Changes in diabetes-related complications in the United States, 1990-2010.

BACKGROUND Preventive care for adults with diabetes has improved substantially in recent decades. We examined trends in the incidence of diabetes-related complications in the United States from 1990 through 2010. METHODS We used data from the National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System, and the U.S. National Vital Statistics System to compare the incidences of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis between 1990 and 2010, with age standardized to the U.S. population in the year 2000. RESULTS Rates of all five complications declined between 1990 and 2010, with the largest relative declines in acute myocardial infarction (-67.8%; 95% confidence interval [CI], -76.2 to -59.3) and death from hyperglycemic crisis (-64.4%; 95% CI, -68.0 to -60.9), followed by stroke and amputations, which each declined by approximately half (-52.7% and -51.4%, respectively); the smallest decline was in end-stage renal disease (-28.3%; 95% CI, -34.6 to -21.6). The greatest absolute decline was in the number of cases of acute myocardial infarction (95.6 fewer cases per 10,000 persons; 95% CI, 76.6 to 114.6), and the smallest absolute decline was in the number of deaths from hyperglycemic crisis (-2.7; 95% CI, -2.4 to -3.0). Rate reductions were larger among adults with diabetes than among adults without diabetes, leading to a reduction in the relative risk of complications associated with diabetes. When expressed as rates for the overall population, in which a change in prevalence also affects complication rates, there was a decline in rates of acute myocardial infarction and death from hyperglycemic crisis (2.7 and 0.1 fewer cases per 10,000, respectively) but not in rates of amputation, stroke, or end-stage renal disease. CONCLUSIONS Rates of diabetes-related complications have declined substantially in the past two decades, but a large burden of disease persists because of the continued increase in the prevalence of diabetes. (Funded by the Centers for Disease Control and Prevention.).

[1]  M. Venermo,et al.  Fewer Major Amputations Among Individuals With Diabetes in Finland in 1997-2007 A population-based study , 2013 .

[2]  E. Ford,et al.  Trends in Total and Low-Density Lipoprotein Cholesterol among U.S. Adults: Contributions of Changes in Dietary Fat Intake and Use of Cholesterol-Lowering Medications , 2013, PloS one.

[3]  Jiaquan Xu,et al.  Deaths: final data for 2010. , 2013, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[4]  Mohammed K. Ali,et al.  Achievement of goals in U.S. Diabetes Care, 1999-2010. , 2013, The New England journal of medicine.

[5]  K. Konty,et al.  Changes in Trans Fatty Acid Content , 2012, Annals of Internal Medicine.

[6]  S. Wild,et al.  Reduced Incidence of Lower-Extremity Amputations in People With Diabetes in Scotland , 2012, Diabetes Care.

[7]  K. Konty,et al.  Change in Trans Fatty Acid Content of Fast-Food Purchases Associated With New York City's Restaurant Regulation , 2012, Annals of Internal Medicine.

[8]  David Moher,et al.  Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis , 2012, The Lancet.

[9]  S. Saydah,et al.  Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006 , 2012, Diabetes Care.

[10]  C. Richards,et al.  Emergency Hospitalization for Adverse Drug Events in Older Americans , 2012 .

[11]  L. Geiss,et al.  Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008 , 2012, Diabetes Care.

[12]  Dl Hoyert,et al.  National Vital Statistics Reports NCHS.pdf , 2012 .

[13]  J.,et al.  The New England Journal of Medicine , 2012 .

[14]  C. Richards,et al.  Emergency hospitalizations for adverse drug events in older Americans. , 2011, The New England journal of medicine.

[15]  S. Saydah,et al.  Long-Term and Recent Progress in Blood Pressure Levels Among U.S. Adults With Diagnosed Diabetes, 1988–2008 , 2011, Diabetes Care.

[16]  Daniel Polsky,et al.  Coronary revascularization trends in the United States, 2001-2008. , 2011, JAMA.

[17]  D. Williamson,et al.  Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence , 2010, Population health metrics.

[18]  A. Majeed,et al.  Changes in the Incidence of Lower Extremity Amputations in Individuals With and Without Diabetes in England Between 2004 and 2008 , 2010, Diabetes Care.

[19]  Edward Giovannucci,et al.  Diabetes and Cancer , 2010, Diabetes Care.

[20]  Alan S. Go,et al.  Population trends in the incidence and outcomes of acute myocardial infarction. , 2010, The New England journal of medicine.

[21]  B. Gersh.  Declining Severity of Myocardial Infarction From 1987 to 2002: The Atherosclerosis Risk in Communities (ARIC) Study , 2010 .

[22]  J. N. Fisher,et al.  Hyperglycemic Crises in Adult Patients With Diabetes , 2009, Diabetes Care.

[23]  Desmond E. Williams,et al.  Full Accounting of Diabetes and Pre-Diabetes in the U.S. Population in 1988–1994 and 2005–2006 , 2009, Diabetes Care.

[24]  H. Kuo,et al.  Diabetes and the Risk of Multi-System Aging Phenotypes: A Systematic Review and Meta-Analysis , 2009, PloS one.

[25]  Simon Capewell,et al.  Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. , 2007, The New England journal of medicine.

[26]  M. Engelgau,et al.  Changes in incidence of diabetes in U.S. adults, 1997-2003. , 2006, American journal of preventive medicine.

[27]  J. Tu,et al.  Recent trends in cardiovascular complications among men and women with and without diabetes. , 2006, Diabetes care.

[28]  J. Hux,et al.  Time trends and geographic disparities in acute complications of diabetes in Ontario, Canada. , 2005, Diabetes care.

[29]  Va Puget,et al.  Preventing foot ulcers in patients with diabetes , 2005 .

[30]  Betsy L Cadwell,et al.  Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S. , 2004, Diabetes care.

[31]  Oluf Pedersen,et al.  Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. , 2003, The New England journal of medicine.

[32]  R. Pokras,et al.  Design and operation of the National Hospital Discharge Survey: 1988 redesign. , 2000, Vital and health statistics. Ser. 1, Programs and collection procedures.

[33]  J. Mckinlay,et al.  US public health and the 21st century: diabetes mellitus , 2000, The Lancet.

[34]  Jack R. Anderson.  Design and estimation for the National Health Interview Survey, 1995-2004. , 2000, Vital and health statistics. Series 2, Data evaluation and methods research.

[35]  E. Wynder.  Tobacco use--United States, 1900-1999. , 1999, MMWR. Morbidity and mortality weekly report.

[36]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[37]  Uk-Prospective-Diabetes-Study-Group.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[38]  F. Vinicor.  Is diabetes a public-health disorder? , 1994, Diabetes care.

[39]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[40]  J. Assal,et al.  [Long-term complications in diabetes mellitus]. , 1989, Acta medica portuguesa.

[41]  A. H. Dinsmore,et al.  New England , 1894, Letters from America.