In April federal researchers reported for the first time the broad national picture of progress against the most severe complications of diabetes, finding that rates of heart attacks, strokes, kidney failures, and amputations drastically declined over the past two decades.
The largest declines were seen in rates of heart attacks and death from high blood sugar, which fell more than 60 percent from 1990 to 2010.
"This is the first really credible, reliable data that demonstrates all of the efforts at reducing risk have paid off," said Dr. David M. Nathan, director of the Diabetes Center at Massachusetts General Hospital, who was not affiliated with with the study, which was published in the New England Journal of Medicine. "Given that diabetes is the chronic epidemic of this millennium, this is a very important finding."
During the period of the study the number of diabetics nearly tripled and is currently up to 26 million. The majority of the increase came from Type 2 diabetes, which is related to obesity. More than 79 million Americans have pre-diabetes and are at high-risk for developing the disease.
Researchers credit the decline with years of efforts to improve the health of patients with the disease. Doctors have improved their treatments for the disease, including medications to control blood sugar, cholesterol and blood pressure. Efforts to better educate patients have also improved the lives of diabetics, as well as providers tracking the progress of their patients.
Edward W. Gregg, a senior epidemiologist at the Centers for Disease Control and Prevention and lead author of the study, said the research team used four federal data sets: the National Health Interview Survey, the National Hospital Discharge Survey, the United States Renal Data System, and Vital Statistics. The study included hundreds of thousands of diabetics who had heart attacks, and thousands who died from high blood sugar.
"This is the first time we've put the full spectrum together over a long period of time," said Dr. Gregg. Heart attacks, which used to be the most common complication, fell to the level of strokes, which also fell.
"We were a bit surprised by the magnitude of the decrease in heart attack and stroke," he said.
As well as the number of heart attacks and death by high blood sugar dropping, the rates of strokes and lower extremity amputations fell by half. Rates for final stage kidney failure fell about 30 percent. The study did not look at blindness.
Declines in complications began in 1995 and continued over time. Improved blood sugar control made a difference in reducing the rates of amputations and end-stage kidney disease. Decreased smoking and the use of statins to lower cholesterol and other medications to control blood pressure also helped with declines in heart attacks and strokes.
While heart attacks declined for the whole population, those without diabetes saw a decline of 31 percent since 1990 and those with diabetes had a 68 percent drop.
Since cardiovascular disease is typically what kills the most people with diabetes, the focus has shifted to treating those conditions, said Dr. Joel Zonszein, director of the Clinical Diabetes Center at the Montefiore Medical Center in the Bronx. Now there are medications not available in the past that can also help protect the kidneys and prevent or postpone kidney failure.
Dr. Nathan says that even though the average person faces fewer risks for complications, diabetes is still a growing epidemic.
"There's nothing else in the world that's increasing as fast as the rate of diabetes," he said. "As a society, we are still facing an enormous burden."
Reference: New York Times
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