The Imperative to Prevent Diabetes

Diabetes is the seventh leading cause of death in the U.S. and increases the risk of death twofold over age-matched individuals. Even these are conservative numbers, as diabetes has been found to be underreported on death certificates (1). These findings are even more remarkable for the recent decline seen in diabetes mortality rates due to improved management of cardiovascular risk factors (2). Despite remarkable advances in our understanding of the disease and pharmacological interventions for its treatment, diabetes remains the leading cause of renal failure, nontraumatic lower-limb amputation, and blindness in working-age adults. Improved therapeutics and health care delivery have brought remarkable declines in the incidence of both diabetic microvascular and macrovascular complications, with a 50% reduction in amputations from their peak in 1997 and ∼35% reduction in the incidence of end-stage renal disease (3). Similarly, 10-year coronary heart disease risk dropped from 21% in 2000 to 16% in 2008 (4). The observed decline in the event rates of complications and death due to diabetes is swamped by the increase in the number of individuals affected by the disease. The multiplier effect of a growing population with diabetes converts a declining incidence of complications into an increase in the total number of events observed. Among adults aged 18–79 years, the number of individuals with diagnosed diabetes in …