SLR - November 2014 - Kyle E Wamelink

Changes in Diabetes-Related Complications in the United States, 1990-2010

Reference: Gregg EW, Li Y, Wang J, Burrows NR, Ali MK, Rolka D, Williams DE, Geiss L. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med. 2014 Apr 17; 370(16): 1514-23.

Scientific Literature Review

Reviewed By: Kyle E Wamelink, DPM
Residency Program: Steward St. Elizabeth Medical Center, Brighton, MA

Podiatric Relevance: Between 1990 and 2010, diabetes has more than tripled from 6.5 million to 20.7 million, a 218 percent increase. In addition, the United States population has increased by 27 percent during the same time period. During this 20-year span, in the population of adults with diabetes, the rates of all five major complications related to the disease has declined significantly. Most notably, the largest reduction has been in cardiovascular disease; specifically, the most common diabetes-related complication, acute myocardial infarctions. The reduction in major diabetic complications is likely a reflection of an increased emphasis on integrated management care and advances in intensive medical procedures, including revascularization procedures and wound care. Given the growth of the disease and its relevance to the podiatric profession, thorough understanding of the trends related to the disease is of increased importance. Given the epidemic of diabetes the role of podiatric professionals is clear in continuing to prevent one of the major complications of this disease process.

Methods: Data was collected and processed from the time period of 1990 to 2010 to examine trends in rates of all five diabetic complications including: acute myocardial infarction, death from hyperglycemic crisis, stroke, amputation and renal disease. Data was obtained from the National Health Interview Survey (NHIS), the National Hospital Discharge Survey (NHDS), the U.S. Renal Data System (USRDS) and the U.S National Vital Statistics System. From the data collected, each complication was assumed to be related to diabetes if any of the listed diagnoses included diabetes. Lower extremity amputations included the upper leg, lower leg, ankle, foot and toes.

Results: All five major diabetic complications have shown a decline between 1990 and 2010, with the largest decline being acute myocardial infarction (95.6 fewer cases per 10,000) and the smallest decline being death by hyperglycemic crisis (2.7 fewer cases per 10,000). Stroke (58.9 fewer cases per 10,000) and lower extremity amputation (30.0 fewer cases per 10,000) have declined by about half. The next lowest was end-stage renal disease (7.9 fewer cases per 10,000).

Conclusion: The decline in major diabetic complications over the past two decades is only a snap-shot of the reduction in morbidities and mortalities related to the disease. While these results are encouraging, they do not overshadow the overall burden of diabetes-related complications. Due to the fact that the incidence of diabetes has doubled in the past 15 years and the prevalence has tripled, the annual number of amputations, cases of end-stage renal disease and strokes continue to increase. Furthermore, we lack national data to examine trends in the incidence of diabetic retinopathy, hypoglycemia and age-related complications of Type 2 diabetes, including cognitive decline, Alzheimer’s disease, depression and physical disability. 

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