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Diabetes is a serious, common, costly and potentially fatal disease. It is characterized by high levels of blood glucose, or blood sugar. Insulin, which is made in the pancreas, helps blood glucose get into the body's cells. Without insulin, glucose builds up in the blood, causing blood glucose levels to rise and damaging cells. Diabetes develops when the body stops making insulin (type 1) or stops using it properly (type 2). Diabetes can also arise temporarily during pregnancy (gestational diabetes). Prediabetes is diagnosed when a person has higher than normal blood sugar levels, but has not met the threshold for a diabetes diagnosis. People with prediabetes have a high risk of developing diabetes. Diabetes and prediabetes can be diagnosed using a blood test.

Symptoms include frequent urination, frequent thirst and hunger, fatigue, blurry vision, injuries that are slow to heal, and tingling, pain, or numbness in the hands and/or feet. People with diabetes are at greater risk of developing serious health complications such as heart disease and stroke, blindness, kidney failure, and lower-extremity amputation. There is no cure for diabetes; therefore, proper management through education, medication and lifestyle changes is critical to preventing or delaying complications.

Diabetes is the 7th leading cause of death in the United States and in Hawai'i. An estimated 30.3 million people in the United States have diabetes and 1 in 4 of them don't know they have it. In Hawai'i, over 120,000 adults have been diagnosed with diabetes and over 151,000 Hawai'i adults have been diagnosed with prediabetes. In the last 20 years, the number of adults with diabetes has more than tripled as the American population has aged and become more overweight.

Medical costs for people with diabetes are twice as high as for people who don't have diabetes. Medical costs and lost work and wages for people with diagnosed diabetes total $327 billion each year in the United States.

About 84 million Americans aged 20 and older have prediabetes, a condition that puts them at high risk for developing diabetes. For many individuals, taking small steps, such as losing 5-7 percent of their weight or increasing physical activity, can help them delay or prevent developing diabetes.

In Hawai'i in 2017, 10.8% of adults had been diagnosed with diabetes and 12.2% with prediabetes. Prevalence was about the same among men and women, but varied significantly by age, ranging from 2.9% among 25-34 year olds to 23.2% among those 75 and older. Caucasians had the lowest prevalence of diabetes (6.1%) and Filipinos (14.6%) and Japanese (14.5%) had the highest.

People with diabetes are twice as likely to have heart disease or a stroke as people without diabetes--and at an earlier age. Diabetes is the leading cause of chronic kidney disease, lower-limb amputations and adult-onset blindness in the US.

Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers. People with diabetes who smoke are more likely to develop serious related health problems including heart disease and kidney disease.

No one is immune from diabetes, but risk factors vary by type.
  • Type 1 diabetes accounts for about 5% of all cases and is thought to be an auto-immune reaction where the body attacks itself by mistake and stops producing any insulin. Risk factors include a family history (parent or sibling) of type 1 diabetes; and young age (it is more likely to develop in children, teens and young adults).
  • Type 2 diabetes is where the body does not produce enough insulin or the body becomes resistant to the insulin it produces and accounts for 90-95% of all cases. Risk factors include: overweight, age of 45 years or more, family history (parent or sibling) of type 2 diabetes, physical inactivity, and ever had gestational diabetes or gave birth to a baby weighing more than 9 pounds.
  • Gestational diabetes is diabetes that develops during pregnancy. It usually goes away after the baby is born but increases the risk for type 2 diabetes later in life. Risk factors include: previous diagnosis of gestational diabetes, previous birth to a baby weighing over 9 pounds, overweight, age of 25 years or more, family history of type 2 diabetes, having polycystic ovary syndrome, and race (African American, Hispanic/Latino American, American Indian/Alaska Native, or Pacific Islander).

There are many ways to reduce your risk for diabetes. Following these guidelines can reduce your risk for diabetes and improve your general health.
  • Maintain a healthy weight. If you are overweight, you may be able to prevent or delay diabetes by losing 5 to 7 percent of your starting weight.
  • Exercise regularly. Get at least 30 minutes of physical activity on 5 days each week.
  • Eat healthy foods most of the time. Eat smaller portions, increase fruit and vegetable consumption, avoid highly processed foods, and drink water instead of sugar-sweetened beverages.
  • Do not smoke or use tobacco products; if you already use tobacco, look for ways to quit.
  • Abstain from alcohol or drink only in moderation. Alcohol is high in sugar and calories.

The Diabetes Prevention Program (DPP) study showed that weight loss and participation in regular physical activity can significantly decrease the risk of developing diabetes. The DPP clinical trial included over 3,000 people who had impaired fasting glucose and were at an increased risk for developing diabetes. Participants who engaged in moderately intense physical activity for 30 minutes per day and lost 5 to 7 percent of their body weight decreased their risk of diabetes dramatically. This behavioral activity was effective for all participants in the study, regardless of age or ethnic group.

Diabetes data comes from a variety of sources.
  • Screening and Prevalence: The Behavioral Risk Factor Surveillance System (BRFSS) monitors diabetes prevalence annually. The BRFSS also includes an optional prediabetes module that assesses screening and prevalence and a diabetes module that includes questions about diabetes self-care, management and complications. BRFSS can also be used to assess risk factors for diabetes, co-morbidities and health behaviors among people with diabetes.
  • Morbidity: Hospital discharge data provides emergency room and inpatient visits for diabetic emergencies or where diabetes is an underlying cause.
  • Mortality: Death certificates are a fundamental source of demographic, geographic, and cause-of-death information. They make it possible to track every death in the nation due to diabetes. Deaths are reported as being due to diabetes where diabetes was an underlying cause of death.