Diabetes complications—rates are down, but numbers are still high

Although the incidence of diabetes-related complications in the United States has decreased since 1990, the burden remains high because of rising prevalence of diabetes, according to a report in the New England Journal of Medicine.

The researchers compiled nationwide data from multiple sources to assess trends in diabetes-related complications from 1990 to 2010. Age-standardized to the United States population in 2000, the data showed decreased incidence rates for all five complications of interest. Relative decreases were 67.8 percent for acute myocardial infarction, 64.4 percent for death resulting from hyperglycemic crisis, 52.7 percent for stroke, 51.4 percent for lower-extremity amputations, and 28.3 percent for ESRD.

When 1995 was used as the start year rather than 1990, the decline in ESRD was more similar to that for the other outcomes. Absolute declines in cases per 10,000 persons per year were 95.6 for myocardial infarction, 58.9 for stroke, 30.0 for lower-extremity amputation, 7.9 for ESRD, and 2.7 for death resulting from hyperglycemic crisis.

However, once the rising prevalence of diabetes was taken into account, the reductions were significant only for myocardial infarction and death resulting from hyperglycemic crisis: by 32.2 and 42.0 percent, respectively. There was no significant change in the rates for amputation or stroke, and the ESRD rate increased by 90.9 percent: from 1.1 to 2.1 cases per 10,000 population.

The results suggest that improvements in preventive care have reduced the rates of important diabetes-related complications over the past two decades. However, as diabetes prevalence continues to rise, high numbers of complications persist nationwide. “The encouraging reductions in the rates of morbidity and hyperglycemia-related mortality in the population of adults with diabetes do not signify imminent reductions in the overall burden of diabetes-related complications,” the researchers conclude [Gregg EW, et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med 2014; 370:1514–1523].