American Diabetes Month: What are the complications? They can be disabling or life-threatening over time
A person is twice as likely to have heart disease or a stroke as someone who does not have diabetes, and it could happen at a younger age, says the CDC
Diabetes can affect any part of the body over time, and long-term complications of the condition can 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. According to health experts, diabetes complications can develop without any obvious symptoms.
What are the possible complications?
Heart disease: Having diabetes means that a person is more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. Over time, high blood glucose from diabetes can damage the blood vessels and the nerves that control the heart and blood vessels.
According to the US Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death among people with diabetes. “You’re twice as likely to have heart disease or a stroke as someone who doesn’t have diabetes, and it could happen at a younger age,” the agency cautions.
A recent analysis of 373,185 people, aged 18 years and older, found that most type 2 diabetes patients are at high risk of a fatal heart attack or stroke. The most striking result was that the vast majority (93%) of patients had a high (39.6%) or very high risk (53.4%) of fatal events within a decade. “Half of the patients in the very high-risk group had no history of heart disease, meaning they would not be receiving medications to prevent heart attacks and strokes,” writes study author Dr Manel Mata-Cases, a general practitioner for the Catalan Institute of Health in Sant Adrià de Besòs.
Nerve damage: Diabetic neuropathy is nerve damage that can occur in people with diabetes. Different types of nerve damage cause different symptoms. Depending on which type of diabetic neuropathy a person has, symptoms can range from pain and numbness in the feet to problems with the functions of one’s internal organs, such as the heart. As many as half of people with diabetes have nerve problems, but not all have symptoms.
Foot problems: They are common in people with diabetes. Over time, diabetes may cause nerve damage, which can cause tingling and pain and can make a person lose feeling in their feet. When a person loses feeling in the feet, he/she may not feel a blister on the foot, which can lead to cuts and sores. A sore or wound can also become infected and not heal properly. This is because diabetes can lower the amount of blood flow in your feet, and this can make it hard for a sore or an infection to heal. Sometimes, a bad infection never heals, which may lead to gangrene. Foot ulcers and gangrene that do not get better with treatment can lead to an amputation of your toe, foot, or part of your leg to prevent the infection from spreading, warns the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Sexual problems: These along with bladder problems are common as people age, but diabetes can make them worse. Additionally, both men and women with diabetes are more likely to get urinary tract infections.
Kidney disease: Kidney damage caused by diabetes usually occurs slowly, over many years. High blood sugar can damage cells and blood vessels in the kidneys, as a result of which they are unable to filter out waste as well as they should. “This condition is called chronic kidney disease, or CKD. About 1 in 3 adults with diabetes have CKD. CKD usually gets worse over time and can lead to kidney failure. If your kidneys fail, you’ll need regular dialysis (a treatment that filters waste out of your blood) or a kidney transplant,” explains the CDC.
Many people with diabetes also develop high blood pressure, which can also damage the kidneys. African-Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.
Vision loss: If you have diabetes, you are at risk for eye problems that can lead to vision loss. Diabetic eye disease is a group of eye problems that can affect people with diabetes, which include diabetic retinopathy (blood vessels of the retina are damaged), cataracts (clouding of the lens), and glaucoma (a group of diseases that damage the optic nerve). A very common diabetes complication, diabetic retinopathy is the leading cause of blindness in American adults. “Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2018 indicated that 11.7% reported vision disability, including blindness,” according to a CDC report.
Hearing Loss: Over time, high blood sugar levels can damage small blood vessels and nerves in the inner ear. This may also affect your balance. Hearing loss often happens gradually, so a person may not know he/she is having trouble hearing.
Oral health: Too much glucose in the blood from diabetes can cause pain, infection, and other problems in the mouth. This includes gum disease, which can lead to tooth loss, unhealthy or inflamed gums, the growth of a naturally occurring fungus that the body is unable to control, and a lack of saliva in the mouth that raises the risk for tooth decay and gum disease.
What do the numbers say?
Estimates show that in 2017, diabetes was the seventh leading cause of death in the US. The CDC finding is based on 83,564 death certificates in which diabetes was listed as the underlying cause of death -- representing a crude rate of 25.7 per 100,000 persons. In 2017, there were 270,702 death certificates with diabetes listed as the underlying or contributing cause of death: which indicates a crude rate of 83.1 per 100,000 persons. As far as emergency department visits are concerned, 16 million were reported with diabetes as any listed diagnosis in 2016 among adults aged 18 years or older.
Further, in 2016, a total of 7.8 million hospital discharges were reported with diabetes as any listed diagnosis among US adults aged 18 years or older, accounting for 339.0 per 1,000 adults with diabetes. These discharges included 1.7 million for major cardiovascular diseases (75.3 per 1,000 adults with diabetes). This number includes 438,000 for ischemic heart disease (18.9 per 1,000 adults with diabetes), 313,000 for stroke (13.6 per 1,000 adults with diabetes), and 130,000 for a lower-extremity amputation (5.6 per 1,000 adults with diabetes), among others.
Among US adults aged 20 years or older with diagnosed diabetes, the estimated crude prevalence of chronic kidney disease (stages 1-4) was 36.5% during 2011-2012. Among those with diabetes and moderate to severe kidney disease (stage 3 or 4), 19.4% were aware of their kidney disease during 1999-2012. In 2014, a total of 52,159 people developed end-stage renal disease with diabetes as the primary cause. Adjusted for age group, sex, and racial or ethnic group, the rate was 154.4 per 1 million persons.
Among US adults aged 18 years or older with diagnosed diabetes, estimates for 2013-2016 were 37.0% for chronic kidney disease (stages 1-4), of which over half (52.5%) had moderate to severe chronic kidney disease (stage 3 or 4). About 24.9% of such patients were aware of their kidney disease.
“In 2017, the crude prevalence of end-stage kidney disease with diabetes listed as the primary cause was 38.6% (288,451 out of 746,557 people). Consequently, diabetes was the leading cause of end-stage kidney disease, followed by high blood pressure (25.9%), and glomerulonephritis (15.5%). Crude incidence of end-stage kidney disease with diabetes as the primary cause was 180.3 per 1 million population (58,372 new cases),” the report suggests.
The disease is costly: the total direct and indirect estimated costs of diagnosed diabetes in the US in 2017 was $327 billion. The total direct estimated costs of diagnosed diabetes increased from $188 billion in 2012 to $237 billion in 2017 (2017 dollars), while the total indirect costs increased from $73 billion to $90 billion in the same period. Between 2012 and 2017, excess medical costs per person associated with diabetes also increased from $8,417 to $9,601.