Amputation, Heart Attack in Diabetics Way Down Since 1990: But denominator keeps increasing

Complications tied to diabetes — such as amputation and cardiovascular disease — have plummeted over a 20-year span, according to government researchers.

An analysis of national data found that rates of myocardial infarction (MI) in diabetic patients dropped about 68%, and amputation rates were halved between 1990 and 2010,Edward Gregg, PhD, of the CDC in Atlanta, and colleagues reported in the April 17 issue of the New England Journal of Medicine.

“These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” Gregg said in a statement. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”

Complication rates fell in lock-step with improvements in preventive care for adults with diabetes. Several studies showing that good glycemic control can reduce macro- and microvascular complications of the disease have changed practice, the researchers said.

They looked at data from four national studies from 1990 to 2010: the National Health Interview Survey, the National Hospital Discharge Survey, the Renal Data System, and the National Vital Statistics System.

They found that rates of five specific complications — amputation, end-stage renal disease (ESRD), MI, stroke, and death from hyperglycemic crisis — fell during that time.

The largest reductions occurred for MI, which fell about 68%, and for death due to hyperglycemic crisis, which dropped about 64% over the 20-year study period.

Stroke and amputation rates fell by about half during that time, they reported.

The smallest decline was seen in rates of ESRD, which fell only 28%. This could be due to a greater burden of disease among ethnic populations who are more prone to renal failure, such as blacks, Gregg and colleagues wrote.

Or, the figure could be affected by a reduction in competing risks, they said. For instance, since cardiovascular mortality is declining, patients with diabetes may have more years of life during which chronic kidney disease can progress.

Gregg and colleagues attributed the overall reductions in complications to a combination of advances in acute clinical care, improvements in the performance of the healthcare system, and health promotion efforts directed at patients with diabetes.

They noted that the declining rates could also have something to do with changes in the characteristics of the population, especially if disease is being screened for and caught earlier.

However, they warned that a large burden of disease still persists because of the continued increase in the prevalence of diabetes. During the study period, the number of adults reporting a diagnosis of diabetes more than tripled, from 6.5 million to 20.7 million.

Thus, they said, major diabetes complications continue to put a heavy burden on the healthcare system, with diabetes and its complications accounting for $176 billion in total medical costs annually.