Diabetes mellitus (DM) influences the frequency and cost of RRT more than any other disease process in industrialized countries. Optimal management of DM can result in significant improvement of QOL, reduced mortality and cost savings. More than 30% of Type I and 10 to 30% Type II diabetic patients develop nephropathy1-4. DM results in excess of 50,000 amputations, 8,000 new cases of blindness and 3 million hospitalizations per year in the U.S. alone5,6. DM is the fastest growing cause of ESRD in most industrialized nations7.
- 20.8 million American children and adults or 7% of the population have diabetes
- 14.6 million diagnosed
- 6.2 million undiagnosed
- 54 million pre-diabetics
- 2 million teens aged 12-19 with pre-diabetes
- $132 billion estimated cost of diabetes in 2002 (included direct and indirect costs)
- 1 out of every 10 health care dollars is spent on diabetes and complications
Diabetic nephropathy is a critical determinant of morbidity and mortality. In Type I diabetics, proteinuria increases the relative risk of death 40-fold that of non-diabetics, cardiovascular disease 200-400-fold and ESRD >1000-fold8,9.
DM is associated with arterial hypertension (HTN) in more than 3 million Americans and diabetics are twice as likely to be affected by HTN than non-diabetics. The incidence of both DM and HTN continues to increase in industrialized nations. HTN contributes to the progression of diabetic micro- and macroangiopathy2-4,10,11.
Distribution of cardiac disease, diabetes, and hypertension
prior to initiation of dialysis. Based on reference 12.
Adjusted incident rates of ESRD due to diabetes, adjusted for age, gender and race13.
Click image to enlarge
References:
- Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med 328:1676-1685, 1993
- Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension 19:403-418, 1992
- The National High Blood Pressure Education Program Working Group (Chair JRS. National high blood pressure education program working group report on hypertension in diabetes (Special Article). Hypertension 23:145-158, 1994
- Bakris GL, Mehler P, Schrier R. Hypertension and diabetes. In: Schrier RW, Gotschalk CW, eds. Diseases of the Kidney. (6th Ed) Boston: Little Brown and Company, 1996:1281-1328
- Ortiz-Butcher C. Entendiendo la nefropatía diabética. Medico Interamericano 16:517-521, 1997
- Rubin RJ, Altman WM, Mendelson DN. Health care expenditures for people with diabetes mellitus. J C Endo Metab 78:809A-809F, 1994
- U.S. Renal Data System, USRDS 1997 Annual Data Report. Bethesda, Maryland: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1997
- Borch-Johnsen K, Andersen PK, Deckert T. The effect of proteinuria on relative mortality in Type I (insulin-dependent) diabetes mellitus. Diabetologia 28:590-596, 1985
- Andersen AR, Sandahl Christiansen J, Andersen JK, Kreiner S, Deckert T. Diabetic neuropathy in Type I (insulin-dependent) diabetes: An epidemiologic study. Diabetologia 25:496-501, 1983
- Sowers J, Epstein M. Diabetes mellitus and associated hypertension, vascular disease, and nephropathy: An update. Hypertension 26:869-879, 1995
- Diaz-Buxo JA, Burgess WP, Greenman M, Chandler JT, Farmer CD, Walker PJ. Visual function in diabetic patients undergoing dialysis-comparison of peritoneal and hemodialysis. Int J Artif Organs 7:257-262, 1984
- U.S. Renal Data System, USRDS 2001 Annual Data Report. Bethesda, Maryland: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2001
- U.S. Renal Data System, Excerpts from the USRDS 2004 Annual Data Report. Am J Kidney Dis 45 (Suppl 1):S1-S280, 2005