Free Diabetes
Information
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Almost everyone knows someone who has diabetes.
An estimated 17 million people--6.2 percent of the population--in
the United States have diabetes mellitus--a serious, lifelong
condition. About 5.9 million people have not yet been diagnosed.
Each year, about 1 million people age 20 or older are diagnosed
with diabetes.
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What Is Diabetes?
Diabetes is a disorder of metabolism--the way our bodies
use digested food for growth and energy. Most of the food
we eat is broken down into glucose, the form of sugar in
the blood. Glucose is the main source of fuel for the body.
After digestion, glucose passes into the
bloodstream, where it is used by cells for growth and energy.
For glucose to get into cells, insulin must be present.
Insulin is a hormone produced by the pancreas, a large gland
behind the stomach.
When we eat, the pancreas is supposed to
automatically produce the right amount of insulin to move
glucose from blood into our cells. In people with diabetes,
however, the pancreas either produces little or no insulin,
or the cells do not respond appropriately to the insulin
that is produced. Glucose builds up in the blood, overflows
into the urine, and passes out of the body. Thus, the body
loses its main source of fuel even though the blood contains
large amounts of glucose.
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What Are the Types
of Diabetes?
The three main types of diabetes are
Type 1 diabetes
Type 2 diabetes
Gestational diabetes
Type 1 diabetes
Type 1 diabetes is an autoimmune disease. An autoimmune
disease results when the body's system for fighting infection
(the immune system) turns against a part of the body. In
diabetes, the immune system attacks the insulin-producing
beta cells in the pancreas and destroys them. The pancreas
then produces little or no insulin. Someone with type 1
diabetes needs to take insulin daily to live.
At present, scientists do not know exactly
what causes the body's immune system to attack the beta
cells, but they believe that autoimmune, genetic, and environmental
factors, possibly viruses, are involved. Type 1 diabetes
accounts for about 5 to 10 percent of diagnosed diabetes
in the United States.
Type 1 diabetes develops most often in
children and young adults, but the disorder can appear at
any age. Symptoms of type 1 diabetes usually develop over
a short period, although beta cell destruction can begin
years earlier.
Symptoms include increased thirst and urination,
constant hunger, weight loss, blurred vision, and extreme
fatigue. If not diagnosed and treated with insulin, a person
can lapse into a life-threatening diabetic coma, also known
as diabetic ketoacidosis.
Type 2 diabetes
The most common form of diabetes is type 2 diabetes. About
90 to 95 percent of people with diabetes have type 2. This
form of diabetes usually develops in adults age 40 and older
and is most common in adults over age 55. About 80 percent
of people with type 2 diabetes are overweight. Type 2 diabetes
is often part of a metabolic syndrome that includes obesity,
elevated blood pressure, and high levels of blood lipids.
Unfortunately, as more children and adolescents become overweight,
type 2 diabetes is becoming more common in young people.
When type 2 diabetes is diagnosed, the
pancreas is usually producing enough insulin, but, for unknown
reasons, the body cannot use the insulin effectively, a
condition called insulin resistance. After several years,
insulin production decreases. The result is the same as
for type 1 diabetes--glucose builds up in the blood and
the body cannot make efficient use of its main source of
fuel.
The symptoms of type 2 diabetes develop
gradually. They are not as sudden in onset as in type 1
diabetes. Some people have no symptoms. Symptoms may include
fatigue or nausea, frequent urination, unusual thirst, weight
loss, blurred vision, frequent infections, and slow healing
of wounds or sores.
Gestational Diabetes
Gestational diabetes develops only during pregnancy. Like
type 2 diabetes, it occurs more often in African Americans,
American Indians, Hispanic Americans, and people with a
family history of diabetes. Though it usually disappears
after delivery, the mother is at increased risk of getting
type 2 diabetes later in life.
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What Tests Are
Recommended for Diagnosing Diabetes?
The fasting plasma glucose test is the preferred test for
diagnosing type 1 or type 2 diabetes. However, a diagnosis
of diabetes is made for any one of three positive tests,
with a second positive test on a different day:
A random plasma glucose value (taken any
time of day) of 200 mg/dL or more, along with the presence
of diabetes symptoms.
A plasma glucose value of 126 mg/dL or more, after a person
has fasted for 8 hours.
An oral glucose tolerance test (OGTT) plasma glucose value
of 200 mg/dL or more in the blood sample, taken 2 hours
after a person has consumed a drink containing 75 grams
of glucose dissolved in water. This test, taken in a laboratory
or the doctor's office, measures plasma glucose at timed
intervals over a 3-hour period.
Gestational diabetes is diagnosed based on plasma glucose
values measured during the OGTT. Glucose levels are normally
lower during pregnancy, so the threshold values for diagnosis
of diabetes in pregnancy are lower. If a woman has two plasma
glucose values meeting or exceeding any of the following
numbers, she has gestational diabetes: a fasting plasma
glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL,
a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.
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What Are the Other
Forms of Impaired Glucose Metabolism, Also Called Prediabetes?
People with prediabetes, a state between "normal" and "diabetes,"
are at risk for developing diabetes, heart attacks, and
strokes. About 16 million people ages 40 to 74 in the United
States have prediabetes. There are two forms of prediabetes.
Impaired Fasting Glucose
A person has impaired fasting glucose (IFG) when fasting
plasma glucose is 110 to 125 mg/dL. This level is higher
than normal but less than the level indicating a diagnosis
of diabetes.
Impaired Glucose Tolerance
Impaired glucose tolerance (IGT) means that blood glucose
during the oral glucose tolerance test is higher than normal
but not high enough for a diagnosis of diabetes. IGT is
diagnosed when the glucose level is 141 to 199 mg/dL 2 hours
after a person is given a drink containing 75 grams of glucose.
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What Are the Scope
and Impact of Diabetes?
Diabetes is widely recognized as one of the leading causes
of death and disability in the United States. In 1999, about
450,000 deaths occurred among adults with diabetes.
Diabetes is associated with long-term complications
that affect almost every part of the body. The disease often
leads to blindness, heart and blood vessel disease, strokes,
kidney failure, amputations, and nerve damage. Uncontrolled
diabetes can complicate pregnancy, and birth defects are
more common in babies born to women with diabetes.
In 1997, diabetes cost the United States
$98 billion. Indirect costs, including disability payments,
time lost from work, and premature death, totaled $54 billion;
direct medical costs for diabetes care, including hospitalizations,
medical care, and treatment supplies, totaled $44 billion.
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Who Gets Diabetes?
Diabetes is not contagious. People cannot "catch" it from
each other. However, certain factors can increase the risk
of developing diabetes.
Type 1 diabetes occurs equally among males
and females, but is more common in whites than in nonwhites.
Data from the World Health Organization's Multinational
Project for Childhood Diabetes indicate that type 1 diabetes
is rare in most African, American Indian, and Asian populations.
However, some northern European countries, including Finland
and Sweden, have high rates of type 1 diabetes. The reasons
for these differences are not known.
Type 2 diabetes is more common in older
people, especially in people who are overweight, and occurs
more often in African Americans, American Indians, Asian
and Pacific Islander Americans, and Hispanic Americans.
On average, non-Hispanic African Americans are twice as
likely to have diabetes as non-Hispanic whites of the same
age. Hispanic Americans are nearly twice as likely to have
diabetes as non-Hispanic whites. American Indians have the
highest rates of diabetes in the world. Among the Pima Indians
living in Arizona, for example, half of all adults have
type 2 diabetes. On average, American Indians and Alaska
Natives are 2.6 times as likely to have diabetes as non-Hispanic
whites. Although prevalence data for diabetes among Asian
Americans and Pacific Islanders is limited, some groups,
such as Native Hawaiians, are 2.5 times more likely to have
diabetes as white residents of Hawaii.
The prevalence of diabetes in the United
States is likely to increase for several reasons. First,
a large segment of the population is aging. Also, Hispanic
Americans and other minority groups make up the fastest-growing
segment of the U.S. population. Finally, Americans are increasingly
overweight and sedentary. According to recent estimates,
the prevalence of diabetes in the United States is predicted
to be 8.9 percent of the population by 2025.
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How Is Diabetes
Managed?
Before the discovery of insulin in 1921, everyone with type
1 diabetes died within a few years after diagnosis. Although
insulin is not considered a cure, its discovery was the
first major breakthrough in diabetes treatment.
Today, healthy eating, physical activity,
and insulin via injection or an insulin pump are the basic
therapies for type 1 diabetes. The amount of insulin must
be balanced with food intake and daily activities. Blood
glucose levels must be closely monitored through frequent
blood glucose checking.
Healthy eating, physical activity, and
blood glucose testing are the basic management tools for
type 2 diabetes. In addition, many people with type 2 diabetes
require oral medication and insulin to control their blood
glucose levels.
People with diabetes must take responsibility
for their day-to-day care. Much of the daily care involves
keeping blood glucose levels from going too low or too high.
When blood glucose levels drop too low from certain diabetes
medicines--a condition known as hypoglycemia--a person can
become nervous, shaky, and confused. Judgment can be impaired.
If blood glucose falls too low, a person can faint.
A person can also become ill if blood glucose
levels rise too high, a condition known as hyperglycemia.
People with diabetes should see a doctor
who helps them learn to manage their diabetes and monitors
their diabetes control. An endocrinologist is one type of
doctor who may specialize in diabetes care. In addition,
people with diabetes often see ophthalmologists for eye
examinations, podiatrists for routine foot care, and dietitians
and diabetes educators to help teach the skills of day-to-day
diabetes management.
The goal of diabetes management is to keep
blood glucose levels as close to the normal range as safely
possible. A major study, the Diabetes Control and Complications
Trial (DCCT), sponsored by the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK), showed that keeping
blood glucose levels as close to normal as safely possible
reduces the risk of developing major complications of type
1 diabetes.
The 10-year study, completed in 1993, included
1,441 people with type 1 diabetes. The study compared the
effect of two treatment approaches--intensive management
and standard management--on the development and progression
of eye, kidney, and nerve complications of diabetes. Intensive
treatment aimed at keeping hemoglobin A-1-c as close to
normal (6 percent) as possible. Hemoglobin A-1-c reflects
average blood sugar over a 2- to 3-month period. Researchers
found that study participants who maintained lower levels
of blood glucose through intensive management had significantly
lower rates of these complications. More recently, a followup
study of DCCT participants showed that the ability of intensive
control to lower the complications of diabetes persists
up to 4 years after the trial ended.
The United Kingdom Prospective Diabetes
Study, a European study completed in 1998, showed that intensive
control of blood glucose and blood pressure reduced the
risk of blindness, kidney disease, stroke, and heart attack
in people with type 2 diabetes.
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What Is the Status
of Diabetes Research?
NIDDK conducts research in its own laboratories and supports
a great deal of basic and clinical research in medical centers
and hospitals throughout the United States. It also gathers
and analyzes statistics about diabetes. Other Institutes
at the National Institutes of Health (NIH) conduct and support
research on diabetes-related eye diseases, heart and vascular
complications, pregnancy, and dental problems.
Other Government agencies that sponsor
diabetes programs are the Centers for Disease Control and
Prevention, the Indian Health Service, the Health Resources
and Services Administration, the Department of Veterans
Affairs, and the Department of Defense.
Many organizations outside of the Government
support diabetes research and education activities. These
organizations include the American Diabetes Association,
the Juvenile Diabetes Research Foundation International,
and the American Association of Diabetes Educators.
In recent years, advances in diabetes research
have led to better ways to manage diabetes and treat its
complications. Major advances include
- The development of a quick-acting insulin
analog.
- Better ways to monitor blood glucose
and for people with diabetes to check their own blood
glucose levels.
- Development of external insulin pumps
that deliver insulin, replacing daily injections.
- Laser treatment for diabetic eye disease,
reducing the risk of blindness.
- Successful transplantation of kidneys
and pancreas in people whose own kidneys fail because
of diabetes.
- Better ways of managing diabetes in
pregnant women, improving chances of successful outcomes.
- New drugs to treat type 2 diabetes
and better ways to manage this form of diabetes through
weight control.
- Evidence that intensive management
of blood glucose reduces and may prevent development of
diabetes complications.
- Demonstration that antihypertensive
drugs called ACE (angiotensin-converting enzyme) inhibitors
prevent or delay kidney failure in people with diabetes.
- Promising results with islet transplantation
for type 1 diabetes reported by the University of Alberta
in Canada. A nationwide clinical trial funded by the NIH
and the Juvenile Diabetes Research Foundation International
is currently trying to replicate the Canadian advance.
- Evidence that people at high risk for
type 2 diabetes can lower their chances of developing
the disease through diet and exercise.
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What Will the Future
Bring?
In the future, it may be possible to administer insulin
through inhalers, a pill, or a patch. Devices are also being
developed that can monitor blood glucose levels without
having to prick a finger to get a blood sample.
Researchers continue to search for the
cause or causes of diabetes and ways to prevent and cure
the disorder. Scientists are looking for genes that may
be involved in type 1 or type 2 diabetes. Some genetic markers
for type 1 diabetes have been identified, and it is now
possible to screen relatives of people with type 1 diabetes
to see if they are at risk.
The Diabetes Prevention Trial--Type 1 (DPT-1)
identifies relatives at risk for developing type 1 diabetes
and treats them with an oral form of insulin in the hope
of preventing type 1 diabetes. In the same study, researchers
recently completed a separate trial in which they found
that low-dose insulin injections do not prevent type 1 diabetes
in relatives of people with type 1 diabetes. For more information,
call 1-800-HALT-DM1 (1-800-425-8361
The DPT-1 is funded by the NIDDK, the National
Institute of Allergy and Infectious Diseases, the National
Institute of Child Health and Human Development, and the
National Center for Research Resources within the National
Institutes of Health as well as the American Diabetes Association
and the Juvenile Diabetes Research Foundation International.
Transplantation of the pancreas or insulin-producing
beta cells offers the best hope of cure for people with
type 1 diabetes. Some pancreas transplants have been successful.
However, people who have transplants must take powerful
drugs to prevent rejection of the transplanted organ. These
drugs are costly and may eventually cause other health problems.
Scientists are working to develop less
harmful drugs and better methods of transplanting beta cells
to prevent rejection by the body. Using techniques of bioengineering,
researchers are also trying to create artificial beta cells
that secrete insulin in response to increased glucose levels
in the blood.
Recently, researchers at the University
of Alberta in Edmonton, Canada, announced promising results
with islet transplantation in seven patients with type 1
diabetes. At the time of the report in the New England Journal
of Medicine, all seven patients who had received the transplant
remained free of insulin injections up to 14 months after
the procedure.
A clinical trial funded by the NIH and
the Juvenile Diabetes Research Foundation International
will try to replicate the Edmonton advance. With the insights
gained from this trial and other studies, scientists hope
to further refine methods of islet harvesting and transplantation
and learn more about the immune processes that affect rejection
and acceptance of transplanted islets.
In 1996, NIDDK launched its Diabetes Prevention
Program (DPP). The goal of this research effort was to learn
how to prevent or delay type 2 diabetes in people with impaired
glucose tolerance (IGT), a strong risk factor for type 2
diabetes.
The findings of the DPP, which were released
in August 2001, showed that people at high risk for type
2 diabetes could sharply lower their chances of developing
the disease through diet and exercise. In addition, treatment
with the oral diabetes drug metformin also reduced diabetes
risk, though less dramatically.
Participants randomly assigned to intensive
lifestyle intervention reduced their risk of getting type
2 diabetes by 58 percent. On average, this group maintained
their physical activity at 30 minutes per day, usually with
walking or other moderate intensity exercise, and lost 5
to 7 percent of their body weight. Participants randomized
to treatment with metformin reduced their risk of getting
type 2 diabetes by 31 percent.
Of the 3,234 participants enrolled in the
DPP, 45 percent were from minority groups that suffer disproportionately
from type 2 diabetes: African Americans, Hispanic Americans,
Asian Americans and Pacific Islanders, and American Indians.
The trial also recruited other groups known to be at higher
risk for type 2 diabetes, including individuals age 60 and
older, women with a history of gestational diabetes, and
people with a first-degree relative with type 2 diabetes.
Several new drugs have been developed to
treat type 2 diabetes. By using the oral diabetes medications
now available, many people can control blood glucose levels
without insulin injections. Studies are under way to determine
how best to use these drugs to manage type 2 diabetes. Scientists
also are investigating strategies for weight loss in people
with type 2 diabetes.
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Points to Remember
What is diabetes?
a disorder of metabolism--the way the body
digests food for energy and growth
What are the main types of diabetes?
type 1 diabetes
type 2 diabetes
gestational diabetes
What is the impact of diabetes?
affects 17 million people
is a leading cause of death and disability
costs $98 billion per year
Who gets diabetes?
people of any age
people with a family history of diabetes
most common in older people, overweight and sedentary people,
African Americans, Alaska Natives, American Indians, Asian
and Pacific Islander Americans, and Hispanic Americans
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Where Is More Information Available?
For more information about type 1, type 2, and gestational
diabetes, as well as diabetes research, statistics, and
education, contact
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or (301) 654-3327
The following organizations also distribute
materials and support programs for people with diabetes
and their families and friends:
American Diabetes Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1-800-342-2383 or (703) 549-1500
Juvenile Diabetes Research Foundation International
120 Wall Street, 19th Floor
New York, NY 10005
Phone: 1-800-533-2873 or (212) 785-9500
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