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
1­800­860­8747 to request a copy.
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.
What are the types of
diabetes?
The three main types of diabetes are
* type 1 diabetes
* type 2 diabetes
* gestational diabetes
National Diabetes Information Clearinghouse
National
Institute of
Diabetes and
Digestive
and Kidney
Diseases
NATIONAL
INSTITUTES
OF HEALTH
Diabetes
Overview
U.S. Department
of Health and
Human Services
Estimated total prevalence of diabetes in
people aged 20 years or older, by age group--
United States, 2005
20­39 40­59 60+
Age Group
Source: 1999­2002 National Health and Nutrition Examination
Survey estimates of total prevalence (both diagnosed and
undiagnosed) were projected to year 2005.
Percent
0
5
10
15
20
25
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.
2 Diabetes Overview
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.
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.
3 Diabetes Overview
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 prediabetes,
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.
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.
4 Diabetes Overview
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 nonHispanic
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 nonHispanic
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.
5 Diabetes Overview
Estimated age-adjusted total prevalence of
diabetes in people aged 20 years or older,
by race/ethnicity--United States, 2005
Source: For American Indians/Alaska Natives, the estimate of
total prevalence was calculated using the estimate of diagnosed
diabetes from the 2003 outpatient database of the Indian
Health Service and the estimate of undiagnosed diabetes from
the 1999­2002 National Health and Nutrition Examination
Survey. For the other groups, 1999­2002 NHANES estimates
of total prevalence (both diagnosed and undiagnosed) were
projected to year 2005.
Percent
Non-Hispanic
whites
Non-Hispanic
blacks
Hispanic/Latino
Americans
American Indians/
Alaska Natives
0 2 10 14 204 6 8 12 1816
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
6 Diabetes Overview
ˇ 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.
7 Diabetes Overview
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, longacting,
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
8 Diabetes Overview
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
www.DiabetesTrialNet.org or call
1­800­HALT­DM1 (1­800­425­8361).
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 atrisk
people from the Diabetes Prevention
Trial--Type 1 (DPT­1). This study showed
9 Diabetes Overview
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
10 Diabetes Overview
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.
11 Diabetes Overview
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.
12 Diabetes Overview
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.
13 Diabetes Overview
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 www.ClinicalTrials.gov.
14 Diabetes Overview
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 20814­9692
Phone: 1­800­438­5383
Internet: www.ndep.nih.gov
To find a clinical trial, check NIH's database
at www.ClinicalTrials.gov online.
To participate in studies about type 1
diabetes, contact:
Type 1 Diabetes TrialNet
Phone: 1­800­425­8361
Internet: 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: 1­800­342­2383
Internet: www.diabetes.org
Juvenile Diabetes Research Foundation
International
120 Wall Street
New York, NY 10005
Phone: 1­800­533­2873
Internet: www.jdrf.org
15 Diabetes Overview
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
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 06­3873
August 2006
National Diabetes
Information Clearinghouse
1 Information Way
Bethesda, MD 20892­3560
Phone: 1­800­860­8747
Fax: 703­738­4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov
The National Diabetes Information
Clearinghouse (NDIC) is a service of the
National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK). The NIDDK
is part of the National Institutes of Health
under the U.S. Department of Health and
Human Services. Established in 1978, the
Clearinghouse provides information about
diabetes to people with diabetes and to their
families, health care professionals, and the
public. The NDIC answers inquiries, develops
and distributes publications, and works closely
with professional and patient organizations and
Government agencies to coordinate resources
about diabetes.
Publications produced by the Clearinghouse are
carefully reviewed by both NIDDK scientists
and outside experts.
This publication is not copyrighted. The
Clearinghouse encourages users of this fact
sheet to duplicate and distribute as many
copies as desired.
This fact sheet is also available at
www.diabetes.niddk.nih.gov.