November 27, 2004
Beware Diabetes-Related Complications
SATURDAY, Nov. 27 (HealthDayNews) -- As a diabetes educator, Mary Austin sometimes counsels diabetic patients who are acutely aware of how the disease, over time, can ravage the human body, from the eyes down to the feet.
"If any family member or close friend had diabetes, somehow the horror stories come out," said Austin, president of the American Association of Diabetes Educators, whose members teach patients to manage their diabetes on a daily basis.
Others, though, are terribly uninformed about the risks, as Austin, a former renal dietician, has witnessed. "I can count the times that I had patients say over and over, 'I had no idea that the diabetes could cause my kidneys to fail like this,'" she recalled.
Exacerbated by the nation's obesity epidemic, diabetes is now the sixth-leading cause of death in United States and is rapidly becoming a public health nightmare. The number of U.S. adults who've been diagnosed with diabetes, including pregnant women with gestational diabetes, has increased 61 percent since 1991 and is projected to more than double by 2050, according to the U.S. Centers for Disease Control and Prevention.
Of the 18.2 million Americans who currently suffer from diabetes, 5.2 million don't even know they have it, the U.S. Department of Health and Human Services reports. Almost all of the undiagnosed cases are people who suffer from type 2 diabetes, a condition in which the body fails to use insulin properly. And, increasingly, it's afflicting people at younger and younger ages -- even children and teens.
Type 2 diabetes usually can be controlled through diet and exercise, but sometimes people require medication or insulin. With type 1 diabetes, which is far less common, the pancreas no longer makes insulin, so patients must inject insulin or use an insulin pump.
When people don't manage their diabetes, glucose and fats remain in the blood, eventually damaging vital organs, according to the CDC's National Center for Chronic Disease Prevention and Health Promotion. The condition can lead to terrible complications:
Heart disease and stroke cause about 65 percent of deaths among people with diabetes.
About 42,813 people with diabetes develop kidney failure each year, and more than 100,000 are treated for this condition.
Some 82,000 people have diabetes-related leg, foot or toe amputations each year.
Between 12,000 and 24,000 people become blind because of diabetic eye disease.
About 18,000 women with pre-existing diabetes and another 135,000 women with gestational diabetes who give birth each year face serious complications such as stillbirth, congenital malformations and the need for a Caesarean section.
About 10,000 to 30,000 people with diabetes die of complications from flu or pneumonia each year.
"This is the kind of disease where vigilance is demanded," said Andrew J. Karter, a research scientist with Kaiser Permanente in Oakland, Calif., who has studied the relationship between genetics and risk for diabetic complications.
Karter's study, published in 2002 in the Journal of the American Medical Association, found no one racial group is more affected by diabetic complications than another. Whites had the greatest risk of heart attack as a diabetes-related complication, while other groups were more likely to suffer from end-stage renal disease.
Genetics likely play a role in the development of complications, but non-genetic factors such as health behaviors and quality health care are also clearly important, Karter said. "So regardless of their genetic makeup, patients with diabetes who carefully manage their health can reduce the risk of long-term complications," he said.
Diabetes patients could learn a lot about how to avoid serious complications by meeting with a diabetes educator for self-management training, Austin said. Medicare, in fact, covers up to 10 hours of initial training in a year, and two hours of follow-up training each subsequent year, according to the National Diabetes Education Program. Patients only need a referral from their physician or a qualified health practitioner who is treating the beneficiary for diabetes.
Yet few Americans who suffer from this chronic condition are getting the benefit of such services. "They're not getting referred for it," Austin said.
According to Sen. Kay Bailey Hutchison, a Texas Republican and co-sponsor of a bill that would allow certified diabetes educators to authorize self-management services, the Centers for Medicare and Medicaid Services estimates that only 30 percent of beneficiaries are using the benefit.
Keeping diabetes in control can require difficult lifestyle changes, and that's why having an advocate can help. "You don't have to have diabetes on your own," Austin said she tells patients.
Even people who don't have access to a diabetes educator can help themselves. For starters, the National Institutes of Health and the American Diabetes Association advise people to know the "ABCs" of diabetes:
"A" stands for hemoglobin A1c, a test that measures a person's average blood glucose during the past three months. The goal is an A1c below seven, which equates to an average blood glucose of 150.
"B" is for blood pressure. It's best to keep it below 130 over 80.
"C" is for cholesterol. Keep low-density lipoprotein, the "bad" kind of cholesterol that can clog your arteries, below 100.
Visit the National Diabetes Education Program to learn more about diabetes prevention and control.
SOURCES: Mary Austin, R.D., MA, CDE, president, American Association of Diabetes Educators, and nutrition and diabetes specialist, The Austin Group, Shelby Township, Mich.; Andrew J. Karter, Ph.D., research scientist, Epidemiology & Health Services Research, Kaiser Permanente, Oakland, Calif.; Diabetes Detection Initiative, U.S. Department of Health and Human Services; National Diabetes Education Program brochure; Centers for Medicare & Medicaid Services, Baltimore; May 14, 2002, Journal of the American Medical Association ~DIA1~~DIAB~~DIA2~