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Diabetes Patients Not Getting Proper Care

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

April 15, 2002 -- Each year in the U.S. some 450,000 people die from diabetes-related causes, and thousands more develop life-altering complications, including blindness, kidney failure, and heart disease. But these alarming statistics could be reduced dramatically with better management of the disease, according to the CDC.

In its newly published "national report card" for diabetes care in the U.S., the CDC found much room for improvement in the general care of Americans with diabetes. The grade for managing the disease was poor, says epidemiologist Jinan Saaddine, MD, who was lead author of the report.

"We can do much better, and we must do much better," Saaddine tells WebMD. "We have made tremendous advances in managing this disease over the past decade or so. There are interventions and treatments that we didn't have in the past, and they have to be made available to everyone."

Some 16 million Americans have diabetes, but only half have been diagnosed. The number of cases is projected to almost double within the next two decades. According to figures from the National Institutes of Health:

  • A diabetic's risk of heart attack and stroke is two to four times higher than normal. Heart disease is the leading cause of diabetes-related deaths.
  • Diabetes-related retinopathy is responsible for as many as 24,000 new cases of blindness each year in the U.S. Diabetes is the leading cause of blindness among adults aged 20-74.Diabetes is the leading cause of end-stage renal disease, accounting for 43% of new cases. More than 114,000 people with diabetes-related renal failure underwent dialysis or kidney transplant in 1999.
  • Sixty percent of amputations not caused by accident or injury -- roughly 82,000 leg amputations annually -- are due to diabetes.

Interventions that can prevent these complications include blood pressure, blood glucose, and cholesterol regulation through medication, diet, and exercise; having annual dilated-eye exams; and checking feet for signs of nerve damage at each visit to the physician.

The NIH estimates that more than half of vision loss in diabetics could be prevented with annual exams and prompt treatment. In addition, comprehensive foot care programs can reduce amputations by 45-85%. And early detection and treatment of diabetes-related renal disease could reduce kidney failure by 30-70%.

In the CDC report, published April 16 in the journal Annals of Internal Medicine, 1,026 diabetics participating in an ongoing health study were surveyed about the management of their disease. Less than one-third had been given a comprehensive glucose control test within the past year, and one-fifth of those who had been tested had dangerously elevated blood sugar levels. More than half of tested patients had high LDL cholesterol levels, roughly one-third had high blood pressure, less than two-thirds reported routine eye exams and half did not have routine foot exams.

David Nathan, MD, who directs the diabetes center at Massachusetts General Hospital, says the CDC report is just the latest in a series of studies suggesting poor grades for diabetes management. Nathan is a professor of medicine at Harvard Medical School.

"There is no easy way of reducing the complexity of this disease," he tells WebMD. "There are a long list of potential medical problems that have to be kept on top of in managing a patient with type 2 diabetes. Testing for these problems has got to become as routine as, say, giving a woman a mammogram. That will only happen with better education of the physician and the patient."

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