Diabetes Self-Management Blog

Fewer people with diabetes are suffering leg amputation, blindness, and deaths from heart disease or stroke. This hopeful trend has been on for about 15 years. But what accounts for it, and how can you benefit?

I guess we shouldn’t overthink good news. But it’s interesting. Rates of diabetes are still going up for both Type 1 and Type 2. So why are complication rates dropping? Let’s look.

Several large studies have found major amputations (above the ankle) have decreased by roughly 50% in some populations. According to the physicians’ Web site Wounds International, the rates of lower extremity amputation in people with diabetes over age 40 dropped from 11.2% in 1996 to 3.2% in 1998.

Several researchers credit better foot care procedures for saving all those legs. A Danish study published in Diabetologia said that “revascularization” procedures are what’s doing it.

Of course they would say that. These procedures include bypass grafts and angioplasty. They either bypass or open up blocked blood vessels. So these physicians and surgeons think it’s their treatment of complications that are improving outcomes.

Ophthalmologists seem to think preventing complications is more important. Many fewer people with diabetes are going blind. Some doctors give credit to better glucose and blood pressure control, and they may be right.

According to an article in Ophthalmology Times Europe, “the risk of diabetic retinopathy (eye disease)…depends [mainly] on blood glucose control and blood pressure. For example, a 1% difference in [HbA1c] changes the rate of development of retinopathy by one third.” They also say that retinopathy is less likely to progress in people who have well-controlled blood pressure.

Einar Stefansson, MD, PhD, said that these results show that screening and preventive treatment can greatly reduce incidence of diabetic eye disease. Presumably, screening accomplishes this by getting people at risk under better diabetes control.

Heart Disease and Death Rates Dropping
Perhaps the most dramatic good news is the rapid decline in deaths from heart disease and strokes. According to the Centers for Disease Control (CDC), death rates from diabetes dropped 23% from 1997–2006. Deaths from heart disease and stroke dropped 40% among people with diabetes! Great news, but what could explain this improvement?

According to the Web site Nurse.com — which, being a nurse, I really admire — improved medical management of cardiovascular disease and diabetes has really helped. But “some healthy lifestyle changes contributed to the decline, the researchers reported.”

People with diabetes are now less likely to smoke than before. Better control of cholesterol and hypertension also may have contributed.

It’s interesting to note that obesity levels among people with diabetes have continued to increase while the death rates have been dropping. Another data point showing that weight is not the problem.

Ann Albright, PhD, RD, director of CDC’s Division of Diabetes Translation, gave people with diabetes some of the credit for their own improvement. She also sounded a note of caution. “Taking care of your heart through healthy lifestyle choices is making a difference, but Americans continue to die from a disease that can be prevented,” Albright wrote. “Although the cardiovascular disease death rate for people with diabetes has dropped, it is still twice as high as for adults without diabetes.”

Rates of cardiovascular disease have been dropping for all US adults, but they are dropping faster for people with diabetes than those without. According to Nurse.com, “recent CDC studies also have found declining rates of kidney failure, amputation of feet and legs, and hospitalizations for heart disease and stroke among people with diabetes.”

One important cause for all these health improvements may be that people are smoking less. Smoking rates in the USA dropped from around 40% in 1955 to roughly 19% in 2010, although the numbers may have leveled off now.

Possibly people’s going smoke free accounts for most of the health improvements. Better medical care may account for some more, and better self-management may be the biggest piece of all. I think the trend to encourage all people with diabetes to get their A1C levels down is making a big difference. But all these new drugs might be, too, even though I hate to admit it.

It’s remarkable to me that people’s health is improving even while our economic situation worsens. Nobody has been able to explain that. I just hope the trends continue. I’m sure our readers are doing their part to keep complication numbers down!

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