The January 28 issue of JAMA/Archives journals confirms the fact that the rate of diabetes among Americans older than 65 is on the rise. The authors say that while the occurrence of diabetes increased by 62 percent, the annual frequency of diabetes increased by 23 percent, between 1994 to 1995 and 2003 to 2004.
The prevalence of diabetes mellitus is increasing, in part because of population aging, but also in younger persons, according to background information in the article. The high rate of existing diabetes also contributes to a high rate of diabetes-related complications and premature death. 'Awareness of the importance of active monitoring and management of diabetes has become more widespread; however, adherence to recommended practices remains low.'
Frank A. Sloan, Ph.D., and colleagues at the Duke University Medical Center, Durham, North Carolina, and colleagues analyzed Medicare program data for patients first diagnosed with diabetes during 1994 (33,164 patients), 1999 (31,722 patients) and 2003 (40,058 patients). This data was compared with that of two control groups consisting of individuals without the disease who were of similar race and ethnicity to those with diabetes. Death and complications of diabetes such as cardiovascular, cerebrovascular (damage to blood cells in the brain), ophthalmic (eye), renal (kidney) and lower extremity events were recorded.
'The annual incidence of diabetes increased by 23 percent between 1994 to 1995 and 2003 to 2004, and prevalence increased by 62 percent,' the authors write. After diagnosis, the death rate in patients having diabetes decreased by 8.3 percent when compared with those who were not diagnosed with the disease.
Most patients with diabetes experienced at least one complication within the next six years; for example, almost half had congestive heart failure. 'Complication rates among persons diagnosed as having diabetes generally increased or stayed the same compared with those in the control groups during 1994 to 2004 except for ophthalmic diseases associated with diabetes,' the authors note. 'In some cases, most notably renal events, including the most serious complications, there were increases in prevalence in both the diabetes and control groups.'
'Overall, our findings emphasize the overwhelming burden of diabetes, including the near 90 percent prevalence of an adverse outcome and many serious and resource-consuming outcomes such as coronary heart failure, myocardial infarction [heart attack] and stroke,' the authors conclude. 'The burden of financing and providing medical care for persons older than 65 in the United States having diagnosed diabetes is growing rapidly as a result of increased incidence and, especially, prevalence of diagnosed diabetes, decreased mortality and overall lack of improvement in rates of complications in persons having diagnosed diabetes.'