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April 15, 2019

Resurgence in Diabetes-Related Complications

Author Affiliations
  • 1Epidemiology and Statistics Branch, Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Now with School of Public Health, Imperial College London, London, England
JAMA. 2019;321(19):1867-1868. doi:10.1001/jama.2019.3471

The improved long-term outlook for adults after receiving a diagnosis of diabetes is one of the most important clinical and public health successes in recent decades. During the early 1990s, patients with diabetes had reductions in lifespan of 7 to 10 years and an increased risk of lower-extremity amputation (LEA) vs those without diabetes (58 vs 3 cases/10 000 persons/year, respectively) and kidney failure (28 vs 2 cases/10 000 persons/year).1 Risk of cardiovascular events, which caused the most deaths, also was higher among persons with diabetes vs those without diabetes (141 vs 38 hospitalizations for acute myocardial infarction [AMI] per 10 000 persons/year).1 But through multifaceted improvements in diabetes care, risk factor management, self-management education and support, and better integration of care, these risk differences were reduced by 28% to 68% across a range of complications between 1990 and 2010, with gains most notable for reductions in AMI, stroke, and death due to hyperglycemia.1,2 Although the excess morbidity risk remained too high and the reduction in cardiovascular disease mortality led to new types of complications and causes of death,3 a continued reduction in the overall public health burden caused by diabetes seemed promising.

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