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• CDC's Diabetes Control Programs, 2000
• Diabetes: A Growing Public Health Problem
• Many Complications of Diabetes Can Be Prevented
• CDC's National Leadership

CDC's Diabetes Control Programs, 2000*

*CDC also funds the following territories for core diabetes control programs: American Samoa, Federated States of Micronesia, Guam, Marshal Islands, Northern Mariana Islands, Palau, Puerto Rico, and the U.S. Virgin Islands
Note: A text version of this information is available.

Dramatic new evidence signals the unfolding of a diabetes epidemic in the United States. With obesity on the rise, we can expect the sharp increase of diabetes rates to continue. Unless these dangerous trends are halted, the impact on our nation's health and medical care costs will be overwhelming.

Jeffrey P. Koplan, MD, MPH
Director, Centers for Disease Control and Prevention

Diabetes: A Growing Public Health Problem

Diabetes is a serious, costly, and increasingly common chronic disease that affects nearly 16 million Americans and contributes to almost 200,000 deaths a year. An estimated 10.3 million Americans have diagnosed diabetes, and another 5.4 million have undiagnosed diabetes. Among adults, the prevalence of diagnosed diabetes, including gestational diabetes, increased 33% from 1990 to 1998. The largest increase (76%) occurred among people aged 30-39.

People with diabetes have either a shortage of insulin or a decreased ability to use insulin, a hormone secreted by the pancreas. Insulin allows glucose (sugar) to enter cells and be converted to energy. In uncontrolled diabetes, glucose and fats remain in the blood and, over time, damage vital organs.

Diabetes is classified into two main types: type 1, which most often appears in childhood or adolescence, and type 2, which affects 90%-95% of people with diabetes and most often appears after age 40. However, type 2 diabetes is now being diagnosed more frequently among children and adolescents.

Type 2 diabetes is linked to obesity and physical inactivity—two modifiable risk factors. Improving nutrition and increasing physical activity can delay the progression of diabetes, as can controlling blood glucose levels and improving access to proper medical treatment.

Diabetes causes preventable complications that can be life-threatening. Diabetes is a leading cause of blindness, kidney failure, leg and foot amputations, pregnancy complications, and deaths related to flu and pneumonia.

Diabetes and its complications have their greatest impact on the elderly and on certain racial and ethnic populations. More than 18% of adults older than age 65 have diabetes, and American Indians and Alaska Natives are 2.8 times more likely to have diagnosed diabetes than non-Hispanic whites of similar age. In addition, African Americans are 2 times more likely than whites to die of diabetes.

The direct and indirect costs of diabetes are nearly $100 billion a year. The average health care cost for a person with diabetes in 1997 was $10,071, compared with $2,699 for a person without diabetes. However, the full burden of diabetes is hard to measure: death records often fail to reflect the role of diabetes, and the costs related to undiagnosed diabetes are unknown.

Prevalence of Diabetes Among U.S. Adults*

*Includes gestational diabetes.
Source: CDC, Behavioral Risk Factor Surveillance System.
Note: A text version of this information is available.

Many Complications of Diabetes Can Be Prevented

Early detection, improved delivery of care, and better self-management are key strategies for preventing the following diabetes-related complications:

Eye Disease and blindness. Each year, an estimated 12,000-24,000 people become blind because of diabetic eye disease. Appropriate screening and care could prevent up to 90% of diabetes-related blindness. However, only 60% of people with diabetes receive annual dilated eye exams.

Kidney disease. Each year, about 33,000 people with diabetes develop kidney failure, and more than 100,000 are treated for this condition. Treatment to better control blood pressure and blood glucose levels could reduce diabetes-related kidney failure by 50%.

Amputations. About 86,000 people undergo diabetes-related lower-extremity amputations each year. Over half of these amputations could be prevented with regular examinations and patient education.

Complications of pregnancy. Women with preexisting diabetes give birth to more than 18,000 babies each year. Preconception diabetes care for these mothers can prevent diabetes-related health problems for both mothers and infants.

Flu-and Pneumonia-related death. Each year, 10,000 to 30,000 people with diabetes die of complications of flu and pneumonia; they are roughly three times more likely to die of these complications than people without diabetes. However, only 54% of people with diabetes get an annual flu shot.

CDC's National Leadership

CDC provides leadership to increase awareness and education about diabetes, promote early detection of diabetes and treatment of its complications, and improve the quality of and access to diabetes care. The following strategies are key to achieving these goals.

Establish Effective State Programs Nationwide

CDC supports state and territorial diabetes control programs to reduce the complications of diabetes. With fiscal year 2001 funding of $58.3 million,* CDC provides limited support to 34 states, 8 territories, and the District of Columbia for core diabetes programs and more substantive support to 16 states for comprehensive programs.

Examples of state activities include the following:

• The California Diabetes Control Program assessed the effects of case management on blood glucose levels among Medicaid patients. Blood glucose levels had declined significantly at 18 months among patients who received diabetes care guidelines, blood glucose monitoring instruction, and nutrition education in addition to usual care. Improved glucose control decreases the risk of complications and ultimately decreases health care costs.
• The New York Diabetes Control Program is collaborating with a variety of partners to improve diabetes care. In 2 years, provider-and community-focused interventions have reduced diabetes hospitalization rates by 35% and decreased lower-extremity amputation rates by 39%.

Implement the National Diabetes Education Program

CDC and the National Institutes of Health jointly sponsor the National Diabetes Education Program (NDEP). Through collaboration with over 200 public and private partners, this program seeks to improve treatment, promote early detection, and ultimately prevent the onset of diabetes.

The NDEP's award-winning public awareness campaign Control Your Diabetes. For Life. includes public service announcements for general audiences and messages tailored to African Americans, American Indians, Asian Americans/ Pacific Islanders, and Hispanic/ Latino communities. In addition, NDEP offers community partnership workshops that present approaches for increasing community awareness about diabetes and for conducting community-based prevention activities. NDEP has also developed an intervention kit for promoting diabetes control activities in the workplace.

Develop Innovative Approaches

As part of CDC's ongoing public service campaign Diabetes. One Disease. Many Risks, the Diabetes and Flu/ Pneumococcal Campaign educates people with diabetes about the importance of getting flu and pneumonia shots.

Another innovative approach is Diabetes Today, an educational program that enables health professionals and community leaders to develop a community plan for preventing diabetes complications and improving care. Materials have been translated into Spanish, and a regional site has been established to serve Hawaii and the Pacific basin.

Better Define the Diabetes Burden

Understanding how diabetes is distributed in the population is essential to effectively targeting prevention efforts. To estimate the diabetes burden, CDC uses several national data sources and its Behavioral Risk Factor Surveillance System, a telephone survey that provides state-specific information on risk factors and health care practices. CDC is also exploring new ways to improve diabetes surveillance among populations most at risk.

Translate Science Into Quality Care

CDC is working with partners in managed care to determine how to improve care for people with diabetes. Through TRIAD (Translating Research into Action for Diabetes), CDC

• Assesses how health care providers and delivery systems apply accepted standards of care.
• Explores variations in the implementation of quality diabetes care.
• Develops and tests strategies to move existing care practices closer to optimal standards.

CDC has dedicated $3 million to the National Diabetes Laboratory to support scientific studies that will improve the lives of people with diabetes.

Target Special Populations

• National Diabetes Prevention Center—To address the high prevalence of diabetes and its complications among American Indian populations, CDC funds a center in Gallup, New Mexico, to develop culturally relevant diabetes prevention strategies among the Navajo Nation and the Zuni Pueblo. Research findings will ultimately be applicable to other American Indian populations.
• National minority organizations—Through NDEP, CDC collaborates with six national minority organizations to develop and deliver culturally and linguistically appropriate diabetes prevention and control messages to African American, Hispanic/ Latino, American Indian, and Asian American/ Pacific Islander populations.
• U. S./ Mexico Border Diabetes Prevention and Control Project—CDC is working with southwestern U. S. border states, Mexican border states, the Pan American Health Organization, and Mexico's Secretariat of Health to assess the burden of diabetes, patterns of care, and barriers to good self-management.
• Children and type 2 diabetes—Because of the increasing incidence of type 2 diabetes among children and the increase in type 1 diabetes worldwide, CDC is initiating a scientific effort to improve the surveillance of childhood diabetes and identify prevention strategies.
• Diabetes and Women's Health Monograph—CDC's Diabetes and Women's Health Across the Life Stages: A Public Health Perspective highlights the effects of diabetes on the life cycle of women.
• Diabetes worldwide—By 2025, 300 million people worldwide will have diabetes. As a World Health Organization Collaborating Center for Diabetes, CDC works with the Pan American Health Organization to implement the Declaration of the Americas, which includes developing guidance for international diabetes control programs.

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This page last reviewed April 19, 2001.

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation