People with diabetes have another critical reason to take care of their health: Diabetes is deadlier than previously believed.
New research offers evidence that 12 percent of deaths in the U.S. are caused by diabetes or its complications, making it the third leading cause of death behind heart disease and cancer. The finding should be “a wake-up call” for people with the disease, says Samuel Preston, a sociology professor at the University of Pennsylvania and one of the researchers who analyzed national health data to come to this conclusion.
This calculation is higher than previous estimates, which put it at 2.8 percent in 2010; diabetes was the seventh leading cause of death in 2013, according to the Centers for Disease Control and Prevention.
The reason for the gap is that diabetes as the underlying cause of death had been significantly underreported in the United States, Preston says. “It’s difficult for a physician to say, ‘If this person didn’t have diabetes, he wouldn’t have died,’ but we are able to do that looking at national statistics. We are looking at excess mortality from diabetes. If it was eliminated as a disease process, we’d expect 12 percent fewer deaths each year in the United States,” he says.
People rarely die directly from the disease, Preston says. They die from a condition that is caused by diabetes, such as heart disease, stroke, kidney disease or dementia. Diabetes as a cause of these conditions isn’t often recorded on death certificates, but researchers inferred it’s a key contributor.
Ann Albright, director of the CDC’s diabetes division, says because so many people are developing Type 2 diabetes, “it will continue to be a significant contributor to the mortality data in this country.”
More than 29 million people have diabetes, which is a disease in which blood sugar levels are above normal. People with the disease either don’t make enough insulin (Type 1) or can’t use insulin properly (Type 2). Insulin allows blood sugar (glucose) to enter cells, where it can be used for energy. When the body doesn’t have enough insulin or can’t use it effectively, blood sugar builds up in the blood, damaging nerves and blood vessels.
High blood sugar levels can lead to heart disease, stroke, blindness, kidney failure and amputation of toes, feet or legs. Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases of diabetes, and Type 1 diabetes accounts for about 5 percent.
The disease can reduce people’s quality of life in their later years, so they need to understand it and take it seriously, Albright says. Among the CDC’s recommendations:
— Healthy eating, physical activity and insulin injections for people with Type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.
— Healthy eating, physical activity and blood glucose testing for those with Type 2 diabetes. In addition, many people require oral medication, insulin or both to control their blood glucose levels.
— Seeing a health care provider who will monitor their diabetes control and help them learn to manage the disease. In addition, they may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills for daily health management.
About 86 million people have prediabetes, which means their blood sugar level is higher than normal, but not high enough for the Type 2 diabetes diagnosis. Prevention is important so more people don’t develop the disease, Albright says.
Preston has done research that shows most of the increase in Type 2 diabetes is attributable to the increase in obesity. “The two are very clearly linked.” Obesity can be tackled through changes in personal behavior and public policies, he says. “We need to work harder to bring it under control.”
People with prediabetes may want to:
Look into the National Diabetes Prevention Program, a CDC-recognized lifestyle change plan offered in person or online. A trained lifestyle coach leads the program to help people eat healthier, become more physically active and reduce stress. The program is based on research that shows people with prediabetes can prevent or delay Type 2 diabetes if they follow a healthy diet, lose a moderate amount of weight (5 to 7 percent of total body weight) and do 30 minutes of physical activity five days a week.
Find a weight-loss program that works for them. It’s not one-size-fits all when it comes to the best diet for reducing calories, says Elizabeth Mayer-Davis, chair of the department of nutrition at the University of North Carolina, Chapel Hill. “The trick is to find a plan you can live with so you keep the weight off.” Some eating plans to consider: Weight Watchers, the DASH Diet and the Mediterranean Diet.
Step it up. Gradually increase your physical activity, Mayer-Davis says. Any amount of exercise is better than none at all, so if you haven’t been physically active for a while, start slowly by taking short walks and using the stairs instead of the elevator. “Even walking briskly helps your body use insulin better.”
Physical activity may also help you reduce stress and improve your quality of sleep, which can also help reduce your risk of diabetes, Mayer-Davis says.
The important thing is to start small and develop healthy habits that will last you a lifetime, she says. Changing your lifestyle “is not something that happens in one day or a week or a month.”
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