Currently, more than 18 million Americans have diabetes and projections show that the number of persons with the disease will continue to grow without public health intervention.1 Diabetes consists of a group of diseases in which the body is unable to produce insulin (type 1 diabetes) or makes too little insulin and resists its action (type 2 diabetes). In addition to diabetes, an estimated 41 million Americans have pre-diabetes, a condition that puts them at high risk for developing type 2 diabetes.2 If current trends continue, one in every three children born in the year 2000 will develop diabetes within their lifetime.3 Diabetes often causes severe complications that can include heart disease and stroke, blindness, lower extremity amputations, kidney failure, dental disease, and increased susceptibility to infections.4 In addition to the personal and social costs resulting from impaired health and quality of life for people affected by diabetes, the disease also carries significant economic costs. Estimates suggest the cost of diabetes to be about $132 billion per year.5
Diabetes is a serious public health problem, but the good news is that important advances are being made in prevention, detection, and treatment of diabetes. For example, the Diabetes Control and Complications Trial established that intensive control of blood glucose levels greatly reduces complications for people with type 1 diabetes, and the U.K. Prospective Diabetes Study has shown similar dramatic reductions in complications with control of blood glucose for persons with type 2 diabetes.6 In 2002, results from the Diabetes Prevention Program demonstrated that type 2 diabetes can be prevented or delayed by weight loss and increased physical activity for many people at risk for the disease.7 These findings provide exciting evidence that the potentially devastating consequences of diabetes can be reduced dramatically.
However, without significant action, the prevalence of diabetes, together with diabetes-related complications, will continue to increase.
To help ensure that Americans take the steps needed to quell the growing diabetes problem, Secretary of Health and Human Services Tommy G. Thompson has identified diabetes prevention, detection, and treatment as one of the central components of his health agenda for the nation. Activities supporting the Secretary’s focus on diabetes include Steps to a HealthierUS: Putting Prevention First, the Diabetes Detection Initiative, and the Small Steps, Big Rewards, Prevent Type 2 Diabetes campaign. In addition, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, establishes coverage of a one-time “Welcome to Medicare Physical Examination” within 6 months of a beneficiary’s first coverage under Part B to encourage health promotion and disease detection. The MMA also adds coverage for cardiovascular and diabetes screening for Medicare beneficiaries. Both benefits take effect January 1, 2005. More information on MMA and Medicare benefits in general can be found at http://www.medicare.gov/ or 1-800-Medicare (1-800-633-4227). Appendix B provides additional information on diabetes benefits offered through Medicare.
The Diabetes: A National Plan for Action is the latest initiative sponsored by the U.S. Department of Health and Human Services to address diabetes prevention, detection, and treatment. Prompted by the Secretary’s commitment to disease prevention and health promotion, together with efforts of individuals and organizations—including the American Diabetes Association, Juvenile Diabetes Research Foundation International, American Association of Diabetes Educators, and other professional associations—the national action plan utilizes a comprehensive action-oriented approach to identify activities among relevant stakeholders to improve diabetes prevention, detection, and care.
This document is designed to:
- Reduce the prevalence of diabetes and factors that increase the risk of diabetes;
- Promote improved diabetes detection, monitoring, and treatment; and
- Reduce the complications of diabetes.
The plan seeks to raise national awareness of existing resources, facilitate and coordinate efforts, and leverage resources for the prevention, detection, and treatment of diabetes. In addition, the plan outlines steps individual Americans can take to help prevent or delay type 2 diabetes, together with recommendations persons already diagnosed with diabetes can use to prevent or delay complications from the disease. However, individual action alone is not sufficient for addressing diabetes. Thus, the plan also recommends and outlines action steps for families, friends, health care providers, schools, the media, communities, health insurance providers, employers, researchers and professional educators, and tribal and other government agencies, to help mitigate the increase in the prevalence of diabetes and its complications. Additional information and resources about diabetes prevention, detection, and treatment are also provided.
1 Centers for Disease Control and Prevention (CDC). (2003). Promising practices in chronic disease prevention and control: A public health framework for action. Atlanta, GA: Department of Health and Human Services.
2 U.S. Department of Health and Human Services. Prevention: A blueprint for action. Available at: http://aspe.hhs.gov/health/blueprint/.
3 Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. (2003). Lifetime risk for diabetes mellitus in the United States. Journal of the American Medical Association, 290(14), 1884-1890.
4 CDC, op.cit.
5 American Diabetes Association (ADA). (2003) Economic costs of diabetes in the U.S. in 2002. Diabetes Care, 26, 917-932.
6 The Diabetes Control and Complications Trial Research Group (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329(14), 977-986; and Turner, RC. (1998). The U.K. prospective diabetes study: A review. Diabetes Care, 21(Suppl. 3), C35-C38.
7 Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. New England Journal of Medicine, 346(6), 393-403.