Section 2: Focus — Diabetes Diabetes a Serious Health Problem

Diabetes is a serious public health problem in the United States. According to statistics from the Center for Disease Control (CDC) ¹, diabetes is the seventh leading cause of death listed on U.S death certificates. In 1996 alone, it contributed to more than 193,000 deaths.

Currently, an estimated 10.3 million people in the United States have been diagnosed with diabetes–a six-fold increase over the past 40 years–and another 5.4 million people have undiagnosed diabetes. About 2,200 new cases are diagnosed every day in the United States. The prevalence of diabetes among adults increased 33 percent between 1990 and 1998.² These people are all at increased risk for serious health complications.

Diabetes is the leading cause of end-stage (chronic, irreversible) kidney disease, lower extremity amputations not related to injury, and new cases of blindness among adults 20—74 years old. It increases the risk of heart attack and strokes two to four times. And although people with diabetes are about three times more likely to die of complications from influenza (flu) and pneumonia than are people without diabetes, only 50% get an annual flu shot.

Populations at increased risk

Diabetes occurs among Americans of all ages and racial and ethnic groups. CDC data indicate, however, that a larger percentage of Americans over age 65 (18+%) have the disease than those younger. Although AgrAbility data on type of disability was not collected by age category, the data does indicate 220 clients, which is about 3% of all those who received direct on-site assistance, reported having some form of diabetes.

In addition to older Americans, certain racial and ethnic populations, including African Americans, Hispanics/Latinos, American Indians, and Alaskan Natives are more prone to develop diabetes than their non-Hispanic white counterparts of similar age. Several studies have also shown increased rates of diabetes among certain Asian and Pacific Islander populations.

Cost to society

The American Diabetes Association ³ estimates that the nation spends more than $98 billion annually on the direct and indirect costs of diabetes. Medicare costs for treatment of kidney failure alone average $51,000 per person. The full economic impact of diabetes is, however, difficult to measure, because death records frequently do not indicate whether diabetes was a contributing factor in the deaths. The costs related to undiagnosed diabetes are unknown. In addition, we have no way to measure the costs to families and communities when their members’ lives and abilities are lost.

Definition

The term diabetes describes either a deficiency of insulin or a decreased ability of the body to use insulin, a hormone manufactured by cells in the pancreas. Insulin allows glucose (sugar) to enter cells and be converted to energy. Insulin is also needed to synthesize protein and store fats. In uncontrolled diabetes, glucose and lipids (fats) remain in the bloodstream and, with time, damage vital organs and contribute to heart disease. ¹

Categories of Diabetes

Type 1 (previously called juvenile-onset) diabetes is an auto-immune disease in which the body does not produce any insulin because of damage to the pancreas. Between 5% and 10% of people with diabetes have type 1, which most often appears in childhood or the teenage years. People with type 1 diabetes must take daily insulin injections to stay alive. Symptoms include weight loss, frequent urination, hunger, thirst, blurred vision, fatigue, and/or coma. The goal of treatment is to lower glucose levels with insulin shots plus good diet and/or exercise.

Type 2 (formerly called adult-onset) diabetes is a metabolic disorder resulting from the body’s inability to make enough or properly use insulin. In either case, glucose builds up in the blood. Type 2 is the most common form of the disease, which affects 90%—95% of people with diabetes, and usually appears after age 40. It is nearing epidemic proportions due to an increased number of older Americans and a greater prevalence of obesity and sedentary lifestyles. The goal of treatment is to lower blood sugar and improve the body’s use of insulin with effective meal planning, exercise, and weight loss. Sometimes, however, healthful habits like eating well, losing weight, and exercising are not enough. In that case, a doctor may prescribe insulin pills or injections.

Gestational diabetes develops in 2—5% of all pregnant women who have never had diabetes before but it disappears when a pregnancy is over. The exact cause is unknown. Women who have had gestational diabetes are at increased risk for developing type 2 diabetes later in life.

"Other specific types" of diabetes are less common and together may account for 1%—2% of all diagnosed cases. These types result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Treatment varies depending on the type.

Complications of Diabetes

Many of the complications resulting from diabetes can be prevented with early detection, improved delivery of care, and better education on diabetes self-management. Four of the most serious diabetes-related complications that could be prevented or reduced are listed below.

Eye Disease and Blindness–Diabetes is the leading cause of new cases of blindness among adults 20—74 years old. Twenty-five percent of adults with diabetes, or about 1.6 million people, report that they are visually impaired. Each year, an estimated 12,000—24,000 people become blind because of diabetic eye disease.³ Early detection and treatment could prevent up to 90% of diabetes-related blindness. Only 60% of people with diabetes are receiving annual dilated eye examinations–a key strategy for preventing diabetes-related blindness.

Kidney Failure–Each year, about 33,000 people with diabetes develop kidney failure, and more than 100,000 people with diabetes receive treatment for this condition. One half of the new cases of diabetes-related kidney failure could be prevented.

Nerve Disease and Amputations–About 60-70% of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations. ³ In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15-40 times greater for a person with diabetes than for one without. Each year, more than 86,000 amputations are performed among people with diabetes.¹ Over half of these amputations could be prevented.

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In This Issue
Section 1: Farming with Diabetes Section 2: Focus—Diabetes a Serious Health Problem Section 3: Assistive Technology Notes—Technologies for Controlling and Monitoring, and Accommodating Secondary Complications of Diabetes	Section 4: A Client's Story—Carmen Schacht's Story Section 5: Resources and References Section 6: Contacts Section 7: Assistive Technology Notes Resources