Category Archives: Diabetes

According to an analysis of global health trends from the year 1990 up to 2013,1 there has been a striking and alarming rise in the occurrence of diabetes mellitus, a trend that continues now, especially in the United States. In a study published in 2015, its said that at least 50 percent of American adults2 are now either in a state of prediabetes or are already struggling with the illness.

The American Diabetes Association says 30.3 million Americans, or 9.4 percent of the population, have diabetes, while 84.1 million U.S. adults age 18 and older had prediabetes.3 Even children are now being diagnosed with Type 2 diabetes, with the numbers continuing to rise.

Diabetes is an illness that can affect anyone. Its now a leading cause of death according to the Diabetes Research Institute, diabetes now takes more lives compared to breast cancer and AIDS combined claiming the life of one American every three minutes.4 But what exactly is diabetes mellitus? Why does it happen and how can you break free from it?

WebMD defines diabetes mellitus (also known simply as diabetes) as a chronic, lifelong condition that affects your body's ability to use the energy found in food.5 This is a group of metabolic diseases wherein the glucose that you get from food remains in your bloodstream (high blood sugar).

When you eat, your body transforms food into a special sugar (glucose) that your cells use for energy. However, in order for your cells to be able to take in the glucose and use it as fuel, it first needs a particular hormone called insulin.6 This essential hormone is produced in your pancreas.

In normal, healthy people, the pancreas does a good job of providing your body with just the right amount of insulin it needs. Insulin opens your cells and lets glucose enter so it can be used for energy.7

However, if you have diabetes, it means that your insulin production is inadequate, the body's cells do not respond properly to insulin, or a combination of these two factors. Because the cells are unable to take in the glucose, it then builds up in your blood where it wreaks havoc on your health.8

Aside from insulin, however, there are two more hormones that can predispose you to diabetes: leptin and ghrelin. Produced by your fat cells, leptin is a hormone that is responsible for telling the brain three things:

In addition, leptin is also necessary for your immune system, fertility and energy burning.

Meanwhile, ghrelin is the hormone that tells your body that youre hungry. Its secreted by the lining of your stomach. Since ghrelin is influenced by the growth hormone in your body, it tends to work differently in women and men.

These two hormones, along with insulin, are the three primary players (along with other factors) in the occurrence of diabetes.

If there is a problem in your bodys leptin or ghrelin signaling, then you tend to consume too much food for your activity level and metabolism rate, resulting in weight gain and obesity. And once obesity sets in, your cells become insulin-resistant, predisposing you to high blood glucose levels.

The excessively high levels of sugar in your blood cause damage to the tiny blood vessels in different body organs. This includes the heart, kidneys, nervous system and eyes. This is why diabetes has been widely associated with a wide range of health problems, including heart disease, kidney disease, eye problems and blindness, stroke and nerve damage in the feet.9

People with diabetes also experience various symptoms, the most common of which are frequent urination, increasing thirst and always being hungry.10

Living with diabetes can be emotionally and physically overwhelming. Its also a financial burden for most people annually, this illness costs the American public over $245 billion.11

The good news is that diabetes is potentially reversible and completely preventable without having to resort to conventional drugs. All it takes is a few disciplined lifestyle tweaks, particularly in your diet, so that you can avoid this damaging disease.

Diabetes: An Introduction

Causes of Diabetes

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What Is Diabetes Mellitus? - articles.mercola.com

Overview

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.

The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have, it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.

To understand diabetes, first you must understand how glucose is normally processed in the body.

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

Glucose a sugar is a source of energy for the cells that make up muscles and other tissues.

The exact cause of type 1 diabetes is unknown. What is known is that your immune system which normally fights harmful bacteria or viruses attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear. Weight is not believed to be a factor in type 1 diabetes.

In prediabetes which can lead to type 2 diabetes and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes too. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Risk factors for diabetes depend on the type of diabetes.

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:

Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:

Long-term complications of diabetes develop gradually. The longer you have diabetes and the less controlled your blood sugar the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:

Complications in the mother also can occur as a result of gestational diabetes, including:

Prediabetes may develop into type 2 diabetes.

Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:

Lose excess pounds. If you're overweight, losing even 7 percent of your body weight for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.7 kilograms) can reduce the risk of diabetes.

Don't try to lose weight during pregnancy, however. Talk to your doctor about how much weight is healthy for you to gain during pregnancy.

To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage, Glumetza, others) may reduce the risk of type 2 diabetes but healthy lifestyle choices remain essential. Have your blood sugar checked at least once a year to check that you haven't developed type 2 diabetes.

Aug. 08, 2018

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Diabetes - Symptoms and causes - Mayo Clinic

Diagnosis

Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes:

Glycated hemoglobin (A1C) test. This blood test, which doesn't require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.

If the A1C test results aren't consistent, the test isn't available, or you have certain conditions that can make the A1C test inaccurate such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) your doctor may use the following tests to diagnose diabetes:

Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

If type 1 diabetes is suspected, your urine will be tested to look for the presence of a byproduct produced when muscle and fat tissue are used for energy because the body doesn't have enough insulin to use the available glucose (ketones). Your doctor will also likely run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies.

Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy:

Your doctor may use the following screening tests:

Initial glucose challenge test. You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs.

If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will order a follow-up test to determine if you have gestational diabetes.

Follow-up glucose tolerance testing. For the follow-up test, you'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution this one containing a higher concentration of glucose and your blood sugar level will be checked every hour for a period of three hours.

If at least two of the blood sugar readings are higher than the normal values established for each of the three hours of the test, you'll be diagnosed with gestational diabetes.

Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. Eating a healthy diet, maintaining a healthy weight and participating in regular activity also are important factors in managing diabetes.

An important part of managing diabetes as well as your overall health is maintaining a healthy weight through a healthy diet and exercise plan:

Healthy eating. Contrary to popular perception, there's no specific diabetes diet. You'll need to center your diet on more fruits, vegetables, lean proteins and whole grains foods that are high in nutrition and fiber and low in fat and calories and cut down on saturated fats, refined carbohydrates and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they're counted as part of your meal plan.

Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes.

Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells.

Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine.

Aim for at least 30 minutes or more of aerobic exercise most days of the week. Bouts of activity can be as brief as 10 minutes, three times a day. If you haven't been active for a while, start slowly and build up gradually.

Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or both.

Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar as many as four times a day or more often if you're taking insulin. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People with type 2 diabetes who aren't taking insulin generally check their blood sugar much less frequently.

People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology hasn't yet completely replaced the glucose meter, it can significantly reduce the number of fingersticks necessary to check blood sugar and provide important information about trends in blood sugar levels.

Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress and for women, fluctuations in hormone levels.

In addition to daily blood sugar monitoring, your doctor will likely recommend regular A1C testing to measure your average blood sugar level for the past two to three months.

Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your oral medication, insulin regimen or meal plan.

Your target A1C goal may vary depending on your age and various other factors, such as other medical conditions you may have. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C target is.

Insulin. People with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy.

Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action. Often insulin is injected using a fine needle and syringe or an insulin pen a device that looks like a large ink pen.

An insulin pump also may be an option. The pump is a device about the size of a cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen.

A tubeless pump that works wirelessly also is now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

An emerging treatment approach, not yet available, is closed loop insulin delivery, also known as the artificial pancreas. It links a continuous glucose monitor to an insulin pump, and automatically delivers the correct amount of insulin when needed.

There are a number of versions of the artificial pancreas, and clinical trials have had encouraging results. More research needs to be done before a fully functional artificial pancreas receives regulatory approval.

However, progress has been made toward an artificial pancreas. In 2016, an insulin pump combined with a continuous glucose monitor and a computer algorithm was approved by the Food and Drug Administration. However, the user still needs to tell the machine how many carbohydrates will be eaten.

Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells.

Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Metformin (Glucophage, Glumetza, others) is generally the first medication prescribed for type 2 diabetes.

Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy.

But transplants aren't always successful and these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, which is why transplants are usually reserved for people whose diabetes can't be controlled or those who also need a kidney transplant.

Bariatric surgery. Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who are obese and have a body mass index higher than 35 may benefit from this type of surgery. People who've undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure's long-term risks and benefits for type 2 diabetes aren't yet known.

Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications.

Your doctor also will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin which can lead to low blood sugar right after birth.

If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing about 7 percent of your body weight may prevent or delay type 2 diabetes.

Sometimes medications such as metformin (Glucophage, Glumetza, others) also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.

In other cases, medications to control cholesterol statins, in particular and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you're at high risk. However, healthy lifestyle choices remain key.

Because so many factors can affect your blood sugar, problems may sometimes arise that require immediate care, such as:

Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet, fruity breath.

You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.

Hyperglycemic hyperosmolar nonketotic syndrome. Signs and symptoms of this life-threatening condition include a blood sugar reading over 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations. Hyperosmolar syndrome is caused by sky-high blood sugar that turns blood thick and syrupy.

It is seen in people with type 2 diabetes, and it's often preceded by an illness. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.

Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). If you're taking medication that lowers your blood sugar, including insulin, your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. Low blood sugar also occurs if you take too much insulin or an excess of a glucose-lowering medication that promotes the secretion of insulin by your pancreas.

Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. Careful management of diabetes can reduce your risk of serious even life-threatening complications.

Make physical activity part of your daily routine. Regular exercise can help prevent prediabetes and type 2 diabetes, and it can help those who already have diabetes to maintain better blood sugar control. A minimum of 30 minutes of moderate exercise such as brisk walking most days of the week is recommended.

A combination of exercises aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week often helps control blood sugar more effectively than does either type of exercise alone.

It's also a good idea to spend less time sitting still. Try to get up and move around for a few minutes at least every 30 minutes or so when you're awake.

In addition, if you have type 1 or type 2 diabetes:

Keep your vaccinations up-to-date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor may recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven't previously been vaccinated against hepatitis B and you're an adult ages 19 to 59 with type 1 or type 2 diabetes.

The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes, and haven't previously received the vaccine, talk to your doctor about whether it's right for you.

If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation one drink a day for women and two drinks a day for men and always with food.

Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count. And check your blood sugar levels before going to bed.

Numerous substances have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, there aren't any alternative therapies that are currently recommended to help everyone with blood sugar management.

If you decide to try any type of alternative therapy, don't stop taking the medications that your doctor has prescribed. Be sure to discuss the use of any of these therapies with your doctor to make sure that they won't cause adverse reactions or interact with your current therapy.

Additionally, there are no treatments alternative or conventional that can cure diabetes, so it's critical that people who are receiving insulin therapy for diabetes don't stop using insulin unless directed to do so by their physicians.

Living with diabetes can be difficult and frustrating. Sometimes, even when you've done everything right, your blood sugar levels may rise. But stick with your diabetes management plan, and you'll likely see a positive difference in your A1C when you visit your doctor.

Because good diabetes management can be time-consuming, and sometimes overwhelming, some people find it helps to talk to someone. Your doctor can probably recommend a mental health professional for you to speak with, or you may want to try a support group.

Sharing your frustrations and your triumphs with people who understand what you're going through can be very helpful. And you may find that others have great tips to share about diabetes management.

Your doctor may know of a local support group, or you can call the American Diabetes Association at 800-DIABETES (800-342-2383) or the Juvenile Diabetes Research Foundation at 800-533-CURE (800-533-2873).

You're likely to start by seeing your primary care doctor if you're having diabetes symptoms. If your child is having diabetes symptoms, you might see your child's pediatrician. If blood sugar levels are extremely high, you'll likely be sent to the emergency room.

If blood sugar levels aren't high enough to put you or your child immediately at risk, you may be referred to a doctor who specializes in diabetes, among other disorders (endocrinologist). Soon after diagnosis, you'll also likely meet with a diabetes educator and a dietitian to get more information on managing your diabetes.

Here's some information to help you get ready for your appointment and to know what to expect.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:

Your doctor is likely to ask you a number of questions, such as:

Aug. 08, 2018

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Diabetes - Diagnosis and treatment - Mayo Clinic

In the 1950s, about 1 in 5 people died within 20 years after being diagnosed with type 1 diabetes, formerly known as juvenile diabetes. Almost all of them developed diabetic retinopathy, which accounted for about 12% of new cases of blindness between the ages of 45 and 74. People with diabetes relied on inaccurate urine tests to track their blood sugar. They used crude animal-derived insulins to control it.

In 1983, NIH began the Diabetes Control and Complications Trial, which enrolled 1,441 people with type 1 diabetes. This landmark study was stopped early because the results so clearly showed that careful control of blood sugar reduced eye, kidney, and nerve complications by 50% to 75%. In a follow-up study 10 years later, researchers learned that rates of heart disease and stroke had declined by half.

Today, people with type 1 diabetes are living longer and healthier lives. New technologies help them keep tight control of their blood sugar using continuous glucose monitors and insulin pumps that deliver rapid-acting, bioengineered human insulin.

We also know a lot more about type 2 diabetes. We know that family history, obesity, and physical inactivity are risk factors for this condition, formerly known as adult-onset diabetes. NIH-funded research has shown that type 2 diabetes can be delayed or prevented. Basic lifestyle interventions modest weight loss and regular exercise slash type 2 diabetes risk by 58% over 3 years in people with pre-diabetes. Despite this good news, type 2 diabetes still accounts for 90% of diabetes cases nationwide and has been increasing at an alarming rate due to the rise in obesity in the United States.

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Diabetes | National Institutes of Health (NIH)

More than 100 million American adults are living withprediabetesor type 2 diabetes, according to the latest estimates from the Centers for Disease Control and Prevention (CDC). But the number of people who know they have the diseases which can lead to life-threatening complications, like blindness and heart disease is far lower.

Data from theCDCsuggests that of the estimated 30.3 million Americans withtype 2 diabetes, 7.2 million, or 1 in 4 adults living with the disease, are not aware of it. And among those people living withprediabetes, only 11.6 percent are aware that they have the disease.

Prediabetesis marked by higher than normal blood sugar levels though not high enough to qualify as diabetes. TheCDCnotes that this condition often leads to full-blown type 2 diabetes within five years if it's left untreated through diet and lifestyle modifications.

Type 2 diabetes, which is often diagnosed when a person has anA1Cof at least 7 on two separate occasions, can lead to potentially serious issues, likeneuropathy, or nerve damage; vision problems; an increased risk of heart disease; and otherdiabetes complications. A persons A1C is the two- to three-month average of his or her blood sugar levels.

According to theMayo Clinic, doctors may use other tests to diagnose diabetes. For example, they may conduct a fasting blood glucose test, which is a blood glucose test done after a night of fasting. While a fasting blood sugar level of less than 100 milligrams per deciliter (mg/dL) is normal, one that is between 100 to 125 mg/dL signalsprediabetes, and a reading that reaches 126 mg/dL on two separate occasions means you have diabetes.

People with full-blown type 2 diabetes are not able to use the hormone insulin properly, and have whats called insulin resistance. Insulin is necessary for glucose, or sugar, to get from your blood into your cells to be used for energy. When there is not enough insulin or when the hormone doesnt function as it should glucose accumulates in the blood instead of being used by the cells. This sugar accumulation may lead to the aforementioned complications.

You can help assessyour chances of developing type 2 diabetesby requesting an A1C test from your doctor, as well as by talking with your family about their health history with the disease, asyour geneticsmay influence your risk of diabetes.

Other risk factors of type 2 diabetes include obesity, inactivity, old age, a personal history of gestational diabetes, and race, according to theMayo Clinic. For instance, if you are Hispanic, African-American, or Asian-American, you may be at a greater risk of type 2 diabetes.

Nevertheless, you can preventprediabetesand type 2 diabetes by maintaining a healthy weight; following a healthy diet thats rich in whole grains, fruit, vegetables, and lean protein; getting sufficient sleep; and exercising regularly.

But preventing the disease from progressing if you already have it requires first being able to spot the signs and symptoms of diabetes when they appear. While sometype 2 diabetes symptomsmay not ever show up, you can watch out for the following common signs of the disease and alert your doctor, especially if you have any of the common risk factors for diabetes. Also keep in mind that while most signs of type 2 diabetes are the same in men and women, there are some distinctions.

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7 Warning Signs and Symptoms of Type 2 Diabetes

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

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Patel, S. and Reddy, D. (Updated 2012 September 18). Gestational Diabetes Testing Protocol. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/2049380-overview through http://emedicine.medscape.com. Accessed September 2014.

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Parkin, C. (2013 February). LADA, the Other Diabetes, Can Be Hard to Spot. Diabetes Forecast [On-line information]. Available online at http://www.diabetesforecast.org/2013/feb/lada-the-other-diabetes-can-be-hard-to-spot.html through http://www.diabetesforecast.org. Accessed September 2014.

(2013 September). Gestational Diabetes: What You Need to Know. National Diabetes Information Clearinghouse [On-line information]. Available online at http://www.diabetes.niddk.nih.gov/dm/pubs/gestational_ES/ through http://www.diabetes.niddk.nih.gov. Accessed September 2014.

(2014 January). Standards of Medical Care in Diabetes 2014. Diabetes Care Volume 37, Supplement 1 [On-line information]. Available online at http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html through http://care.diabetesjournals.org. Accessed September 2014.

(2014 January). Diagnosis and Classification of Diabetes Mellitus. Diabetes Care Volume 37, Supplement 1 [On-line information]. Available online at http://care.diabetesjournals.org/content/37/Supplement_1/S81.full.pdf+html through http://care.diabetesjournals.org. Accessed September 2014.

(2013 September). Gestational Diabetes. American College of Obstetricians and Gynecologists [On-line information]. Available online at http://www.acog.org/Patients/FAQs/Gestational-Diabetes through http://www.acog.org. Accessed September 2014.

Copeland, K. et. al. (2013 January 28). Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents. Pediatrics v 131 (2) [On-line information]. Available online at http://pediatrics.aappublications.org/content/131/2/364.full?sid=d1840c80-287b-43ca-ac9c-68b0b1d5dfa8 through http://pediatrics.aappublications.org. Accessed September 2014.

(Reviewed 2013 August 2). Hemochromatosis. American Diabetes Association [On-line information]. Available online at http://www.diabetes.org/living-with-diabetes/complications/related-conditions/hemochromatosis.html through http://www.diabetes.org. Accessed September 2014.

Gebel, E. (2010 May). Another Kind of Diabetes: MODY, Often misdiagnosed, the disease is caused by a faulty gene. Diabetes Forecast [On-line information]. Available online at http://www.diabetesforecast.org/2010/may/another-kind-of-diabetes-mody.html through http://www.diabetesforecast.org. Accessed September 2014.

Gebel, E. (2010 May). The Other Diabetes: LADA, or Type 1.5, Latent autoimmune diabetes in adults is gradually being understood. Diabetes Forecast [On-line information]. Available online at http://www.diabetesforecast.org/2010/may/the-other-diabetes-lada-or-type-1-5.html through http://www.diabetesforecast.org. Accessed September 2014.

(2014 July). Overview of Diabetes in Children and Adolescents. From the National Diabetes Education Program [On-line information]. Available online at http://ndep.nih.gov/media/Overview-of-Diabetes-Children-508_2014.pdf through http://ndep.nih.gov. Accessed September 2014.

(October 2014) U.S. Preventive Services Task Force. Draft Recommendation Statement. Abnormal Glucose and Type 2 Diabetes Mellitus in Adults: Screening. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus through http://www.uspreventiveservicestaskforce.org. Accessed November 22, 2014.

July 25, 2013. Lisa Nainggolan. ACOG Issues New Practice Bulletin on Gestational Diabetes. Medscape News. Available online at http://www.medscape.com/viewarticle/808409 through http://www.medscape.com. Accessed October 29.

July 01, 2014. Brown, HL. ACOG Guidelines at a Glance: Gestational Diabetes. Available online at http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/acog-guidelines/acog-guidelines-glance-gestational-diabetes-mellitus through http://contemporaryobgyn.modernmedicine.com. Accessed October 2014.

Soures Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

(1995-2004). Diabetes Mellitus. The Merck Manual of Medical Information-Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec13/ch165/ch165a.html?qt=Diabetes&alt=sh through http://www.merck.com.

(2005 January). Diagnosis of Diabetes. National Diabetes Information Clearinghouse, NIH Publication No. 05-4642 [On-line information]. Available online at http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/index.htm through http://diabetes.niddk.nih.gov. Reaccessed 2/20/08.

All About Diabetes. American Diabetes Association [On-line information]. Available online at http://www.diabetes.org/about-diabetes.jsp through http://www.diabetes.org. Reaccessed 2/20/08.

National Diabetes Fact Sheet. Centers for Disease Control [On-line information]. Available online at http://www.cdc.gov/diabetes/pubs/factsheet.htm through http://www.cdc.gov.

Jonnalagadda, S. (2004 February 19). Serum ketones. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003498.htm.

Magee, C. (2005 December 9, Updated). Ketones urine. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm.

(2003). Ketone testing. National Academy of Clinical Biochemistry, Laboratory Medicine Practice Guidelines [On-line information]. PDF available for download at http://www.nacb.org/lmpg/diabetes/5_diabetes_keytone.pdf#search='%2C%20ketone%20diabetes' through http://www.nacb.org.

National Diabetes Information Clearinghouse: National Diabetes Statistics (2005). Available online at http://diabetes.niddk.nih.gov/dm/pubs/statistics/ through http://diabetes.niddk.nih.gov.

U.S. Preventive Services Task Force. Recommendations and Rationale: Screening for Gestational Diabetes Mellitus (February 2003). Available online at http://www.ahrq.gov/clinic/3rduspstf/gdm/gdmrr.htm through http://www.ahrq.gov.

American Diabetes Association. Executive summary: standards of medical care in diabetes2010. Jan 2010. Diabetes Care 33: S4-S10.

(January 2010) The Endocrine Society Statement on the use of A1c for Diabetes Diagnosis and Risk Estimation. PDF available for download at http://www.endo-society.org/advocacy/upload/TES-Statement-on-A1C-Use.pdf through http://www.endo-society.org. Accessed January 2010.

(Updated 2011 May 5). Basics about Diabetes. Centers for Disease Control and Prevention [On-line information]. Available online at http://www.cdc.gov/diabetes/consumer/learn.htm through http://www.cdc.gov. Accessed May 2011.

(2011). National Diabetes Fact Sheet, 2011. CDC [On-line information]. PDF available for download at http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf through http://www.cdc.gov. Accessed May 2011.

(Updated 2010 October). Type 2 Diabetes Fact Sheet. National Institutes of Health [On-line information]. Available online at http://report.nih.gov/NIHfactsheets/Pdfs/Type2Diabetes(NIDDK).pdf through http://report.nih.gov. Accessed May 2011.

Khardori, R. (Updated 2011 May 19). Type 2 Diabetes Mellitus. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/117853-overview through http://emedicine.medscape.com. Accessed May 2011.

Moore, T. (Updated 2011 April 13). Diabetes Mellitus and Pregnancy. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/127547-overview through http://emedicine.medscape.com. Accessed May 2011.

Mayo Clinic Staff (2011 March 9). Diabetes. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/diabetes/DS01121/METHOD=print through http://www.mayoclinic.com. Accessed May 2011.

Grenache, D. (Updated 2011 April). Diabetes Mellitus. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/DiabetesMellitus.html#tabs=0 through http://www.arupconsult.com. Accessed May 2011.

Kerr, M. (Updated 2009 June 23) ADA 2009: New Blood Test Bridges Time Gap Between Serum Glucose and Hemoglobin A1c. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/704358 through http://www.medscape.com. Accessed May 2011.

American Diabetes Association. Standards of Medical Care in Diabetes2011. Diabetes Care January 2011 34:S11-S61. Available online at http://care.diabetesjournals.org/content/34/Supplement_1/S11.full throughhttp://care.diabetesjournals.org.

Metzger BE, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-82.

Link:
Diabetes - Patient Education on Blood, Urine, and Other Lab ...

According to research conducted in late 2016, life expectancy in the United States has declined for the first time in two decades, leaving the researchers baffled as to what the exact cause is.1

One of the primary perpetrators of this decline is believed to be drug overdose. But there is another major factor that has been pinpointed by a supporting study: diabetes, specifically Type 2 diabetes.2

Theres no doubt that diabetes is steadily growing to be an epidemic, particularly among Americans. According to data from the American Diabetes Association, at least half of all adults in the U.S. are either in a state of prediabetes or already have diabetes.3

Researchers also noted that it is actually an underreported cause of death on death certificates and should be considered the third leading cause of mortality in America, right after cancer and heart disease.4

Unfortunately, there is a growing amount of misinformation surrounding this common health condition. And, in some cases, it is the physicians themselves who are perpetuating this misinformation. But what exactly is diabetes? Why does it manifest, and more importantly, how can you protect yourself from falling victim to this growing epidemic?

The U.S. Centers for Disease Control and Prevention (CDC) defines diabetes as the condition in which the body does not properly process food for use as energy.5 When you eat, the food you consume is transformed by your body into sugar to be used as energy. For glucose to enter the cells of your body, it needs a hormone called insulin.

The pancreas, an organ found near the stomach, is responsible for releasing this hormone into your bloodstream. However, if you have diabetes, either your body fails to produce enough insulin or it does not use insulin as well as it needs to. This causes glucose levels to build up in your blood.6

There are three well-known types of diabetes: Type 1 diabetes, Type 2 diabetes and gestational diabetes. However, there are other lesser known types or classifications of this illness.

Many people think that diabetes is a disease of blood sugar but it is not. Rather, it is a disorder of insulin and leptin signaling. Insulin acts as a source of energy for your cells. In other words, you NEED insulin to live. In healthy people, the pancreas does a wonderful job of providing your body with just the right amount.

But in some, risk factors and certain circumstances put the pancreas at risk of not functioning properly. This causes insulin and leptin resistance, which then evolves over a long period of time. It starts as prediabetes and if left untreated, goes on to become full-blown diabetes.

The reason why conventional medicine fails to treat diabetes is because the solutions they put in place address the insulin deficiency through insulin shots or pills. In short, they are addressing the symptom and NOT the root cause, which isinsulin sensitivity.

What many fail to realize is that diabetes, particularly Type 2 diabetes, is preventable and reversible. All it takes is proper attention to your lifestyle, especially your diet. In fact, in the majority of cases, diabetes does not need any type of medication.

Many diabetics usually find themselves falling down a black hole of helplessness, as theyre clueless on how to reverse their illness. But there is a way out, and the first step is to be informed.

Visit these pages and learn everything you need to know about diabetes: common risk factors, its hallmark symptoms, the different types, and how to effectively reverse this condition. Find out how your diet and lifestyle play a role in the occurrence of this illness.

Diabetes now affects people of all ages and from all walks of life, so this is crucial, must-know information. Share these pages with someone you know whos struggling with this illness. Who knows, you just might save them from the perils of this disease.

What Is Diabetes?

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What You Need to Know About Diabetes

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.

There are2 main types of diabetes:

Type 2 diabetes is far more common than type 1. Inthe UK,around 90% of all adultswith diabetes have type 2.

During pregnancy, some women have such high levels of blood glucose that their body is unable toproduce enough insulin to absorb it all. This is known asgestational diabetes.

Flu can be very serious if you have diabetes. Ask for your free NHS flu jab at:

Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes.

This is sometimes known as pre-diabetes. Ifyour blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased.

It's very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.

Visit your GP as soon as possible if you experience the main symptoms of diabetes, which include:

Type 1 diabetes can develop quickly over weeks or even days.

Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.

The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach).

When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it's broken down to produce energy.

However,if you havediabetes, yourbody is unable to break down glucose into energy. This is because there's either not enough insulin to move the glucose, or the insulin produced doesn't work properly.

Although there are no lifestyle changes you can make to lower your risk of type 1 diabetes, type 2 diabetes is often linked to being overweight.

Read about how to reduce your diabetes risk.

If you're diagnosed with diabetes, you'll need toeat healthily, take regular exerciseand carry out regular blood teststo ensure your blood glucose levels stay balanced.

You can use theBMI healthy weight calculator to check whether you're a healthyweight.

You can find apps and tools in the NHS Apps Library to help you manage your diabetes and have a healthier lifestyle.

People diagnosed with type 1 diabetes also require regularinsulin injections for the rest of their life.

As type 2 diabetes is a progressive condition, medication may eventually be required, usually in the form of tablets.

Read about:

Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year.

If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it's not treated.

Screening, which involvesa half-hour check to examine the back of the eyes,is a way of detecting the condition early so it can be treated more effectively.

Read more about diabetic eye screening.

Page last reviewed: 12/07/2016Next review due: 12/07/2019

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Diabetes - NHS

Diabetes is a disease in which blood sugar (glucose) levels in your body are too high. Diabetes can cause serious health problems, including heart attack or stroke, blindness, problems during pregnancy, and kidney failure. About 15 million women in the United States have diabetes, or about 1 in every 9 adult women.1

Diabetes is a disease caused by high levels of blood sugar (glucose) in your body. This can happen when your body does not make insulin or does not use insulin correctly.

Insulin is a hormone made in the pancreas, an organ near your stomach. Insulin helps the glucose from food get into your body's cells for energy. If your body does not make enough insulin, or your body does not use the insulin correctly, the glucose stays and builds up in your blood.

Over time, this extra glucose can lead to prediabetes or diabetes. Diabetes puts you at risk for other serious and life-threatening health problems, such asheart disease, stroke, blindness, and kidney damage.

The three main types of diabetes are:

A risk factor is something that puts you at a higher risk for a disease compared to the average person.

Risk factors fortype 1 diabetesin women and girls include:

Risk factors fortype 2 diabetesin women and girls include:4

If you have any of these risk factors, talk to your doctor about ways to lower your risk for diabetes. You can also take theDiabetes Risk Testand talk about the results with your doctor.

Type 1 diabetesusually develops in children and young adults, but it can happen at any age.5 It is more common in non-Hispanic whites and non-Hispanic blacks than in Hispanic populations.6 About 5% of people with diabetes have type 1 diabetes.1If you have a parent or sibling with the disease you may be more likely to develop type 1 diabetes.

Type 2 diabetesis more common in adults, especially in people who are 45 and older, have a family history of diabetes, or have overweight or obesity. About 9095% of people with diabetes have type 2 diabetes.Type 2 diabetes is becoming more common in children and teens, which may be because more of them have overweight and obesity.7,8,9

Yes. It is more common for certain racial and ethnic groups to have diabetes. This affects women who are:

Learn more about risk factors for diabetes.

Diabetes affects women and men in almost equal numbers. However, diabetes affects women differently than men.

Compared with men with diabetes, women with diabetes have:12

Yes. The longer you have type 2 diabetes, the higher your risk for developing serious medical problems from diabetes. Also, if you smoke and have diabetes, you are even more likely to develop serious medical problems from diabetes, compared with people who have diabetes and do not smoke.14

The extra glucose in the blood that leads to diabetes can damage your nerves and blood vessels. Nerve damage from diabetes can lead to pain or a permanent loss of feeling in your hands, feet, and other parts of your body.15

Blood vessel damage from diabetes can also lead to:

Women with diabetes are also at higher risk for:

Researchers do not know the exact causes of type 1 and type 2 diabetes. Researchers do know that inheriting certain genes from your family can raise your risk for developing diabetes. Obesity is also a major risk factor for type 2 diabetes. Smoking can also cause type 2 diabetes. And the more you smoke the higher your risk for type 2 diabetes and other serious health problems if you already have diabetes.16

Weight loss can help control type 2 diabetes so that you are healthier. Quitting smoking can also help you control your blood sugar levels. Being a healthy weight and not smoking can help all women be healthier.

But, obesity and smoking do not always cause diabetes. Some women who are overweight or obese or smoke never develop diabetes. Also, women who are a normal weight or only slightly overweight can develop diabetes if they have otherrisk factors, such as a family history of diabetes.

Type 1 diabetessymptoms are usually more severe and may develop suddenly.

Type 2 diabetesmay not cause any signs or symptoms at first. Symptoms can develop slowly over time. You may not notice them right away.

Common signs and symptoms of type 1 and type 2 diabetes include:

Maybe. You should be tested for diabetes if you are between 40 and 70 years old and are overweight or obese. Your doctor may recommend testing earlier than age 40 if you also have otherrisk factors for diabetes. Also, talk to your doctor about diabetes testing if you havesigns or symptomsof diabetes. Your doctor will use a blood test to see if you have diabetes.

If the testing shows that your blood sugar levels are high, you can begin making healthy changes to your eating habits and getting more physical activity to help prevent diabetes.

Prediabetes means your blood sugar (glucose) level is higher than normal, but it is lower than the diabetes range. It also means you are at higher risk of getting type 2 diabetes andheart disease.

As many as 27 million American women have prediabetes.17 If you have prediabetes, you can make healthy changes, such as doing some type of physical activity on most days, to lower your risk of getting diabetes and return to normal blood sugar levels. Losing 7% of your body weight (or 14 pounds if you weigh 200 pounds) can lower your risk for type 2 diabetes by more than half. If you have prediabetes, get your blood glucose checked every year by a doctor or nurse.4

Diabetes treatment includes managing your blood sugar levels to control your symptoms. You can help control your blood sugar levels by eating healthy and getting regular physical activity.

With type 1 diabetes, you also will need to take insulinthrough shots or an insulin pump. Insulin cannot be taken as a pill.

Type 2 diabetes treatment also may include taking medicine to control your blood sugar.Over time, people with type 2 diabetes make less and less of their own insulin. This may mean that you will need to increase your medicines or start taking insulin shots to keep your diabetes in control.

Learn more about controlling diabetes at theNational Diabetes Education Programwebsite.

Researchers do not know how to prevent type 1 diabetes. Researchers are still looking for ways to prevent type 1 diabetes in women and girls by studying their close relatives who have diabetes.

Yes. Many studies, including the largeDiabetes Prevention Programstudy, have proven that you can prevent diabetes by losing weight. Weight loss through healthy eating and more physical activity improves the way your body uses insulin and glucose.

Learnhow to eat healthier and get more physical activity.

Yes. If you have type 1 or type 2 diabetes, you can have a healthy pregnancy. If you have diabetes and you want to have a baby, you need to plan ahead,beforeyou get pregnant.

Talk to your doctor before you get pregnant. He or she can talk to you about steps you can take to keep your baby healthy. This may include a diabetes education program to help you better understand your diabetes and how to control it during pregnancy.

For more information about diabetes, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

This content is provided by the Office on Women's Health.

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Diabetes | Womenshealth.gov

The importance of both diabetes and these comorbidities will continue to increase as the population ages. Therapies that have proven to reduce microvascular and macrovascular complications will need to be assessed in light of the newly identified comorbidities.

Lifestyle change has been proven effective in preventing or delaying the onset of type 2 diabetes in high-risk individuals. Based on this, new public health approaches are emerging that may deserve monitoring at the national level. For example, the Diabetes Prevention Program research trial demonstrated that lifestyle intervention had its greatest impact in older adults and was effective in all racial and ethnic groups. Translational studies of this work have also shown that delivery of the lifestyle intervention in group settings at the community level are also effective at reducing type 2 diabetes risk. The National Diabetes Prevention Program has now been established to implement the lifestyle intervention nationwide.

Another emerging issue is the effect on public health of new laboratory based criteria, such as introducing the use of A1c for diagnosis of type 2 diabetes or for recognizing high risk for type 2 diabetes. These changes may impact the number of individuals with undiagnosed diabetes and facilitate the introduction of type 2 diabetes prevention at a public health level.

Several studies have suggested that process indicators such as foot exams, eye exams, and measurement of A1c may not be sensitive enough to capture all aspects of quality of care that ultimately result in reduced morbidity. New diabetes quality-of-care indicators are currently under development and may help determine whether appropriate, timely, evidence-based care is linked to risk factor reduction. In addition, the scientific evidence that type 2 diabetes can be prevented or delayed has stimulated new research into the best markers and approaches for identifying and referring high-risk individuals to prevention programs in community settings.

Finally, it may be possible to achieve additional reduction in the risk of type 2 diabetes or its complications by influencing various behavioral risk factors, such as specific dietary choices, which have not been tested in large randomized controlled trials.

1Nathan DM. Diabetes: Advances in diagnosis and treatment. JAMA. 2015;314(10):1052-62.

2Knowler WC, Fowler SE, Hamman RF, et al; Diabetes Prevention Program Research Group. Ten-year followup of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.

3Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014. Available from:https://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf

4Centers for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2015.

5Emerging Risk Factors Collaboration, Seshasai SR, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364(9):829-41.

6Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314(10):1021-9.

7Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31-40.

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Diabetes | Healthy People 2020