Progress in Diabetes: The Glass is Half-Full and Half-Empty

Yes.   I know that I haven’t written an entry in some time.  But, I am gearing up to get back to more regular entries.  Anyway, I clipped an interesting article from the NYT in April that we need to discuss.  The article was entitled: “For diabetics, health risks fall sharply,” and was written by Sabrina Tavernise and Denise Grady (NYT, April 17, 2014, p A1).  The story summarized an article that had just been published in the New England Journal of Medicine, entitled: “Changes in diabetes-related complications in the United States, 1990-2010,” and was written by E.W Gregg et al. (370:1514-23).  Unless you are seriously into the details, I suggest you start with the NYT story, which does a very good job at summarizing the NEJM paper.

What was the study all about?

The study was conducted by investigators at the Centers for Disease Control and Prevention (the CDC), Division of Diabetes Translation. and involved analyzing data from a number of large national databases in an effort to determine if diabetes care had improved between 1990-2010.  The investigators limited their analyses to incidences of 5 diabetes complications: lower-extremity amputation; end-stage renal disease; acute myocardial infarction; stroke; and death from hyperglycemic crises.

The “bottom line”

For the most part, the investigators found extraordinary decreases in rates for the 5 diabetes complications, ranging from 28% for end-stage renal disease, to 67% for myocardial infarction.  The greatest absolute decline was in the number of cases of myocardial infarction; 95.6 fewer cases per 10,000 persons.  Unfortunately, when looked at in terms of prevalence of diabetes in the overall population, there was only a significant decline in prevalence rates of acute myocardial infarction and death from hyperglycemic crisis.  So, we have made extraordinary progress in decreasing diabetes complications, but given the steady rise in the prevalence of diabetes in the U.S., the health burden of diabetes-related complications remains a large challenge.

What does all of this mean?

It is not easy to “get one’s arms around” these complex data.  Basically, the study results tell us that over the past 20 years, we have made extraordinary progress in improving the health of people with diabetes.  There are many reasons for our success, but I think more than anything, the long-term studies sponsored by the National Institutes of Health (NIH) that started in the 1980’s, most notably, the Diabetes Control and Complications Trial and its successor, the Epidemiology of Diabetes Interventions and Complications, have led the way forward and gave impetus to other studies that taken together have proven that “fixing” blood sugars, lipids, and blood pressure improves outcomes in patients with both type 1 and type 2 diabetes.

Where do we go from here?

The challenge now is to find  ways both to slow down the steady increase in the prevalence of diabetes, and at the same time, to detect diabetes as early as possible so that patients can benefit from what we now know about successful treatment strategies.  We can do it.

 

 

Leave a Reply

Your email address will not be published.