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Today, diabetes is one of the most serious
health challenges facing women in the United States, especially women of
color. Complications from diabetes rank among the top 10 causes of death
for all women.
As shown in the Diabetes Deaths for Women chart, whether diabetes is an underlying cause or among multiple causes of death, the toll on women, especially women of color, is significant. For African American
women, the diabetes death rates are the highest in terms of both underlying cause
(49.6 per 100,000) and multiple causes (156.5 per 100,000).1
American Indian/Alaska Native and Hispanic women have high rates as well. The lowest rates are reported for Asian/Pacific Islander women.
Even within racial and ethnic groups,
disparities exist. Diabetes takes an excessive toll on Pima Indians, who
are at higher risk than other American Indians for many types of
complications, including diabetic eye disease.
Diabetes is a disease
in which the pancreas, the organ that produces the hormone insulin to help
glucose (a sugar) get into the body's cells, does not work properly. The
glucose then builds up in the blood, overflows into the urine, and is
carried out of the body instead of being used by the cells for energy.
Diabetes
Diabetes and Steps
to Healthier Women
The basic steps to improving
women's health apply directly to controlling diabetes. In sum, if
you have diabetes, take care of yourself.
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Reach and maintain a healthy
weight.
Include exercise in your daily
routine.
Control your blood sugar.
Don't smoke.
Take your medication as
prescribed by your doctor.
can lead to serious,
even life-threatening
emergencies and serious damage to many parts of the body: the heart, eyes,
kidneys, blood vessels, nerves, gums and teeth, feet, and legs.1
Type 2 diabetes, previously referred to as
adult onset, is a more serious problem for women of color, as indicated by
the statistics below:1
Among African
American women, this form of diabetes has reached
epidemic proportions;
for those age 20 years or older, the rate is 11.8
percent. |
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About 1 in 4 black
women over the age of 55 years of age has diabetes,
nearly twice the
rate of white women.
Twenty-five
percent of Hispanic women have been diagnosed with type
2 diabetes, and
about 33 percent of deaths among them list diabetes
as the underlying
cause. This rate has risen rapidly in the 30-year period
from 1958 to
1987.
American
Indian/Alaska Native women have almost three times the risk
of being
diagnosed with diabetes as whites of similar age. The disease
is common
in many tribes, and the sickness and mortality can be very
severe.
Older American
Indian/Alaska Native and Mexican American women are among the most likely to
have diabetes (32 and 30 percent, respectively), followed by black women (25
percent) and white women (15 percent).2
Years of potential life lost due to diabetes
before age 75 (age-adjusted per 100,000 population under 75 years ago of
age) clearly reflects the toll taken by diabetes among African American and
American Indian/Alaska Native women. In 1988, black women lost 369.5 years,
and American Indian/Alaska Native women lost 327.8 years of potential life
to diabetes. Hispanic women lost 188.7 years of potential life, white women
lost 127.4 years, and Asian and Pacific Islander women lost 68.2 years.3
Diabetes-related health risks are twofold:
health risks that can lead to diabetes and health risks that result from
having diabetes. The diabetes-associated risks include loss of vision
and blindness, foot ulcers, lower extremity amputations, and pregnancy and
cardiovascular complications. In addition, diabetes is associated with
birth defects, high blood pressure, nervous system damage, dental disease,
kidney disease, stroke, and flu and pneumonia-related deaths.
Cardiovascular
disease is the most costly complication of diabetes, accounting for more
than $17.6 billion of the $91.8 billion annual direct medical costs for
diabetes in 2002. Data
about diabetes-related complications show disparities for women of color.
For example, African Americans experience
Healthy
People 2010 Objectives
Diabetes
The Diabetes
Focus Area of Healthy People 2010 contains 17 objectives, and all
are relevant to women's health. Because of racial and ethnic
patterns, these objectives are very important for women of color.
5-1.
Diabetes
education
5-2. New cases of diabetes
5-3. Overall cases of diagnosed
diabetes
5-4.
Diagnosis of
diabetes
5-5. Diabetes deaths
5-6. Diabetes-related deaths
5-7.
Cardiovascular
disease deaths in persons with
diabetes
5-8.
Gestational diabetes
5-9. Foot ulcers
5-10.
Lower extremity
amputations
5-11. Annual urinary
micro-albumin measurement
5-12.
Annual
glycosylated hemoglobin measurement
5-13.
Annual dilated
eye examinations
5-14.
Annual foot
examinations
5-15.
Annual dental
examinations
5-16. Aspirin therapy
5-17.
Self-blood-glucose-monitoring
*Link
to the complete Healthy People 2010 chapter. |
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higher rates of
diabetes complications such as eye disease, kidney failure, and amputations. They also experience
greater disability from these complications.4
The link between
diabetes and heart disease is especially critical for women of color.
Several risk factors for diabetes, including overweight and high
cholesterol, are risk factors for heart disease as well (see
discussion on
Heart Disease and Stroke).5,
6,
7
Unfortunately, women, even women with
diabetes, are not well informed about the risks. They do not make the
connection between diabetes and heart disease.
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Making the
Connection:
Diabetes and Steps to a HealthierUS
Diabetes has major connections to other
chronic conditions and lifestyle choices targeted by Steps to a
HealthierUS. Taking steps to prevent and control diabetes is essential
in improving women's health.
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The dramatic rise
in type 2 diabetes is largely a consequence of the ongoing increase in
overweight and obesity. |
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The presence of
diabetes in women is associated with a three- to four-fold increase in
coronary heart disease compared with nondiabetic women. |
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Nutrition and
physical activity are key elements in diabetes prevention,
self-management, and control. |
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Tobacco use prevention and cessation are
important steps in diabetes care. |
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Patients' lack of awareness suggests that
doctors are not communicating about the risks. In a recent survey, half of
the respondents indicated that their health care providers did not discuss
ways to reduce the risks for heart disease and stroke, such as lowering
cholesterol or blood pressure.
ithout
treatment, more than 50 percent of patients with proliferative diabetic
retinopathy, the most advanced stage, will become blind within 5 years. Yet,
annual eye exams, timely treatment, and appropriate followup care can reduce
the risk of blindness by 90 percent.
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Unfortunately, many people with diabetic
retinopathy are not receiving or availing themselves of potentially
sight-saving treatments and diabetes self-management approaches. The reasons
are diverse and include a knowledge gap among primary caregivers about the
effectiveness of these treatments and a lack of referrals for comprehensive
dilated eye exams.
The Federal Diabetes Prevention Program has
shown that lifestyle change and/or medication can dramatically reduce the
development of diabetes. Modifying lifestyle can reduce by half the number
of new cases among adults at high risk. As the HealthierUS and
Steps to a HealthierUS initiatives promote, women can reduce their
diabetes-related risks by:
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Diabetes:
Costly to Women
Diabetes causes enormous personal
and societal costs for women.
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More than 100,000 diabetes-related deaths occur among women each year.
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The annual
cost
of diabetes in medical expenditures and lost productivity
is more than $132 billion. |
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Being physically
active every day. |
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Eating a
nutritious diet. |
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Making healthy
choices. |
A Healthy People 2010
developmental objective calls for a decrease in the proportion of pregnant
women with gestational diabetes. When reported late in 2004, baseline data
are expected to illuminate the magnitude of the problem for all pregnant
women, especially women of color.
Because the Steps to a HealthierUS
also targets obesity, gestational diabetes takes on greater importance:
Research shows that pregnant women who are overweight or obese are more
likely to develop gestational diabetes. Furthermore, infants born to women
with gestational diabetes are more likely to be overweight as children and
as adults, thus facing increased risk for diabetes.8
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Pregnant women who have never had diabetes
before but who have high blood sugar levels during pregnancy are said to
have gestational diabetes. Gestational diabetes develops in 2 to 5
percent of all pregnancies, but disappears when a pregnancy is over.
This condition occurs more frequently in
women who have had a baby weighing 9 pounds or more at birth and are African
American, Hispanic/Latino American, American Indian, or have a family
history of diabetes. Women who have had gestational diabetes are at
increased risk for later development of type 2 diabetes.9
Perinatal problems such as macrosomia (large
body size) and neonatal hypoglycemia (low blood sugar) are higher in babies
born to women with gestational diabetes.
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Risk Factors for
Gestational Diabetes
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Previous pregnancy with gestational diabetes
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Being overweight or obese
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Family history of diabetes
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Over age 25
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Smoking
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Being Hispanic,
African American,
Asian American/Pacific Islander, American
Indian or Alaska
Native
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Studies of diabetes
and pregnancy are consistent in their conclusions that proper prepregnancy
and pregnancy glycemia control and careful perinatal obstetrical monitoring
are associated with reduction in perinatal death and congenital
abnormalities. More recently, the importance of good fetal and
neonatal nutrition in general, as well as in persons with diabetes, has been
emphasized.10,
11,
12,
13,
14,
15
Healthy People 2010 seeks
to reduce the death rate from diabetes from 75 deaths per
100,000 population in 1999 to
45 deaths.
The baseline death rate for females was 68 deaths per
100,000 compared to 87
for males.
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The rate of congenital
malformations in babies born to women with preexisting diabetes varies
from 0 percent to 5 percent among women who receive preconception care to 10
percent among women who do not receive preconception care. Between 3
percent to 5 percent of pregnancies among women with diabetes result in
death of the newborn.16
Several studies have
shown that the occurrence of gestational diabetes in African Americans may
be 50 to 80 percent more frequent than in white women. Of African Americans
aged 20 years and older, the proportion of women with diabetes is 11.8
percent.17
Population studies
among Hispanic women with diabetes show significantly higher death and
complication rates during pregnancy. Mexican American women,
especially when they are overweight, have higher rates of gestational
diabetes than non-Hispanic white women.18
The prevalence of
gestational diabetes in certain groups of American Indians and Alaska
Natives is as follows:19
14.5
percent of pregnancies in Zuni Indians
3.4
percent of deliveries in Navajo Indians
5.8
percent of deliveries in Yup'ik Eskimos
Followup studies of American Indian women
with gestational diabetes found risks of developing subsequent diabetes as
follows: 27.5 percent of Pima Indian women developed diabetes within 4
to 8 years, and 30 percent of Zuni Indian women developed diabetes within 6
months to 9 years after pregnancy. Asian American women seem to have rates
of gestational diabetes that are similar to those of non-Hispanic white
women in the United States.19
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Select Federal Resources on
Diabetes
Centers for
Disease Control and Prevention
Diabetes Public Health
Resource
National
Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information
Clearinghouse
2
Ellis, J.L., and Campos-Outcalt, D. Cardiovascular disease risk
factors in Native Americans: A literature review. American
Journal of Preventive Medicine 10(5):295-307, 1994.
3
National Center for Health Statistics. Health, United States 2001,
with urban and rural health chartbook.
Hyattsville,
MD: U.S. Public Health Service (PHS), 2001.
6 Crews, D.R.. Obesity and diabetes. In Zane, N.W.S.; Takeuchi,
D.T.; Young, K.N.J. (eds.) Confronting Critical Health Issues
of Asian and Pacific Islander Americans. Thousand Oaks, CA: Sage
Publications, 1994, 174-207.
7
Delgado, J.L., and Trevino, F.M.. The state of Hispanic health in
the United States. In The State of
Hispanic
America Vol. II.
Oakland, CA: National
Hispanic Center for Advanced
Studies and Policy Analysis, 1985.
8
Ehrenberg, H.M.; Huston-Presley, L.; Catalano, P.M. The
influence of obesity and gestational diabetes mellitus on accretion
and the distribution of adipose tissue in pregnancy. American
Journal of Obstetrics and Gynecology 189(4); 944-948, 2003.
9
HHS. Diabetes: Overview. Washington, DC: HHS, PHS, OWH, 2001.
10
Lesser, K., and Carpenter, M. Metabolic changes associated with
normal pregnancy and pregnancy associated with diabetes mellitus.
Seminars in Perinatalogy 18:399-406, 1994.
11
Kitzmiller, J.; Buchanan, T.; Kjos, S.; et al. Preconception care of
diabetes, congenital malformations, and spontaneous abortions.
Diabetes Care 514-541, 1996.
12
American Diabetes Association (ADA). Preconception care of women
with diabetes. Diabetes Care 20(S1):40-43, 1997.
13
Jovanovic, L. American Diabetes Association's Fourth International
Workshop-Conference on Gestational Diabetes Mellitus: Summary and
discussion. Diabetes Care 21(S2):131-137, 1998.
14
Gold, A.; Reilly, R.; Little, J.; et al. The effect of glycemic
control in the pre-conception period and early pregnancy on birth
weight in women with IDDM. Diabetes Care 21:535-538, 1998.
15
ADA. Preconception care of women
with diabetes. Diabetes Care 22(S1):
56-59, 1999.
16
NIDDK. Diabetes Statistics for the
United
States. Bethesda, MD: NIH, March 2002.
17
NIDDK. Diabetes in African Americans. Bethesda, MD: NIH, May 2002.
18
NIDDK Diabetes Mellitus in Hispanic Women. Information Sheet.
Washington, DC: HHS, OWH, May 1998.
19
NIDDK. Diabetes Mellitus in Indians & Alaska Natives.
Bethesda,
MD: NIH, May 2002.
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From the U.S. Department of Health and Human Services'
Office on Women's Health
Last updated June 2004
http://www.4woman.gov/pub/steps/Diabetes.htm
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