Diabetes can have a significant impact on quality of life by increasing risk for a variety of complications. These include:
- Blindness—Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years, with the greatest number in adults 65 years and older (Figure 4). Retinopathy causes 12,000 to 24,000 new cases of blindness each year in people with diabetes.30
- Kidney Disease—Diabetes is the leading cause of endstage kidney disease, accounting for 43 percent of new cases each year (Figure 5).31 In 2001, nearly 43,000 people with diabetes began treatment for end-stage kidney disease and approximately 143,000 people with endstage kidney disease were living on chronic dialysis or with a kidney transplant due to diabetes.32 The rate of diabetic end-stage kidney disease is 2.6 times higher among Blacks than among Whites.33
- High Blood Pressure—About 73 percent of adults with diabetes have blood pressure greater than or equal to 140/90 mm Hg or use prescription medications for hypertension.34
- Heart Disease and Stroke—About 65 percent of deaths among people with diabetes are due to heart disease and stroke.35 Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes. It is projected that in the year 2025, twenty-nine percent of all heart disease deaths will be due to diabetes (Figure 6). The risk for stroke is two to four times higher among people with diabetes.
- Nervous System Disease—About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage including impaired sensation or pain in the feet or hands, carpal tunnel syndrome, slowed digestion of food in the stomach, and other nerve problems.36 Severe forms of nerve disease are a major contributing cause of lower-extremity amputations for people with diabetes.
- Dental Disease—Gum disease is more common among people with diabetes. Among young adults, those with diabetes have about twice the risk of developing gum disease as those without diabetes. Almost one third of people with diabetes have severe gum diseases.
- Amputations—More than 60 percent of nontraumatic lowerlimb amputations occur among people with diabetes.37 In 2000–2001, about 82,000 nontraumatic lowerlimb amputations were performed annually among people with diabetes.38 Blacks have higher rates of lower extremity amputations than Whites (see Figure 7).39
- Pregnancy Complications—Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5 percent to 10 percent of pregnancies and spontaneous abortions in 15 percent to 20 percent of pregnancies.40 Poorly controlled diabetes during the second and third trimesters of pregnancy can result in very large babies, posing a risk to the mother and the child during delivery.
- Other Complications—People with diabetes are more susceptible to many other illnesses and often have worse outcomes. For example, people with diabetes are more likely to die from pneumonia or the flu than people who do not have diabetes.41
Early and optimal treatment is key to prevent or delay such complications.
Figure 4. Prevalence of diabetic retinopathy among adults 40 years and older (2000)
SOURCE: National Institutes of Health, National Eye Institute data from Prevalence and Causes of Visual Impairment and Blindness Among Adults 40 Years and Older in the United States, http://www.nei.nih.gov/eyedata/.
Figure 5. Primary causes for kidney failure (1998)
SOURCE: National Institute of Diabetes and Digestive Kidney Diseases (1998). Accessed at http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm.
Glomerulonephritis is a variety of kidney disease characterized by inflammation of the capillaries.
Figure 6. Projected increase in total heart disease deaths related to increased diabetes prevalence
SOURCE: Unpublished estimates from the National Heart, Lung and Blood Institute, October 18, 2002.
Figure 7. Age-standardized Rate of Hospital Discharge for Non-traumatic Lower Extremity Amputation per 1,000 Diabetic Population, by Race, United States, 1980-2001
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Care Statistics, data from the National Hospital Discharge Survey and Division of Health Interview Statistics, data from the National Health Interview Survey.
U.S. Bureau of the Census, census of the population and population estimates and Centers for Disease Control and Prevention, National Center for Health Statistics, bridged-race population estimates.
30 CDC, National diabetes fact sheet, op.cit.
33 AHRQ, op.cit
34 CDC, National diabetes fact sheet, op.cit.
39 AHRQ, op.cit.
40 CDC, National diabetes fact sheet, op.cit.