Is Diabetes Responsible for More Deaths Than We Realize?
Diabetes can kill. There is a growing sense, however, that it is not identified as “the cause of death” appropriately on death certificates. It’s a chronic disease, and because it causes complications, those diagnoses may be replacing the “primary cause of death.” A PLOS One journal report suggests that we are dramatically underestimating the number of individuals whose direct cause of death is diabetes.
Current data suggests that approximately 29 million Americans have diabetes and about 8.1 million Americans may be living undiagnosed with diabetes.
The researchers organized the study with the focus on “obesity rate and shorter life span” — more prevalent in the United States compared to Europe — and secondly, what was causing a rise in deaths among middle-aged white Americans. It seemed that diabetes might explain some aspect of these findings.
This PLOS One report compiled statistics and information from the National Health Interview Survey between 1997 and 2009 and the National Health and Nutrition Examination Survey between 1999 and 2010. The researchers continued to follow death rates until 2011. Using recorded A1C levels and patient reported diabetes information from the surveys, the researchers compared death rates and diagnoses of the subjects to what was actually reported on their death certificates.
What they found was that there was a clear identification of diabetes among the surveyed subjects, but, a number of their deaths were not attributed to diabetes, despite the presence of the disease. Also noted was the fact that patients with known diabetes had a 90 percent higher mortality rate over a five-year span, compared to individuals who did not have diabetes.
Based on the data in this report, diabetes may not be the number seven cause of death in the United States, but rather the number three cause, following cancer and heart disease.
So for example, a person with diabetes might have a silent heart attack (no symptoms), die, and have the death certificate attribute the death to heart disease. Yes, heart disease is commonly a co-morbid factor in people with diabetes and it may have “acutely caused the death,” but the person truly died because they had a diagnosis of diabetes with secondary complications. This is also likely to happen in a person who has lived with diabetes for decades, develops severe complications, and has the death attributed to one of the complications.
The researchers cite an imperative to make diabetes prevention strategies a national public health priority. They also highlight the need for health-care professionals who treat individuals already diagnosed with diabetes, to emphasize how important “tight glucose control” is. That translates to making lifestyle modifications a vital part of daily life. It also means that more frequent blood sugar testing, aggressive management, and compliance is crucial.
The acronym ABC has become a pivotal guide in managing diabetes. “A” stands for A1C levels, “B” stands for blood pressure (when elevated contributes to heart disease risk), and “C” refers to cholesterol levels. Anyone with a diagnosis of prediabetes or diabetes, or who is diagnosed with obesity and has a family history of diabetes, should be monitoring these three tests on a regular basis.
Another important recommendation is to make sure that when you have a team of different specialists caring for you and that they all have diabetes documented in your chart. If it preceded all your other co-morbid diagnoses, then it should be listed as the primary diagnosis.
If diabetes is really the number three killer of American men and women then it’s possible that more federal dollars could be spent on research and prevention if it moved up the list. Additionally, and of equal importance, the public needs to know just how deadly this disease can be. It could motivate many individuals to change their diet and exercise habits. It could potentially inspire others to lose excess weight or to simply manage their diabetes with more precision. Any of those outcomes would be game-changers.
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