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Commentary |

The Public Health Response to Diabetes—Two Steps Forward, One Step Back

Edward W. Gregg, PhD; Ann L. Albright, PhD
JAMA. 2009;301(15):1596-1598. doi:10.1001/jama.2009.519.
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New national estimates from 2005-2006 indicate that 13% of US adults have diabetes,1 and the incidence of diagnosed diabetes has doubled during the past decade.2 Furthermore, recent county estimates highlight some of the most affected geographical areas, including the coastal Carolinas, the deep South, and regions of Appalachia and along the Mississippi River, underscoring the diverse cultural factors underlying type 2 diabetes risk.3 The implications of increased diabetes prevalence are extensive due to the well-known risks of cardiovascular disease (CVD), vision loss, amputation, end-stage renal disease (ESRD), disability, and mortality.4

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Figure. Incidence of Diabetes-Related Lower Extremity Amputation, End-Stage Renal Disease, and Hyperglycemic Death in the US Population, 1990-2005, From the US National Diabetes Surveillance System4
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Numerators are derived from the National Hospital Discharge Survey for amputation, the US Renal Disease System for end-stage renal disease, and the US Vital Statistics System for hyperglycemic death. Denominators are based on the estimates of the US population with diabetes from the National Health Interview Survey (A) and the US Census (B). Rates were based on 3-year moving averages and age-adjusted to the 2000 US standard population. Methods are described at http://www.cdc.gov/diabetes/statistics/survl99/chap1/appendix.htm.7 Additional specific data can be found at http://www.cdc.gov/diabetes/statistics4 with sublinks relating to data above include lower extremity amputation (http://www.cdc.gov/diabetes/statistics/lea/fig3.htm) and end-stage renal disease (http://www.cdc.gov/diabetes/statistics/esrd/fig7.htm; http://www.cdc.gov/diabetes/statistics/esrd/fig5.htm). See Wang et al8 for methods related to hyperglycemic death.

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