Diabetes Overview
On this page:
Almost everyone knows someone who has diabetes. An estimated 20.8
million people in the United States—7.0 percent of the
population—have diabetes, a serious, lifelong condition. Of those,
14.6 million have been diagnosed, and 6.2 million have not yet been
diagnosed. In 2005, about 1.5 million people aged 20 or older were
diagnosed with diabetes. For additional statistics, see the
National Diabetes Statistics fact sheet online at www.diabetes.niddk.nih.gov/dm/pubs/statistics
or call the National Diabetes Information Clearinghouse at
1–800–860–8747 to request a copy.
[Top]
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 automatically produces 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 in the urine. Thus, the body loses
its main source of fuel even though the blood contains large amounts
of glucose. [Top]
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 and destroys the insulin-producing beta cells in the
pancreas. The pancreas then produces little or no insulin. A person
who has type 1 diabetes must 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. It develops most often in
children and young adults but 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 may
include increased thirst and urination, constant hunger, weight
loss, blurred vision, and extreme fatigue. If not diagnosed and
treated with insulin, a person with type 1 diabetes 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 is most often associated with older age, obesity, family
history of diabetes, previous history of gestational diabetes,
physical inactivity, and certain ethnicities. About 80 percent of
people with type 2 diabetes are overweight.
Type 2 diabetes is increasingly being diagnosed in children and
adolescents. However, nationally representative data on prevalence
of type 2 diabetes in youth are not available.
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. Their onset is
not as sudden as in type 1 diabetes. Symptoms may include fatigue,
frequent urination, increased thirst and hunger, weight loss,
blurred vision, and slow healing of wounds or sores. Some people
have no symptoms.
Gestational Diabetes
Some women develop gestational diabetes late in pregnancy.
Although this form of diabetes usually disappears after the birth of
the baby, women who have had gestational diabetes have a 20 to 50
percent chance of developing type 2 diabetes within 5 to 10 years.
Maintaining a reasonable body weight and being physically active may
help prevent development of type 2 diabetes.
About 3 to 8 percent of pregnant women in the United States
develop gestational diabetes. As with type 2 diabetes, gestational
diabetes occurs more often in some ethnic groups and among women
with a family history of diabetes. Gestational diabetes is caused by
the hormones of pregnancy or a shortage of insulin. Women with
gestational diabetes may not experience any symptoms. [Top]
How is diabetes diagnosed?
The fasting blood glucose test is the preferred test for
diagnosing diabetes in children and nonpregnant adults. It is most
reliable when done in the morning. However, a diagnosis of diabetes
can be made based on any of the following test results, confirmed by
retesting on a different day:
- A blood glucose level of 126 milligrams per deciliter (mg/dL)
or more after an 8-hour fast. This test is called the fasting
blood glucose test.
- A blood glucose level of 200 mg/dL or more 2 hours after
drinking a beverage containing 75 grams of glucose dissolved in
water. This test is called the oral glucose tolerance test
(OGTT).
- A random (taken at any time of day) blood glucose level of 200
mg/dL or more, along with the presence of diabetes
symptoms.
Gestational diabetes is diagnosed based on blood glucose levels
measured during the OGTT. Glucose levels are normally lower during
pregnancy, so the cutoff levels for diagnosis of diabetes in
pregnancy are lower. Blood glucose levels are measured before a
woman drinks a beverage containing glucose. Then levels are checked
1, 2, and 3 hours afterward. If a woman has two blood glucose levels
meeting or exceeding any of the following numbers, she has
gestational diabetes: a fasting blood 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. [Top]
What is pre-diabetes?
People with pre-diabetes have blood glucose levels that are
higher than normal but not high enough for a diagnosis of diabetes.
This condition raises the risk of developing type 2 diabetes, heart
disease, and stroke.
Pre-diabetes is also called impaired fasting glucose (IFG) or
impaired glucose tolerance (IGT), depending on the test used to
diagnose it. Some people have both IFG and IGT.
- IFG is a condition in which the blood glucose level is high
(100 to 125 mg/dL) after an overnight fast, but is not high enough
to be classified as diabetes. (The former definition of IFG was
110 mg/dL to 125 mg/dL.)
- IGT is a condition in which the blood glucose level is high
(140 to 199 mg/dL) after a 2-hour oral glucose tolerance test, but
is not high enough to be classified as diabetes.
Pre-diabetes is becoming more common in the United States,
according to new estimates provided by the U.S. Department of Health
and Human Services. About 40 percent of U.S. adults ages 40 to 74—or
41 million people—had pre-diabetes in 2000. New data suggest that at
least 54 million U.S. adults had pre-diabetes in 2002. Many people
with pre-diabetes go on to develop type 2 diabetes within 10
years.
The good news is that if you have pre-diabetes, you can do a lot
to prevent or delay diabetes. Studies have clearly shown that you
can lower your risk of developing diabetes by losing 5 to 7 percent
of your body weight through diet and increased physical activity. A
major study of more than 3,000 people with IGT, a form of
pre-diabetes, found that diet and exercise resulting in a 5 to 7
percent weight loss—about 10 to 14 pounds in a person who weighs 200
pounds—lowered the incidence of type 2 diabetes by nearly 60
percent. Study participants lost weight by cutting fat and calories
in their diet and by exercising (most chose walking) at least 30
minutes a day, 5 days a week. [Top]
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 2002, it was the sixth
leading cause of death. However, diabetes is likely to be
underreported as the underlying cause of death on death
certificates. About 65 percent of deaths among those with diabetes
are attributed to heart disease and stroke.
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, stroke, 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 2002, diabetes cost the United States $132 billion. Indirect
costs, including disability payments, time lost from work, and
premature death, totaled $40 billion; direct medical costs for
diabetes care, including hospitalizations, medical care, and
treatment supplies, totaled $92 billion. [Top]
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 non-whites. 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 unknown. Type 1 diabetes
develops most often in children but can occur at any age.
Type 2 diabetes is more common in older people, especially in
people who are overweight, and occurs more often in African
Americans, American Indians, some Asian Americans, Native Hawaiians
and other Pacific Islander Americans, and Hispanics/Latinos. On
average, non-Hispanic African Americans are 1.8 times as likely to
have diabetes as non-Hispanic whites of the same age. Mexican
Americans are 1.7 times as likely to have diabetes as non-Hispanic
whites of similar age. (Data are not available for estimation of
diabetes rates in other Hispanic/Latino groups.) American Indians
have one of the highest rates of diabetes in the world. On average,
American Indians and Alaska Natives are 2.2 times as likely to have
diabetes as non-Hispanic whites of similar age. Although prevalence
data for diabetes among Asian Americans and Pacific Islanders are
limited, some groups, such as Native Hawaiians, Asians, and other
Pacific Islanders residing in Hawaii (aged 20 or older) are more
than twice as likely to have diabetes as white residents of Hawaii
of similar age.
Diabetes prevalence in the United States is likely to increase
for several reasons. First, a large segment of the population is
aging. Also, Hispanics/Latinos and other minority groups at
increased risk make up the fastest-growing segment of the U.S.
population. Finally, Americans are increasingly overweight and
sedentary. According to recent estimates from the Centers for
Disease Control and Prevention (CDC), diabetes will affect one in
three people born in 2000 in the United States. The CDC also
projects the prevalence of diagnosed diabetes in the United States
will increase 165 percent by 2050.
 d
[Top]
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 taking insulin 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. People with diabetes also monitor blood glucose levels
several times a year with a laboratory test called the A1C. Results
of the A1C test reflect average blood glucose over a 2- to 3-month
period.
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, insulin, or
both to control their blood glucose levels.
Adults with diabetes are at high risk for cardiovascular disease
(CVD). In fact, at least 65 percent of those with diabetes die from
heart disease or stroke. Managing diabetes is more than keeping
blood glucose levels under control—it is also important to manage
blood pressure and cholesterol levels through healthy eating,
physical activity, and use of medications (if needed). By doing so,
those with diabetes can lower their risk. Aspirin therapy, if
recommended by the health care team, and smoking cessation can also
help lower risk.
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—a condition known as hypoglycemia—a person can
become nervous, shaky, and confused. Judgment can be impaired, and
if blood glucose falls too low, fainting can occur.
A person can also become ill if blood glucose levels rise too
high, a condition known as hyperglycemia.
People with diabetes should see a health care provider who will
help them learn to manage their diabetes and who will monitor their
diabetes control. Most people with diabetes get care from primary
care physicians—internists, family practice doctors, or
pediatricians. Often, having a team of providers can improve
diabetes care. A team can include
- a primary care provider such as an internist, a family
practice doctor, or a pediatrician
- an endocrinologist (a specialist in diabetes care)
- a dietitian, a nurse, and other health care providers who are
certified diabetes educators—experts in providing information
about managing diabetes
- a podiatrist (for foot care)
- an ophthalmologist or an optometrist (for eye care)
and other health care providers, such as cardiologists and other
specialists. In addition, the team for a pregnant woman with type 1,
type 2, or gestational diabetes should include an obstetrician who
specializes in caring for women with diabetes. The team can also
include a pediatrician or a neonatologist with experience taking
care of babies born to women with diabetes.
The goal of diabetes management is to keep levels of blood
glucose, blood pressure, and cholesterol 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 close to normal reduces the risk of
developing major complications of type 1 diabetes.
This 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, nerve, and
cardiovascular complications of diabetes. Intensive treatment aimed
to keep A1C levels as close to normal (6 percent) as possible.
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
follow-up study of DCCT participants showed that the ability of
intensive control to lower the complications of diabetes has
persisted more than 10 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. [Top]
Hope Through 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,
autoimmunity, pregnancy, and dental problems.
Other Government agencies that sponsor diabetes programs are the
CDC, the Indian Health Service, the Health Resources and Services
Administration, the Department of Veterans Affairs, and the
Department of Defense.
Many organizations outside the Government support diabetes
research and education activities. These organizations include the
American Diabetes Association (ADA), the Juvenile Diabetes Research
Foundation International (JDRF), and the American Association of
Diabetes Educators.
In recent years, advances in diabetes research have led to better
ways of managing diabetes and treating its complications. Major
advances include
- development of quick-acting, long-acting, and inhaled
insulins
- 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 kidney and pancreas transplantation in people whose
kidneys fail because of diabetes
- better ways of managing diabetes in pregnant women, improving
their chances of a successful outcome
- new drugs to treat type 1 and 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 two types of antihypertensive drugs, ACE
(angiotensin-converting enzyme) inhibitors and ARBs (angiotensin
receptor blockers), are more effective than other antihypertensive
drugs in reducing a decline in kidney function in people with
diabetes
- advances in transplantation of islets (clusters of cells that
produce insulin and other hormones) for type 1 diabetes
- evidence that people at high risk for type 2 diabetes can
lower their chances of developing the disease through diet, weight
loss, and physical activity
[Top]
What will the future bring?
Researchers continue to look for the cause or causes of diabetes
and ways to manage, prevent, or cure the disorder. Scientists are
searching 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 determine whether they are at risk.
Type 1 Diabetes
A number of Federally-funded research studies and clinical trials
are under way. Studies focus on the prevention and causes of type 1
diabetes as well as experimental treatments such as islet
transplantation.
The Environmental Determinants of Diabetes in the Young
Consortium
The main mission of The Environmental
Determinants of Diabetes in the Young (TEDDY) consortium, an
international group of clinical centers, is to identify infectious
agents, dietary factors, or other environmental factors (including
psychosocial events) that trigger type 1 diabetes in those who are
genetically susceptible. In addition, the consortium aims to
- create a central repository of data and biological samples for
use by researchers
- develop novel approaches to finding the causes of type 1
diabetes
- find ways to understand how the disease starts and
progresses
- discover new methods to prevent, delay, and reverse type 1
diabetes
TEDDY is funded by the NIDDK, the National Institute of Allergy
and Infectious Diseases (NIAID), the National Institute of Child
Health and Human Development (NICHD), the National Institute of
Environmental Health Sciences, the CDC, the JDRF, and the ADA. For
more information, see www.niddk.nih.gov/patient/TEDDY/TEDDY.htm.
Type 1 Diabetes TrialNet
Type 1 Diabetes
TrialNet is a network of experts and facilities dedicated to
developing new approaches to the understanding, prevention, and
treatment of type 1 diabetes. Clinical centers are located in the
United States, Canada, Europe, and Australia.
TrialNet studies are focusing on
- understanding the natural history of type 1 diabetes (to
determine its causes and how the disease progresses)
- preventing type 1 diabetes in those at risk
- developing ways to preserve the function of the
insulin-producing cells in the pancreas in people recently
diagnosed with type 1 diabetes
For more information, see http://www.diabetestrialnet.org/
or call 1–800–HALT–DM1 (1–800–425–8361).
In many ways, the TrialNet studies build on the advances and
insights gained from earlier research in type 1 diabetes. For
example, researchers learned a great deal about how to predict type
1 diabetes in at-risk people from the Diabetes Prevention Trial—Type
1 (DPT–1). This study showed that people at risk of developing type
1 diabetes can be identified. The DPT-1 researchers discovered ways
to identify two populations at risk of developing type 1 diabetes
within 5 years: those at high risk (with at least a 50 percent
chance) and those with an intermediate risk (having a 25 to 50
percent risk). Then researchers explored possible ways of preventing
type 1 diabetes in both groups. TrialNet will identify people at
risk who may be eligible for clinical trials. In addition, TrialNet
will conduct trials to save beta cell function in those with new
onset type 1 diabetes.
TrialNet is funded by the NIDDK, NICHD, and NIAID. JDRF and ADA
also support this effort.
The Immune Tolerance Network
TrialNet works
closely with the Immune Tolerance Network, another international,
collaborative consortium. Its goal is to find safe and effective
ways to induce long-term immune tolerance—prevention of an unwanted
immune response by the body. For example, type 1 diabetes might be
prevented if scientists could learn how to prevent the immune system
from mistakenly attacking the insulin-producing cells in the
pancreas. Effective immune tolerance could possibly
- prevent the body’s rejection of organ or tissue
transplants
- prevent or treat autoimmune diseases
- prevent or treat allergies and asthma
Islet Transplantation
Researchers are working
on a way for people with type 1 diabetes to live without daily
insulin injections. In an experimental procedure called islet
transplantation, islets are taken from a donor pancreas and
transferred into a person with type 1 diabetes. Once implanted, the
beta cells in these islets begin to make and release insulin.
Scientists have made many advances in islet transplantation in
recent years. Since reporting their findings in the June 2000 issue
of the New England Journal of Medicine, researchers at the
University of Alberta in Edmonton, Alberta, Canada, have continued
to use a procedure called the Edmonton protocol to transplant
pancreatic islets into people with type 1 diabetes. Before use of
the Edmonton protocol, during the 1990s, less than 10 percent of
islet cell transplant recipients were able to control blood glucose
levels for more than 1 year without insulin injections.
The Collaborative Islet Transplant Registry (CITR), funded by
NIDDK, was created in 2001. CITR’s mission is to expedite progress
and promote safety in islet transplantation by collecting,
analyzing, and communicating data on islet transplantation. The CITR
will study islet transplantation alone as well as islet
transplantation following kidney transplant.
The September 2005 CITR annual report noted that with use of the
Edmonton protocol, after 1 year, 58 percent of those who had
transplants no longer needed to inject insulin. Of those who were
still insulin-dependent 1 year after transplantation (33 percent of
those followed by the registry), requirements for insulin were
decreased. The average reduction in insulin requirements was 69
percent. In summary, a total of 91 percent of those with transplants
showed improvement following transplantation. The success of the
Edmonton protocol has been confirmed at other study sites, including
the NIDDK.
The goal of islet transplantation is to infuse enough islets to
control the blood glucose level without insulin injections. For an
average-sized person (154 pounds), a typical transplant requires
about 1 million islets, extracted from two donor pancreases. Because
good control of blood glucose can slow or prevent the progression of
complications associated with diabetes, such as nerve or eye damage,
a successful transplant may reduce the risk of these complications.
However, transplanted islets lose their ability to function over
time. Also, a transplant recipient needs to take immunosuppressive
drugs to stop the immune system from rejecting the transplanted
islets.
These drugs have significant side effects, and their long-term
effects are still unknown. Immediate side effects of
immunosuppressive drugs may include mouth sores and gastrointestinal
problems, such as stomach upset or diarrhea. Patients may also have
increased blood cholesterol levels, decreased white blood cell
counts, decreased kidney function, and increased susceptibility to
bacterial and viral infections. Taking immunosuppressive drugs
increases the risk of tumors and cancer as well. Researchers are
trying to find safer or less toxic immunosuppressants or new
approaches that will allow successful transplantation without the
use of immunosuppressive drugs.
The results of the Edmonton protocol are very encouraging, but
more research is needed to develop safer and more effective
immunosuppression and to enhance islet survival after
transplantation.
Another obstacle to widespread use of islet transplantation is
the severe shortage of islets. Only about 6,000 pancreases a year
become available for transplantation or for harvesting of islets.
However, researchers are pursuing alternative sources, such as
creating islets from other types of cells. New technologies could
then be employed to grow islets in the laboratory.
Type 2 Diabetes
Diabetes Prevention Program
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, released in August 2001, showed that
people at high risk for type 2 diabetes could sharply lower their
chances of developing the disorder through diet and exercise. In
addition, treatment with the oral diabetes drug metformin also
reduced diabetes risk, though less dramatically. Metformin lowers
the amount of glucose released by the liver and also fights insulin
resistance, a condition in which the body doesn't use insulin
properly.
Participants randomly assigned to intensive lifestyle
intervention reduced their risk of getting type 2 diabetes by almost
60 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, Hispanics/Latinos, 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 aged 60 and older, women with a history of
gestational diabetes, and people with a first-degree relative with
type 2 diabetes. Participants are being followed to check for
long-term effects of the interventions, including the effects on
risk of CVD.
Type 2 Diabetes in Children and Teens
Two
studies focusing on type 2 diabetes in children and teens are under
way. The TODAY (Treatment Options for type 2 Diabetes in Adolescents
and Youth) study, a 13-site study sponsored by NIDDK, will compare
treatments for type 2 diabetes in children and teens. Participants
will undergo one of three treatments:
- taking one diabetes medication (metformin)
- taking two diabetes medications (metformin and rosiglitazone,
another medication that fights insulin resistance)
- taking metformin and participating in an intensive lifestyle
change program designed to promote weight loss by cutting calories
and increasing physical activity
The main goal of the study is to determine how well each type of
treatment controls blood glucose levels. The study also will
evaluate how long each type of treatment is effective.
The STOPP-T2D (Studies to Treat or Prevent Pediatric Type 2
Diabetes) study, sponsored by NIDDK with support from the ADA, is
exploring methods to lower risk factors for type 2 diabetes and CVD
in middle-school children (grades 6 through 8) at eight sites. A
3-year program will focus on the benefits of improving nutrition,
promoting physical activity, and making changes in behavior.
Preventing and Treating CVD in People with Type 2
Diabetes
CVD is the main killer of people with type 2
diabetes. For this reason, the NIH is studying the best strategies
to prevent and treat CVD in people with diabetes in three major
studies. These studies are all joint efforts of the NIDDK and the
National Heart, Lung, and Blood Institute.
The Look AHEAD (Action for Health in Diabetes) trial is the
largest clinical trial to date to examine the long-term health
effects of voluntary weight loss. This multi-center, randomized
clinical trial is studying the effects of a lifestyle intervention
designed to achieve and maintain weight loss over the long term
through decreased caloric intake and increased exercise. Look AHEAD
will focus on the disorder most associated with being overweight or
obese, type 2 diabetes, and on the outcome that causes the greatest
morbidity and mortality in people with type 2 diabetes, CVD.
The Action to Control Cardiovascular Risk in Diabetes (ACCORD)
trial, a multi-center, randomized trial, is studying three
approaches to preventing major cardiovascular events in individuals
with type 2 diabetes. ACCORD is designed to compare current practice
guidelines with more intensive glycemic control in 10,000
individuals with type 2 diabetes, including those at especially high
risk for CVD events because of age, evidence of subclinical
atherosclerosis, or existing clinical CVD. More intensive control of
blood pressure than is called for in current guidelines and a
medication to reduce triglyceride levels and raise HDL (good)
cholesterol levels will also be studied in subgroups of these 10,000
volunteers. Each treatment strategy will be accompanied by standard
advice regarding lifestyle choices, including diet, physical
activity, and smoking cessation, appropriate for individuals with
diabetes.
The primary outcome to be measured is the first occurrence of a
major CVD event, specifically heart attack, stroke, or
cardiovascular death. In addition, the study will investigate the
impact of the treatment strategies on other cardiovascular outcomes;
total mortality; limb amputation; eye, kidney, or nerve disease;
health-related quality of life; and cost-effectiveness.
The Bypass Angioplasty Revascularization Investigation 2 Diabetes
(BARI 2D) trial, a 5-year, multi-center clinical trial, is comparing
medical versus early surgical management of patients with type 2
diabetes who also have coronary artery disease and stable angina or
ischemia. At the same time, BARI 2D will study the effect of two
different strategies to control blood glucose—providing insulin
versus increasing the sensitivity of the body to insulin—on the risk
of cardiovascular mortality and morbidity.
A complete listing of clinical trials can be found at http://www.clinicaltrials.gov/. [Top]
Points to Remember
What is diabetes?
- a disorder of metabolism—the way the body uses or converts
food for energy and growth
What are the main types of diabetes?
- type 1 diabetes
- type 2 diabetes
- gestational diabetes
What are the impacts of diabetes?
- It affects 20.8 million people—7.0 percent of the U.S.
population.
- It is a leading cause of death and disability.
- It costs $132 billion per year.
Who gets diabetes?
- people of any age
- people with a family history of diabetes
- others at high risk for type 2 diabetes: older people,
overweight and sedentary people, African Americans, Alaska
Natives, American Indians, Asian Americans, Native Hawaiians, some
Pacific Islander Americans, and Hispanics/Latinos
[Top]
For More Information
To learn more about type 1, type 2, and gestational diabetes, as
well as diabetes research, statistics, and education, contact:
National Diabetes Education Program
1 Diabetes
Way
Bethesda, MD 20892–3560
Phone: 1–800–438–5383
Internet:
http://www.ndep.nih.gov/
To find a clinical trial, check NIH’s database at http://www.clinicaltrials.gov/
online.
To participate in studies about type 1 diabetes, contact:
Type 1 Diabetes TrialNet
Phone:
1–800–425–8361
Internet: http://www.diabetestrialnet.org/
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
Internet: http://www.diabetes.org/
Juvenile Diabetes Research Foundation
International
120 Wall Street, 19th Floor
New York,
NY 10005
Phone: 1–800–533–2873
Internet: http://www.jdrf.org/
[Top]
|
