FREE ESSAY ON DIABETES

DIABETES

What is diabetes?
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose
resulting from defects in insulin secretion, insulin action, or both. Diabetes can be
associated with serious complications and premature death, but persons with diabetes can
take measures to reduce the likelihood of such occurrences. 15.7 million people -- 5.9%
of the population -- have diabetes. But only 10.3 million people are diagnosed so that
leaves 5.4 million people not diagnosed. 
Studies have found death rates to be twice as high among middle-aged people with diabetes
as among middle-aged people without diabetes. Based on death certificate data, diabetes
contributed to 193,140 deaths in 1996. Diabetes was the seventh leading cause of death
listed on U.S. death certificates in 1996, according to CDC's National Center for Health
Statistics. Diabetes is believed to be underreported on death certificates, both as a
condition and as a cause of death.
6.3 million. 18.4% of all people 65 years and older have diabetes.
15.6 million. 8.2% of all people 20 years and older have diabetes.
123,000. 0.16% of all people under age 20 have diabetes. 
Prevalence data for diabetes among Asian Americans and Pacific Islanders are limited.
Some groups within this population are at increased risk for diabetes. For example, data
collected from 1988 to 1995 suggest that Native Hawaiians are twice as likely to have
diagnosed diabetes as white residents of Hawaii.
The four types of diabetes are:
? Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or
juvenile-onset diabetes. Type 1 diabetes may account for 5% to 10% of all diagnosed cases
of diabetes. Risk factors are less well defined for type 1 diabetes than for type 2
diabetes, but autoimmune, genetic, and environmental factors are involved in the
development of this type of diabetes
? Type 2 diabetes was previously called non-insulin dependent diabetes mellitus (NIDDM)
or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all
diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity,
family history of diabetes, prior history of gestational diabetes, impaired glucose
tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino
Americans, American Indians, and some Asian Americans and Pacific Islanders are at
particularly high risk for type 2 diabetes.
? Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a
pregnancy is over. Gestational diabetes occurs more frequently in African Americans,
Hispanic/Latino Americans, American Indians, and persons with a family history of
diabetes. Obesity is also associated with higher risk. Women who have had gestational
diabetes are at increased risk for later developing type 2 diabetes. In some studies,
nearly 40% of women with a history of gestational diabetes developed diabetes in the
future.
? Other specific types of diabetes result from specific genetic syndromes, surgery,
drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account
for 1% to 2% of all diagnosed cases of diabetes. 
Diseases that come with diabetes
Heart disease 
? Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes
have heart disease death rates about 2 to 4 times as high as that of adults without
diabetes. 
Stroke 
? The risk of stroke is 2 to 4 times higher in people with diabetes. 
High blood pressure 
? An estimated 60% to 65% of people with diabetes have high blood pressure. 
Blindness 
? Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old. 
? Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year. 
Kidney disease 
? Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of
new cases. 
? 27,851 people with diabetes developed end-stage renal disease in 1995. 
? In 1995, a total of 98,872 people with diabetes underwent dialysis or kidney
transplantation. 
Nervous system disease 
? About 60% to 70% of people with diabetes have mild to severe forms of nervous system
damage (which often includes impaired sensation or pain in the feet or hands, slowed
digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems). 
? Severe forms of diabetic nerve disease are a major contributing cause of lower
extremity amputations. 
Amputations 
? More than half of lower limb amputations in the United States occur among people with
diabetes. 
? From 1993 to 1995, about 67,000 amputations were performed each year among people with
diabetes. 
Dental disease 
? Periodontal disease (a type of gum disease that can lead to tooth loss) occurs with
greater frequency and severity among people with diabetes. Periodontal disease has been
reported to occur among 30% of people aged 19 years or older with type 1 diabetes. 
Complications of pregnancy 
? The rate of major congenital malformations in babies born to women with preexisting
diabetes varies from 0% to 5% among women who receive preconception care to 10% among
women who do not receive preconception care. 
? Between 3% to 5% of pregnancies among women with diabetes result in death of the
newborn; the rate for women who do not have diabetes is 1.5%. 
Other complications with diabetes 
? Diabetes can directly cause acute life-threatening events, such as diabetic
ketoacidosis and hyperosmolar nonketotic coma. 
? People with diabetes are more susceptible to many other illnesses. For example, they
are more likely to die of pneumonia or influenza than people who do not have diabetes. 
Cost for medical treatment for diabetes
? Direct medical costs: $44 billion 
? Indirect costs: $54 billion 
New diagnostic criteria for diabetes
The new diagnostic criteria for diabetes include the following changes: 
? The routine diagnostic test for diabetes is now a fasting plasma glucose test rather
than the previously preferred oral glucose tolerance test. (However, in certain clinical
circumstances, physicians may still choose to perform the more difficult and costly oral
glucose tolerance test.)
? A confirmed fasting plasma glucose value of greater than or equal to 126
milligrams/deciliter (mg/dL) indicates a diagnosis of diabetes. Previously, a value of
greater than or equal to 140 mg/dL had been required for diagnosis. 
? In the presence of symptoms of diabetes, a confirmed nonfasting plasma glucose value of
greater than or equal to 200 mg/dL indicates a diagnosis of diabetes. 
? When a doctor chooses to perform an oral glucose tolerance test (by administering 75
grams of anhydrous glucose dissolved in water, in accordance with World Health
Organization standards, and then measuring the plasma glucose concentration 2 hours
later), a confirmed glucose value of greater than or equal to 200 mg/dL indicates a
diagnosis of diabetes. 
In pregnant women, different requirements are used to identify the presence of
gestational diabetes.
Treatment of diabetes
Diabetes knowledge, treatment, and prevention strategies advance daily. Treatment is
aimed at keeping blood glucose near normal levels at all times. Training in self-
management is integral to the treatment of diabetes. Treatment must be individualized and
must address medical, psychosocial, and lifestyle issues. 
? Treatment of type 1 diabetes: Lack of insulin production by the pancreas makes type 1
diabetes particularly difficult to control. Treatment requires a strict regimen that
typically includes a carefully calculated diet, planned physical activity, home blood
glucose testing several times a day, and multiple daily insulin injections.
? Treatment of type 2 diabetes: Treatment typically includes diet control, exercise, home
blood glucose testing, and in some cases, oral medication and/or insulin. Approximately
40% of people with type 2 diabetes require insulin injections.