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Diabetes and the Loss of Limbs: A Dreadful Cost of Obesity

April 10, 2013

My weekend cycling buddy is well acquainted with amputees; his dad lost both of his lower legs in Italy in the Second World War. Many of our veterans from more recent foreign combat have come home with missing limbs, and although I don’t know anyone personally, the chances that I will meet an amputee are increasing dramatically. The number of people living with the loss of a limb is expected to more than double from 1.6 million in 2005 to 3.6 million in 2050, with amputations due to diabetes-related (dysvascular) conditions accounting for most of the increase.

The CDC Diabetes Report Card 2012 tells the story in numbers, (using 2010 data, the most recent available):

  • Diabetes affects 25.8 million people of all ages (8.3 percent of the U.S. population)
  • 10.9 million U.S. residents, ages 65 years and older, had diabetes in 2010
  • Approximately 215,000 people younger than 20 years had the disease that year
  • 1.9 million adults ages 20 years or older were newly diagnosed with diabetes in 2010
  • Diabetes is the seventh leading cause of death in the nation
  • Diabetes is a major cause of heart disease and stroke, and is the leading cause of kidney failure, nontraumatic lower-limb amputations (over 60%), and new cases of blindness among adults in the United States
  • Average medical expenses are more than twice as high for a person with diabetes as they are for those without the disease

Physical inactivity and obesity are strongly associated with the development of type 2 diabetes. Given the increase in the prevalence of obesity and the known relationship between obesity and diabetes, it is not surprising that the prevalence of diabetes has risen sharply in the U.S. since 1995, and is projected to nearly double by the year 2030.

The increases are highest in the South and Appalachian regions, probably due to the greater prevalence of risk factors for diabetes, including obesity and sedentary lifestyle.

In 2010, the states with the highest percentage of adults with diagnosed diabetes were as follows:

The diabetes belt. Reprinted with permission from Barker et al. AJPM 2011.

The U.S. diabetes belt. Reprinted with permission from Barker et al. AJPM 2011.

State Percentage
Mississippi 11.3
Alabama 11.1
West Virginia 10.7
Louisiana 10.3
Tennessee 10.2
Kentucky 10.1
Oklahoma 10.1

But

But all is not lost. The Diabetes Prevention Program (DPP) and other studies show that millions of people can lower their risk for type 2 diabetes by making lifestyle changes and losing weight. People with prediabetes can prevent or delay the onset of type 2 diabetes by losing 5%–7% of their body weight and getting at least 150 minutes per week of moderate physical activity. The research also found that lifestyle interventions are more cost-effective than medications, and in 2009 a follow-up study of DPP participants—the Diabetes Prevention Program Outcomes Study (DPPOS)—showed that the benefits of weight loss lasted for at least 10 years after the original study began.

You might also want to check out Healthy People 2020, the ongoing national project to improve the health of Americans. In 2010 it set out a 10-year agenda for improving the Nation’s health, which includes tracking progress toward meeting several diabetes-related objectives during this decade. The overall goal is to reduce the prevalence and economic burden of diabetes and improve the quality of life for all people who have or are at risk of it.

 

For Further Reading:

Check out AJPM’s April 2013 supplement: Advancing the science and practice of diabetes prevention, edited by Sachin Jain and Edward Horton

And for a link to more AJPM articles, you can go to AJPM Collections: Diabetes.

— Michael Lytton, AJPM Blog Editor

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