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

Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med. 2014;370:1514-1523.

Diabetes diagnosis among adults in the U.S. increased from 6.5 million  in 1990 to 20.7 million in 2010. Despite this increase, the rate of diabetes-related complications decreased. 

Diabetes-related complications in adults with diabetes
Significant decreases in five major complications were seen from 1990 to 2010 in adults with diagnosed diabetes per 10,000 persons/year (P<0.001 for all changes; relative percent change and absolute change, respectively [95% CI]):

  • Lower-extremity amputation: -51.4% (-68.2 to -34.5); -30.0 (-42.6 to -17.4)
  • Acute MI: -67.8% (-76.2 to -59.3); -95.6 (-114.6 to -76.6)
  • Stroke: -52.7% (-64.4 to -40.9); -58.9 (-76.2 to -41.6)
  • ESRD: -28.3% (-34.6 to -21.6); -7.9 (-10.2 to -5.5)
  • Death from hyperglycemic crisis: -64.4% (-68.0 to -60.9); -2.7 (-3.0 to -2.4)

Declines were first seen in 1995 and remained consistent thereafter. Additional trends observed:

  • Greatest absolute and relative declines in complications: adults aged ≥75 years (except for ESRD, which declined in younger adults but not in older adults)
  • By 2010: amputation rates similar among younger and older adults; rates of death from hyperglycemic crisis higher in younger adults vs older adults
  • Considerable narrowing of differences between younger and older adults in MI and stroke rates

Click on slide thumbnails to view larger. Slides available for download in the slide library.

 Adults With Diagnosed Diabetes in the U.S., 1990-2010   
Adults With Diagnosed Diabetes in the U.S., 1990–2010 

 Decreases Seen in Diabetes-Related Complications in Adults With Diagnosed Diabetes in the U.S., 1990-2010   
Decreases Seen in Diabetes-Related Complications
in Adults With Diagnosed Diabetes in the U.S., 1990–2010


Diabetes-related complications in adults with and without diabetes
Declines were seen for death from hyperglycemic crisis and acute MI, ESRD increased, and no significant changes were seen for amputation and stroke when data were examined for adults with and without diabetes, per 10,000 persons/year (relative percent change and absolute change, respectively [95% CI]):

  • Death from hyperglycemic crisis:* -42.0%; -0.07
  • ESRD:* 90.9%; 1.0
  • Acute MI: -32.3% (-42.7 to -22.0); -2.7(-3.7 to -1.8); P<0.001
  • Lower-extremity amputation: -0.5% (-21.3 to 20.4); -0.01 (-0.6 to 0.6); P=0.97
  • Stroke: 3.4% (-13.5 to 20.3); 0.3 (-1.0 to 1.5); P=0.35

Click on slide thumbnail to view larger. Slide available for download in the slide library.
Diabetes-Related Complications in Adults With or Without Diagnosed Diabetes in the U.S., 1990-2010   
Diabetes-Related Complications in Adults
With or Without Diagnosed Diabetes in the U.S., 1990–2010
 

Diabetes-related complications and relative risks based on presence or absence of diabetes
When the rate of complications was examined based on presence or absence of diabetes, greater rate reductions were seen for adults with diabetes. From 1990 to 2010, adults without diabetes had (percent change in adults without diabetes vs adults with diabetes):

  • Smaller reductions in acute MI rate: -31.2% vs -67.8%
  • No significant change in rate of stroke (-5.5% vs -52.7%) or lower-extremity amputation (-12.9% vs -51.4%)
  • Increase in rate of ESRD: 65.0% vs -28.3%

Larger rate reductions in adults with diabetes vs those without diabetes led to decreases in relative risks from 1990 to 2010 (95% CI):

  • Lower-extremity amputation: 18.8 (15.1 to 22.6) to 10.5 (6.0 to 15.0)
  • Acute MI: 3.8 (3.3 to 4.2) to 1.8 (1.3 to 2.3)
  • Stroke: 3.1 (2.7 to 3.5) to 1.5 (1.1 to 2.0)
  • ESRD: 13.7 (12.6 to 14.9) to 6.1 (5.7 to 6.3) 

About this study
Incident cases of diabetes-related complications were identified from the National Health Interview Survey (NHIS), the National Hospital Discharge Survey (NHDS), the U.S. Renal Data System (USRDS) and the National Vital Statistics System (NVSS). Age was standardized to the U.S. population in 2000. Complications assessed included lower-extremity amputation, acute MI, stroke, ESRD, and death from hyperglycemic crisis. 

*P value not provided because estimates based on complete registries of U.S. population, not on samples
ESRD=end-stage renal disease; MI=myocardial infarction

  

May 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Previous Article
Ambulatory treatment of type 2 diabetes in the U.S., 1997-2012  

Next Article
Glycated hemoglobin measurement and prediction of cardiovascscular disease   

Back to
Recent Diabetes Articles 

BG Footer

 

 

Last Modified: 8/4/2014