,United States

1. Williams DE, Cadwell BL, Cheng

YJ, Cowie CC, Gregg EW, Geiss LS,Engelgau MM, Venkat Narayan KM,Imperatore G. Prevalence o impairedasting glucose and its relationship withcardiovascular disease risk actors inUS adolescents, 19992000. Pediatrics.2005;116;11221126.

Prevalence of IFG in PeopleAges 20 Years or Older, UnitedStates, 2007

1. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM, Saydah SH, Williams DE, Geiss LS, Gregg EW. Prevalence o diabetes and impaired asting glucose in adults in the U.S. population: NHANES 19992002. Diabetes Care. 2006;29(6):12631268.

2. NHANES 20032006, National Centeror Health Statistics, Centers or DiseaseControl and Prevention. Available at:

www.cdc.gov/nchs/nhanes.htm.

3. U.S. Census Bureau, resident population estimates or 11/1/2007. Availableat: www.census.gov/popest/national/asrh/2006_nat_res.html.

Methods: The prevalence o IFG in thecivilian noninstitutionalized population wasestimated using 20032006 NHANES data.People were classied as having IFG i theyhad asting plasma glucose values o 100 to125 mg/dL. People previously diagnosed

with diabetes and those with undiagnoseddiabetesi.e., without a history o diabetesbut with a asting plasma glucose o 126 ormorewere excluded rom the case countso IFG. The 2007 estimated number othose ages 20 years or older with IFG is thesum o the numbers derived by applyingthe age-race-sex-specic estimates o IFG

prevalence rom the 20032006 NHANESto the corresponding age-race-sex-specicestimates o the 2007 resident population.IGT prevalence was not estimated becauseNHANES did not include glucose tolerancetest measurements in 20032004. IFG prevalence by race are age and sex adjusted by thedirect method based on 2000 U.S. standardpopulation.



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Prevention or Delay of Diabetes1. Knowler WC, Barrett-Connor E, Fowler

SE, Hamman RF, Lachin JM, WalkerEA, Nathan DM. Diabetes PreventionProgram Research Group. Reduction in the incidence o type 2 diabetes

with liestyle intervention or metormin. New England Journal o Medicine.2002;346(6):393403.

2. The Diabetes Prevention ProgramResearch Group. Costs associated with

the primary prevention o type 2 diabetes mellitus in the Diabetes PreventionProgram. Diabetes Care. 2003;26:3647.

3. Diabetes Prevention Program Research Group. Within-trial cost-eectiveness o liestyle intervention or metormin or the primary prevention o type 2 diabetes. Diabetes Care. 2003;26(9):25182523.

4. Herman WH, Hoerger TJ, Brandle M,Hicks K, Sorensen S, Zhang P, Hamman

RF, Ackermann RT, Engelgau MM, Ratner RE. Diabetes Prevention ProgramResearch Group. The cost-eectivenesso liestyle modication or metormin inpreventing type 2 diabetes in adults withimpaired glucose tolerance. Annals o

Internal Medicine. 2005;142:323332.

Prevalence of Diagnosed andUndiagnosed Diabetes in theUnited States, All Ages, 2007

1. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM, Saydah SH, Williams DE, Geiss LS, Gregg EW. Prevalence o diabetes and impaired asting glucose in adults in the U.S. population:

NHANES 19992002. Diabetes Care.2006;29(6):12631268.



3. 20042006 NHIS, National Center or Health Statistics, Centers or Disease Control and Prevention. Available at:


4. U.S. Census Bureau, resident popula

tion estimates or 11/1/2007. Availableat: www.census.gov/popest/national/asrh/2006_nat_res.html.

Methods: The total number o people withdiabetes is the sum o the estimated numbero those ages 20 years or older with diagnosedand undiagnosed diabetes in 2007see nextsection or calculation methodsand theestimated number o those younger than 20

years with diagnosed diabetes in 2007seesection ater next section on diagnosed

diabetes among people under 20 years o ageor calculation methods. The percentage othe population with diabetes is the estimatedtotal number with diabetes in 2007 divided bythe estimated 2007 U.S. resident population.

The total number o people with diagnoseddiabetes in 2007 is the sum o the estimatednumbers o those younger than 20 years andthose ages 20 years or older with diagnoseddiabetes.

Inormation about how NHANES data canbe used to estimate diagnosed, undiagnosed,and total prevalence o diabetes is availablein the Cowie et al. reerence listed above.



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Prevalence of Diagnosed andUndiagnosed Diabetes amongPeople Ages 20 Years or Older,United States, 2007

1. Cowie CC, Rust KF, Byrd-Holt DD, Eberhardt MS, Flegal KM, Engelgau MM, Saydah SH, Williams DE, Geiss LS, Gregg EW. Prevalence o diabetes and impaired asting glucose in adults in the U.S. population: NHANES 19992002. Diabetes Care.

2006;29(6):12631268.




Methods:

Ages 20 years or olderThe 2007 estimated number o those ages20 years or older with diagnosed and undiagnosed diabetes is the sum o the numbersderived by applying the age-race-sex-specicestimates o total diabetes prevalenceboth diagnosed and undiagnosedromthe 20032006 NHANES to 2007 residentpopulation estimates. The percentage o thepopulation with diabetes ages 20 years orolder is this estimated number divided bythe estimated 2007 U.S. resident population

ages 20 years or older. Inormation on theuse o NHANES data to measure diabetesprevalenceincluding diagnosed andundiagnosed diabetesis available romthe Cowie et al. reerence listed above.

Ages 60 years or olderThe 2007 estimated number o those ages60 years or older with diabetes was derivedby applying race-sex-specic estimates ototal diabetes prevalenceboth diagnosedand undiagnosed diabetesin this age grouprom the 20032006 NHANES to 2007 resident population estimates. The percentageo the population with diabetes ages 60 yearsor older is this estimated number divided bythe estimated 2007 U.S. resident populationages 60 years or older.

Men and womenThe 2007 estimated number o men and

women ages 20 years or older with diabetes isthe sum o the sex-specic numbers derivedby applying age-race-sex-specic estimates ototal diabetes prevalenceboth diagnosedand undiagnosed diabetesrom the 20032006 NHANES to 2007 resident population estimates. The percentage o men and

women with diabetes are these estimatednumbers divided by the sex-specic estimated

2007 U.S. resident population ages 20 yearsor older.

Non-Hispanic whites and non-HispanicblacksThe 2007 estimated numbers o non-Hispanic

whites and the number o non-Hispanicblacks ages 20 years or older with diabetes arethe sums o the non-Hispanic race-specicnumbers derived by applying non-Hispanicage-race-sex-specic estimates o totaldiabetes prevalenceboth diagnosed andundiagnosed diabetesrom the 20032006NHANES to 2007 resident populationestimates. The percentages o non-Hispanic

whites and non-Hispanic blacks with diabetesare these estimated numbers divided by thenon-Hispanic race-specic estimates o the2007 U.S. resident population ages 20 yearsor older.



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Graph of prevalence by age groupThe age-specic prevalences o diagnosedand undiagnosed diabetes in people ages20 years or older were obtained by applying age-race-sex-specic estimates o totaldiabetes prevalenceboth diagnosed andundiagnosed diabetesrom the 20032006NHANES to 2007 resident populationestimates. The derived age-specic counts

were then divided by the estimated 2007 U.S.resident population to obtain the 2007 age-specic percentages.

Prevalence of DiagnosedDiabetes in People Younger than20 Years of Age, United States,2007




Methods: The number o people youngerthan 20 years o age with diagnosed diabetes in 2007 was estimated by applying the20042006 NHIS prevalence estimate odiagnosed diabetes in the civilian, noninstitutionalized population younger than 20 yearsto the 2007 resident population estimate othis age group. The percentage o people

younger than 20 years o age with diagnosed

diabetes in 2007 was assumed to be the sameas the 20042006 NHIS estimate. Estimateso undiagnosed diabetes or people youngerthan 20 years are not available.

Race and Ethnic Differencesin Prevalence of DiagnosedDiabetes

1. Acton KJ, Burrows NR, Geiss LS,Thompson T. Diabetes prevalenceamong American Indians and Alaska Natives and the overall populationUnitedStates, 19942002. Morbidity and Mortal-ity Weekly Report. 2003;52(30);702704.

2. Burrows NR, Geiss LS, Engelgau MM, Acton KJ. Prevalence o dia

betes among Native Americans and Alaska Natives, 19901997: an increasing burden. Diabetes Care. 2000;23(12):17861790.



4. Indian Health Service (IHS), 2005 outpatient database.

Methods: All estimates presented are orpeople ages 20 years or older. Rates wereage-adjusted by the direct method based onthe 2000 U.S. standard population. With theexception o the prevalence among AmericanIndians and Alaska Natives (AIANs), race/ethnicity-specic prevalences o diagnoseddiabetes were calculated using the 20042006NHIS, also available atwww.cdc.gov/nchs/

nhis.htm. The estimated diagnosed diabetes prevalence or the Native Hawaiian andother Pacic Islander population was not

included because the NHIS estimate or thisgroup is considered unreliable due to a smallsample size.



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The prevalence o diagnosed diabetes amongAIANs was derived rom the 2005 userpopulation database o the IHS. The IHSoperates a health-services system delivereddirectly through IHS acilities, purchased byIHS through contractual agreements withprivate providers, or delivered through tribally operated programs and urban Indianhealth programs. Approximately 60 percento the nearly 3 million AIANs residing in theUnited States live in IHS health-care deliveryareas, are eligible to receive IHS services,

and use IHS medical acilities. Diabetescases among AIANs ages 20 years or older

were identied by using theInternationalClassifcation o Diseases, Ninth Revision,Clinical Modifcation (ICD9CM) diagnostic codes 250.0250.9 rom the IHS patientcare computerized system or 2005. Thepatient care database includes unduplicatedcase reports or people who attended an IHSservice unit one or more times during 2005.Prevalence was calculated by using the AIANpopulation that received health-care services

at IHS, tribal, or urban acilities at least onceduring the preceding 3 years.

Sucient data are not available toderive estimates o the total prevalenceo diabetesboth diagnosed and undiagnosed diabetesor many U.S. minoritypopulations. However, national estimateso diagnosed diabetes are available or somebut not all minority groups to allow racialand ethnic comparisons. Resources to obtaindata or minority groups at the state or local

level include the Behavioral Risk FactorSurveillance System atwww.cdc.gov/brss/

stateino.htm and the Caliornia HealthInterview Survey atwww.chis.ucla.edu.

See the Census glossary for the definition ofU.S. racial/ethnic minority groups

http://actnder.census.gov/home/en/epss/glossary_a.html

Incidence of Diagnosed Diabetesamong People Ages 20 Years orOlder, United States, 2007


www.cdc.gov/nchs/nhis.htm.2. U.S. Census Bureau, resident popula

tion estimates or 11/1/2007. Availableat: www.census.gov/popest/national/asrh/2006_nat_res.html.

Methods: Age-specic estimates o the incidence o diagnosed diabetes in the civilian,noninstitutionalized population ages 20 yearsor older rom the 20042006 NHIS wereapplied to 2007 estimates o the U.S. residentpopulation without diabetes diagnosed in

the past year to calculate the number o newcases o diabetes. Incidence was calculatedrom data on respondents age at diagnosisand age at interview. Adults who reportedbeing diagnosed with diabetes were asked at

what age they were diagnosed. The numbero years each person had been diagnosed

with diabetes was calculated by subtracting the age at which they were diagnosedrom their current age. Adults who had a

value o zero were identied as having beendiagnosed with diabetes within the last year.

In addition, it was assumed that hal o theadults who had a value o one were classied as having been diagnosed with diabetes

within the last year.



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Type 1 Type 2 Other/Unknown All Types

Denominator Rate 95% CI Rate 95% CI Rate 95% CI Rate 95% CI

Age 09 Years

NHW 2,821,150 23.4 (21.725.3) 0.1 (0.00.3) 0.4 (0.30.8) 24 (22.225.9)

AA 691,390 13 (10.616.0) 0.8 (0.41.9) 0.3 (0.11.1) 14.1 (11.617.2

H 829,310 12.4 (10.215.0) 0.6 (0.31.5) 0.4 (0.11.1) 13.4 (11.116.1)

API 376,650 7.1 (4.910.3) 1.1 (0.52.8) 0 (0.01.1) 8.3 (5.811.7

AI 133,598 4.9 (2.30.3) 0 (0.02.9) 0.2 (0.03.2) 5.1 (2.410.6

All

groups

4,852,098 18.3 (17.119.5) 0.4 (0.30.6) 0.4 (0.20.6) 19 (17.820.3)

Age 1019 Years

NHW 3,107,250 24.1 (22.425.9) 4.3 (3.65.1) 1.7 (1.32.2) 30.1 (28.232.1)

AA 743,360 15.3 (12.818.4) 20.9 (17.924.5) 3.8 (2.65.5) 40 (35.744.8

H 774,192 15.1 (12.618.1) 12.7 (10.415.5) 2.7 (1.84.1) 30.5 (26.834.6)

API 403,460 7.6 (5.310.8) 17.1 (13.521.6) 1.3 (0.63.0) 26 (21.531.5

AI 151,528 6 (3.211.4) 36.7 (28.347.7) 0.2 (0.02.9) 42.9 (33.754.7

All

groups

5,179,790 19.7 (18.520.9) 9.9 (9.110.8) 2.1 (1.72.5) 31.6 (30.133.2)

Source: SEARCH or Diabetes in Youth Study.

NHW=Non-Hispanic Whites; AA=Arican Americans; H=Hispanics; API=Asians/Pacic Islanders; AI=American Indians

Incidence of Diagnosed Diabetesin People Younger than 20 Yearsof Age, United States, 20022003

1. SEARCH Study Group. SEARCH or Diabetes in Youth: a multicenter study o the prevalence, incidence and classication o diabetes mellitus in youth. Controlled Clinical Trials.

2004;25(5):458471.

2. Writing Group or the SEARCH orDiabetes in Youth Study Group, Dabelea D, Bell RA, DAgostino RB Jr,Imperatore G, Johansen JM, Linder B,Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzelder B.Incidence o diabetes in youth in theUnited States. Journal o the American

Medical Association. 2007;297(24):27162724. Available at http://jama.ama-assn.org/cgi/content/ull/297/24/2716.

Methods: SEARCH or Diabetes in Youth isa multicenter observational study to examine diabetes at eight locations throughoutthe United Statesmore than 5 million,

or 6 percent, o all American childrenyounger than 20 years, which is not nationally representative. However, the SEARCHsites were selected or their ability to reachminority populations, making this studygroup the largest and most racially andgeographically diverse group ever involvedin a youth diabetes study. It entails conducting population-based ascertainmento cases o physician-diagnosed diabetes



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in youth younger than 20 years o ageseewww.cdc.gov/diabetes/pubs/actsheets/search.htm. New diabetes cases occurring in2002 and 2003 were identied: a) in geographically dened populations in Ohio,Washington, South Carolina, and Colorado;b) among health plan enrollees in Hawaiithrough Hawaii Medical Service Association,Med-Quest, Kaiser Permanente Hawaii; andin Caliornia through Kaiser PermanenteSouthern Caliornia, excluding San Diego;and c) among American Indian populations

in Arizona and New Mexico. The populationunder observation included noninstitutionalized, civilian youth younger than 20 years oage in the years 2002 and 2003. The population denominator included 10,031,888 people. Race/ethnicity-specic estimates werepooled across sites using ve categories:non-Hispanic white (NHW), Hispanic (H),

Arican American (AA), Asian PacicIslander (API), and American Indian (AI).The annual total number o new cases o diabetes in people younger than 20 years o age

was estimated by applying the age-, sex-, andracial/ethnic group-specic incidence estimates rom SEARCH to the age-, sex-, andracial/ethnic group-specic U.S. populationusing bridged-race postcensal populationestimates o the July 1 U.S. resident population. Data used in the bullets and the gure

were derived rom theJournal o the Ameri-can Medical Association issue listed above.

Deaths among People withDiabetes, United States, 20061. Heron MP, Hoyert DL, Xu J, Scott C,

Tejada-Vera B. Deaths: Preliminarydata or 2006. National vital statisticsreports; Vol. 56 No. 16. Hyattsville, MDNational Center or Health Statistics.2008.

2. McEwen LN, Kim C, Haan M, Ghosh D,Lantz PM, Mangione CM, Saord MM,Marrero D, Thompson TJ, Herman

WH; TRIAD Study Group. Diabetesreporting as a cause o death: resultsrom the Translating Research Into

Action or Diabetes (TRIAD) study.Diabetes Care. 2006;29(2):247253.

3. Saydah SH, Geiss LS, Tierney E, Benjamin SM, Engelgau M, Brancati F. Review o the perormance o methods to identiy diabetes cases among

vital statistics, administrative, and survey data. Annals o Epidemiology.

2004;14(7):507516. 4. Gu K, Cowie CC, Harris MI. Mortal

ity in adults with and without diabetes in a national cohort o the U.S.population, 19711993. Diabetes Care.1998;21:11381145.

5. Hu FB, Stamper MJ, Solomon CG, LiuS, Willett WC, Speizer FE, Nathan DM,Manson JE. The impact o diabetesmellitus on mortality rom all causesand coronary heart disease in women:

20 years o ollow-up. Archives o Inter-nal Medicine. 2001;161:17171723.

Methods: The number o deaths with diabetes as any listed cause o death among U.S.residents was obtained rom the multiplecause-o-death dataset, National Center orHealth Statistics, Centers or Disease Control and Prevention.



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Complications of Diabetes in theUnited StatesHeart Disease and Stroke

1. Gorina Y, Lentzer H. Multiple causeso death in old age. Aging Trends, No.9. Hyattsville, MD. National Centeror Health Statistics, 2008. Available at: www.cdc.gov/nchs/data/ahcd/agingtrends/09causes.pd.

Methods: Tables 12 in the above reerenceprovide the data or the bullets on heart

disease and stroke. A total o 174,130 deathcerticates in 2004 mentioned diabetes as acause o death among people ages 65 yearsor older (Table 1). Among these 174,130deaths, 117,810 (68 percent) also mentionedheart disease as a cause o death and 27,874(16 percent) mentioned stroke (Table 2).

High Blood Pressure1. Ong KL, Cheung B, Wong L, Wat N, Tan

K, Lam K. Prevalence, treatment, andcontrol o diagnosed diabetes in the U.S.

National Health and Nutrition Examination Survey 19992004. Annals o

Epidemiology. 2008;18:222229.

Blindness1. Klein R, Klein BEK. Vision disorders

in diabetes. In: National Diabetes DataGroup, editors. Diabetes in America, 2nd

ed. Washington, DC: U.S. Departmento Health and Human Services, NationalInstitutes o Health, National Instituteo Diabetes and Digestive and KidneyDiseases. NIH PublicationNo. 951468:293336, 1995.

2. Will JC, Geiss LS, Wetterhall SF. Diabetic retinopathy [letter]. New England

Journal o Medicine. 1990;323:613.

Kidney Disease1. United States Renal Data System,Standard Analysis Files, 2007 [dataquery online]. Available at: www.usrds.org/odr/xrender_home.asp.

Nervous System Disease1. Eastman RC. Neuropathy in diabetes.

In: National Diabetes Data Group, editors. Diabetes in America, 2nd ed. Washington, DC: U.S. Department o Healthand Human Services, National Instituteso Health, National Institute o Diabetes and Digestive and Kidney Diseases.NIH Publication No. 951468:339348,1995.

2. Gregg EW, Sorlie P, Paulose-Ram R, GuQ, Eberhardt MS, Wolz M, Burt V, Cur-tin L, Engelgau M, Geiss L; 19992000national health and nutrition examination survey. Prevalence o lower-extremity disease in the U.S. adult population

40 years o age with and without diabetes: NHANES 19992000. Diabetes

Care. 2004;27:15911597.

Amputations1. Centers or Disease Control and Preven

tion. National Diabetes SurveillanceSystem. Available at: www.cdc.gov/diabetes/statistics/index.htm.

Dental Disease1. Tsai C, Hayes C, Taylor GW. Glycemic

control o type 2 diabetes and severeperiodontal disease in the U.S. adultpopulation. Community Dentistry and

Oral Epidemiology. 2002;30(3):182192.

2. Personal communication rom R.H. Selwitz, D.D.S., National Institute o Dental and Cranioacial Research, BethesdaMD, concerning unpublished data romthe NHANES III 19881994.



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Complications of Pregnancy1. Personal communication rom ThomasA. Buchanan, M.D., proessor, Medicine, Obstetrics and Gynecology, andPhysiology and Biophysics, USC KeckSchool o Medicine, Los Angeles.

Other Complications1. Fishbein H, Palumbo PJ. Acute meta

bolic complications in diabetes. In:National Diabetes Data Group, editors.

Diabetes in America, 2nd ed. Washington, DC: U.S. Department o Healthand Human Services, National Instituteso Health, National Institute o Diabetes and Digestive and Kidney Diseases.NIH Publication No. 951468:283291,1995.

2. Valdez R, Narayan KM, Geiss LS,Engelgau MM. Impact o diabetesmellitus on mortality associated withpneumonia and infuenza among non-Hispanic black and white U.S. adults.

American Journal o Public Health.

1999;89:17151721.

3. Gregg EW, Beckles GL, WilliamsonDF, Leveille SG, Langlois JA, EngelgauMM, Narayan KM. Diabetes and physical disability among older U.S. adults.

Diabetes Care. 2000;23(9):12721277.

4. Sinclair AJ, Conroy SP, Bayer AJ. Impact o diabetes on physical unction in older people. Diabetes Care. 2008;31(2):233235.

Preventing DiabetesComplicationsGlucose Control

1. Stratton IM, Adler AI, Neil HA, et al.Association o glycaemia with macrovascular and microvascular complications otype 2 diabetes (UKPDS 35): prospective observational study. British Medical

Journal. 2000;321(7258):405412.

2. The Diabetes Control and Complications Trial Research Group. The eect

o intensive treatment o diabetes on thedevelopment and progression o long-term complications in insulin-dependentdiabetes mellitus. New England Journal

o Medicine. 1993;329:977986.

3. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B; Diabetes Control and Complications Trial/Epidemiology o Diabetes Interventions and Complications (DCCT/EDIC)

Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. New England Journal o Medicine. 2005;353(25):26432653.



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Blood Pressure Control1. Curb JD, Pressel SL, Cutler JA, SavagePJ, Applegate WB, Black H, Camel G,Davis BR, Frost PH, Gonzalez N, Guthrie G, Oberman A, Rutan GH, StamlerJ. Eect o diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients withisolated systolic hypertension. SystolicHypertension in the Elderly ProgramCooperative Research Group. Journal

o the American Medical Association.

1996;276:18861892.2. Hansson L, Zanchetti A, Carruthers SG,

Dahl B, Elmeldt D, Julius S, MnardJ, Rahn KH, Wedel H, Westerling S.Eects o intensive blood-pressurelowering and low-dose aspirin in patients

with hypertension: principal results othe Hypertension Optimal Treatment(HOT) randomised trial. HOT StudyGroup. Lancet. 1998;51:17551762.

3. UK Prospective Diabetes Study Group.

Ecacy o atenolol and captopril inreducing risk o macrovascular andmicrovascular complications in type 2diabetes (UKPDS 39). British Medical

Journal. 1998;317:713720.

4.Adler AI, Stratton IM, Neil HA, YudkinJS, Matthews DR, Cull CA, Wright AD,Turner RC, Holman RR. Association osystolic blood pressure with macrovascular and microvascular complications otype 2 diabetes (UKPDS 36): prospec

tive observational study. British MedicalJournal. 2000;321:412419.

Control of Blood Lipids1. Scandinavian Simvastatin Survival StudyGroup. Randomised trial o cholesterollowering in 4444 patients with coronaryheart disease: the Scandinavian Sim

vastatin Survival Study (4S). Lancet.1994;344:13831389.

2. Downs JR, Cleareld M, Weis S,Whitney E, Shapiro DR, Beere PA,Langendorer A, Stein EA, Kruyer W,Gotto AM. Primary prevention o acutecoronary events with lovastatin in menand women with average cholesterollevels: results o the AFCAPS/Tex-CAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. Journal

o the American Medical Association.1998;279:16151622.

3. Sacks FM, Moy LA, Davis BR, ColeTG, Rouleau JL, Nash DT, Peer MA,Braunwald E. Relationship betweenplasma LDL concentrations duringtreatment with pravastatin and recur

rent coronary events in the Cholesteroland Recurrent Events trial. Circulation.1998;97:14461452.



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Preventive Care Practices forEyes, Feet, and Kidneys

1. Ferris FL 3rd. How eective are treatments or diabetic retinopathy? Journal

o the American Medical Association.1993;269:12901291.

2. Bild DE, Selby JV, Sinnock P, BrownerWS, Braveman P, Showstack JA. Lower-extremity amputation in people withdiabetes. Epidemiology and prevention.

Diabetes Care. 1989;12:2431.

3. Litzelman DK, Slemenda CW, Langeeld CD, Hays LM, Welch MA, BildDE, Ford ES, Vinicor F. Reduction olower extremity clinical abnormalitiesin patients with non-insulin-dependentdiabetes mellitus. A randomized, controlled trial. Annals o Internal Medicine.1993;19:3641.

4. Lewis EJ, Hunsicker LG, Clarke WR,Berl T, Pohl MA, Lewis JB, Ritz E,

Atkins RC, Rohde R, Raz I; Collabora

tive Study Group. Renoprotective eecto the angiotensin-receptor antagonistirbesartan in patients with nephropathydue to type 2 diabetes. New England

Journal o Medicine. 2001;345:851860.

5. Brenner BM, Cooper ME, de ZeeuwD, Keane WF, Mitch WE, Parving HH,Remuzzi G, Snapinn SM, Zhang Z, Shahinar S; RENAAL Study Investigators.Eects o losartan on renal and cardio

vascular outcomes in patients with type 2

diabetes and nephropathy. New EnglandJournal o Medicine. 2001;345:861869.

6. Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S,Arner P; Irbesartan in Patients withType 2 Diabetes and MicroalbuminuriaStudy Group. The eect o irbesartan on the development o diabeticnephropathy in patients with type 2 diabetes. New England Journal o Medicine.2001;345:870878.

7. Hostetter TH. Prevention o end-stagerenal disease due to type 2 diabetes.

New England Journal o Medicine.2001;345:910912.

8. Lewis EJ, Hunsicker LG, Bain RP,Rohde RD. The eect o angiotensinconverting-enzyme inhibition on diabeticnephropathy. The Collaborative StudyGroup. New England Journal o Medi-

cine. 1993;29:14561462.

9. Kunz R, Friedrich C, Wolbers M, MannJF. Meta-analysis: eect o monotherapy and combination therapy with inhib

itors o the renin angiotensin system onproteinuria in renal disease. Annals oInternal Medicine. 2008;148(1):3048.



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Estimated Diabetes Costs in theUnited States in 2007

1. American Diabetes Association.Economic Costs o Diabetes inthe U.S. in 2007. Diabetes Care.2008;31(3):596615.

The estimated costs o diabetes in the UnitedStates were based on a study by the LewinGroup, Inc., or the American Diabetes

Association and are 2007 estimates o boththe direct, which is the cost o medical care

and services, and indirect costs, which are thecosts o short-term and permanent disabil-ity and o premature death, attributable todiabetes. This study used a specifc cost-o-disease methodology to estimate the healthcare costs due to diabetes.

You may also fnd additional inormation about thistopic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain inormation about med-ications. When prepared, this publication includedthe most current inormation available. For updatesor or questions about any medications, contactthe U.S. Food and Drug Administration toll-ree at1888INFOFDA (4636332) or visitwww.fda.gov.Consult your doctor or more inormation.


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National DiabetesInformation Clearinghouse

1 Inormation Way Bethesda, MD 208923560 Phone: 18008608747 TTY: 18665691162Fax: 7037384929 Email: [email protected] Internet: www.diabetes.niddk.nih.gov

The National Diabetes InormationClearinghouse (NDIC) is a service o the

National Institute o Diabetes and Digestiveand Kidney Diseases (NIDDK). The NIDDKis part o the National Institutes o Health othe U.S. Department o Health and HumanServices. Established in 1978, the Clearinghouseprovides inormation about diabetes to peoplewith diabetes and to their amilies, healthcare proessionals, and the public. The NDICanswers inquiries, develops and distributespublications, and works closely with proessionaland patient organizations and Governmentagencies to coordinate resources about diabetes.

Publications produced by the Clearinghouse arecareully reviewed by both NIDDK scientists andoutside experts.

This publication is not copyrighted. The Clearing-house encourages users o this act sheet to duplicateand distribute as many copies as desired.

This act sheet is also available atwww.diabetes.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No 08 3892

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