Complications

In Diabetic forecast this month there is a cool little note titled “It’s less complicated” ("It's less complicated," 2014) about a great study published in the New England Journal of Medicine. The results are awesome and they show incredible changeover the last 20 years. This morning dribble is about that study.

The study published in the New England Journal of Medicine is titled “Changes in Diabetes-Related Complications in the United States, 1990-2010” (Gregg et al., 2014). The study examined results from 20 years of data collected by the “National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System, and the U.S. National Vital Statistics System” (Gregg et al., 2014, Abstract). Chances are pretty good that if you were in the a hospital in the US for almost anything after you developed diabetes between 1990 and 2010, then your statistics were collected meshed, analyzed and used in this study, so start by knowing that almost all US diabetics participated at least in a minor way, therefore to start by giving yourself a high five for participation.

This is what the statistics demonstrate, namely that the chance of having complications for anyone of us is way down verses 20 years ago (Gregg et al., 2014). Here is some of the stark information:

“The largest relative decline is in acute myocardial infarction (−67.8%)
Death from hyperglycemic crisis (−64.4%)
Stroke and amputations, which each declined by approximately half (−52.7% and −51.4%, respectively)
While end stage renal disease is down (−28.3%)” (Gregg et al., 2014,Abstract).

This is good news all around but the study also showed that while percentages are way down, the absolutely number of cases of complications has risen. Why you ask? “Between 1990 and 2010, the number of adults reporting a diagnosis of diabetes more than tripled, from 6.5 million to 20.7 million, whereas the U.S. adult population overall increased by approximately 27%, from about 178 million to 226 million” (Gregg et al., 2014, p. 1516). In other words more people are being identified as diabetic hence the raw number of cases, with these complications is going up.

This means that while more people among the US Population have a complication, the chance that any one of us will have any of the complications is going down. I think we see that in our own community. No official count exists for diabetic complications within TUDiabetes, but I sort of sense this is the case. What makes the difference according to the scientists who did the study? Tighter control, more devices more food choices and great patient awareness has largely led to better outcomes.

It is not a surprise that we as a group are living longer. I suppose it is also not a surprise that the amount of people treated with complications has increased. It was reported in 2007 that 90-95% of all cases of diabetes in the US are the type 2 variety. Meaning that Type 2’s tend to have less aggressive treatment and control at least at initial diagnosis ("Diabetes overview," 2007; Gregg et al., 2014). So despite the good news much work needs to be done.

References



Diabetes overview. (2007). from http://diabetes.niddk.nih.gov/dm/pubs/overview/

Gregg, E. W., Li, Y., Wang, J., Rios Burrows, N., Ali, M. K., Rolka, D., . . . Geiss, L. (2014). Changes in Diabetes-Related Complications in the United States, 1990-2010. The New England Journal of Medicine, 370(16), 1514-1523.

It's less complicated. (2014, July 2014). Diabetes Forecast, 67, 1.

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rick

Views: 118

Tags: Blog, Complications, Diabetes, Phillips

Comment by Jen on July 1, 2014 at 10:09am

This is great news. Thanks for sharing! Did they publish actual statistics about incidence like the DCCT did, or just how much they declined?

Comment by rick the "Blogabetic" on July 1, 2014 at 1:36pm

Jen it is mostly about the decline. If you have access to a university library online, the article is int the New England journal of Medicine April 7 issue. pages 1514 - 1523. If you cannot find it i do have it in PDF and will be delighted to email it to you. I merely skimmed the top in this post. It does give some interesting insights based on the 20 year span.

Comment by Diabetic Dad on July 2, 2014 at 4:29am

Thanks for sharing.

Comment by Judith in Portland on July 2, 2014 at 8:21pm

Love your summaries, always, old friend. Using a narrative to make sense of the data for us is one of the many blessings you bestow upon this community1...xx000

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