Bridget Dillon and Rachel Pryor EPID 691 January 28, 2013 Incidence of Diabetes Type 2 remained relatively steady during the 1980’s, but has steadily increased since 1990 Incidence in 2010 was 1,735,000 people in the United States Incidence in 1980 was 493,000 Source: 2007–2009 National Health Interview Survey estimates projected to the year 2010. “From 1980 to 2011, the crude incidence of diagnosed diabetes increased 133% from 3.3 to 7.7 per 1,000 population. Similarly, the age–adjusted incidence increased 117% from 3.5 to 7.6 per 1,000 population, suggesting that the majority of the change was not due to the aging of the population. ” http://www.cdc.gov/diabetes/statistics/incidence/fig3.htm http://www.cdc.gov/diabetes/statistics/incidence/fig4.htm http://www.cdc.gov/diabetes/statistics/incidence/fig6.htm <10 years 10–19 years Source: SEARCH for Diabetes in Youth Study NHW=non-Hispanic whites; NHB=non-Hispanic blacks; H=Hispanics; API=Asians/Pacific Islanders; AI=American Indians 20.9 million Americans currently have Diabetes (http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm) 20.7 million of the population who have Diabetes are adults aged 18 and older (http://www.cdc.gov/diabetes/statistics/prev/national/figadults.htm) 8.3% of the US population http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm http://www.cdc.gov/diabetes/statistics/p revalence_national.htm http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=51&state=Virgini a&cat=prevalence&Data=data&view=TO&trend=prevalence&id=1 508,000 Virginians were living with Diabetes in 2010 People with diabetes are 2-4 times more likely to die from heart disease or suffer a stroke. 70% of people with diabetes have high blood pressure. Diabetes can also lead to kidney disease, blindness, and nerve damage in extremities. On average, people with diabetes spend $6,000 annually to treat their condition. As of 2008, the estimate cost of diabetes in the United States was $218 billion. • This included costs for those with diagnosed diabetes ($174.4 billion), undiagnosed ($18 billion), gestational diabetes ($636 million) and pre-diabetes ($25 million). Diabetes Type 2 used to be unheard of in children. Now that the incidence is everincreasing, when is it appropriate to screen at risk (ie, obese) children? (Zeitler, Phil. Type 2 Diabetes Mellitus Challenges in Diagnoses and Treatment. Contemporary Pediatrics, 2012 Jul; 29(7): 16-23) Diabetes and Self-Management Education (DSME). There is an association between women who have had DSME and better health outcomes related to Diabetes. (Gumbs, Jean Maydalyne. Relationship between diabetes self-management and education and self-care behaviors among African-American women with Type 2 Diabetes. Journal of Cultural Diversity, 2012 Spring; 19(1): 18-22. There is an increased risk of mortality for post-MI patients with diabetes and depression. (Bot, M; Pouwer, F; Zuidersma, M; van Melle, JP; de Jonge, P. Association of coexisting diabetes and depression with mortality after myocardial infarction. Diabetes Care. 2012 March; 35(3): 503-9) Research continued The FDA is currently considering the approval of a new class of drugs to treat diabetes. The SGLT2 inhibitors target glucose uptake in the kidneys to prevent the absorption of glucose. • This treatment takes a new approach from insulin injections. • There are concerns about its efficacy in patients with renal impairment. Islet transplantation • No need for insulin a year after surgery. • Episodes of low blood sugar reduced for five years. • Effects are not permanent. DCCT/EDIC • Large scale study conducted from 1983 to 1993. • Demonstrated that keeping blood glucose close to normal slowed progression of eye, kidney and nerve damage.