Diabetes Care Still Lagging in U.S.

Report shows some improvement, but it's far from enough

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By Steven Reinberg
HealthDay Reporter

TUESDAY, April 4 , 2006 (HealthDay News) -- Diabetes care in the United States has improved in the last decade, but there is still a long way to go, according to a new report by researchers at the U.S. Centers for Disease Control and Prevention.

"There has been kind of a mixed message in the last five to seven years," said report co-author Dr. K. M. Venkat Narayan, chief of the CDC's Diabetes Epidemiology & Statistics Branch in the Division of Diabetes Translation. "There have been good improvements in some areas, which tell us it is possible to improve things, but there is still a job that is left undone."

The findings appear in the April 4 issue of the Annals of Internal Medicine.

There are 21 million people with diabetes in the United States and 41 million people who are in danger of becoming diabetic, Narayan said.

Acoording to the American Diabetes Association, about 5 percent of all diabetics have the familial, type 1 form of diabetes, caused by a dysfunction in the cells that produce insulin. The other 95 percent of cases are type 2 diabetes, which usually occurs in adulthood and is closely linked to obesity. In type 2 disease, the body either does not produce enough insulin, or the body's cells gradually lose sensitivity to insulin, causing a loss of control of blood sugar levels.

"What this report shows is that the application of good treatment to prevent complications in these people has improved in the last five to 10 years," he added.

Over the past 10 years, control of cholesterol among diabetics has improved substantially. There have also been small improvements in blood sugar control and yearly eye and foot examinations, all important components of the regular care of diabetics.

"The discouraging news is that blood pressure control and blood sugar control have remained fairly constant," Narayan said. "It has not changed in the last five to seven years."

In addition, two in five people with diabetes have poor control of their cholesterol, one in three has poor blood-pressure control, and one in five has poor control of blood-sugar levels, Narayan said.

"There are good treatments available, which can prevent a lot of long-term complications, such as cardiovascular disease, heart attacks, stroke, kidney disease, amputations and blindness," Narayan said.

He also noted there are many national programs aimed at preventing type 2 diabetes, as well as promoting better care for those with the disease. "Diabetes is a major cause of complications, unnecessary sickness and death, but applying what we know, a lot can be achieved. There has been a lot of positive improvement, but it's no time for being complacent," he said.

One expert thinks the health-care system is not set up to prevent type 2 diabetes and its complications.

"This is a trend that has existed for several years that we look at with consternation," said Dr. Robert Rizza, a professor of medicine at the Mayo Clinic and president of the American Diabetes Association.

Treatment of diabetes is a complex process, Rizza added. It takes the patient, doctor and the community working together to provide successful treatment. "This is not a matter of 'take a pill and go home,'" he said.

Caring effectively for diabetes is a team effort that also has to include the health-care systems, health insurers and government, Rizza said. "Keeping patients healthy saves the community and the nation hundreds of thousands of dollars by preventing complications," he said.

"We as a nation are struggling with that concept," Rizza said. "We still tend to treat say, heart attacks, and 50 to 60 percent of people who have heart attacks have diabetes. We are treating the heart attack, but we are not treating the cause."

Diabetes is the No. 1 cause of blindness, kidney failure, amputations and nerve disease in America, Rizza said. "But again, we treat those things rather than put in place the systems of health care to be sure that patients don't get these complications," he said. "We haven't figured it out yet."

Society also needs to focus more on preventing type 2 diabetes and its complications, Rizza said. "There needs to be positive incentives to patients and the health-care system to do a better job in preventing the disease and, once you have the disease, preventing its complications."

Rizza strongly recommended improving fitness as a way of staving off type 2 disease. "If you stay lean and fit throughout your life, you have a 95 percent chance of never getting [type 2] diabetes," he said. "It's almost entirely preventable."

More information

For more on keeping diabetes at bay, head to the American Diabetes Association.

SOURCES: K. M. Venkat Narayan, M.D., M.P.H., M.B.A., chief, Diabetes Epidemiology & Statistics Branch, Division of Diabetes Translation, U.S. Centers for Disease Control and Prevention, Atlanta; Robert Rizza, M.D., professor, medicine, Mayo Clinic, Rochester, Minn., and president, American Diabetes Association, Alexandria, Va.; April 4, 2006, Annals of Internal Medicine

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