`
`Estimates of Diabetes and Its Burden in the
`United States
`**This document is intended to provide up-to-date scientific data and
`statistics on diabetes and its burden in the United States.
`Formerly referred to as the National Diabetes Fact Sheet, this
`consensus document is written for a scientific audience.**
`
`Fast Facts on Diabetes
`29.1 million people or 9.3% of
`the U.S. population have diabetes.
`DiagnoseD
`21.0 million people
`
`UnDiagnoseD
`8.1 million people
`(27.8% of people with diabetes are undiagnosed).
`
`All ages, 2012
`
`Diagnosed and undiagnosed diabetes
`among people aged 20 years or older,
`United States, 2012
`Number with
`diabetes
`(millions)
`
`Percentage with
`diabetes
`(unadjusted)
`
`28.9
`
` 4.3
`13.4
`11.2
`
`Total
`20 years or older
`By age
`20–44
`45–64
`65 years or older
`By sex
`13.6
`15.5
`Men
`11.2
`13.4
`Women
`Source: 2009–2012 National Health and Nutrition Examination Survey estimates applied
`to 2012 U.S. Census data.
`
`12.3
`
` 4.1
`16.2
`25.9
`
`National Center for Chronic Disease Prevention and Health Promotion
`Division of Diabetes Translation
`
`AstraZeneca Exhibit 2062
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`Page 1 of 12
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`Epidemiologic estimation methods
`
`The estimates in this document, unless otherwise indicated, were derived from various data systems of the
`Centers for Disease Control and Prevention (CDC), the Indian Health Service’s (IHS) National Patient
`Information Reporting System (NPIRS), the U.S. Renal Data System of the National Institutes of Health
`(NIH), the U.S. Census Bureau, and published studies. The estimated percentages and the total number
`of people with diabetes and prediabetes were derived from 2009–2012 National Health and Nutrition
`Examination Survey (NHANES), 2010–2012 National Health Interview Survey (NHIS), 2012 IHS data, and
`2012 U.S. resident population estimates. Diagnosed diabetes was determined by self-report among survey
`respondents and by diagnostic codes for American Indians and Alaska Natives. Both fasting glucose and
`hemoglobin A1C (A1C) levels were used to derive estimates for undiagnosed diabetes and prediabetes.
`The tests used to diagnose diabetes vary in who they identify as having diabetes or prediabetes. Detailed
`information is available about the data sources, methods, and references (http://www.cdc.gov/diabetes/pubs/
`references14.htm). More information is available about the tests that are used to diagnose diabetes and the
`test limitations (http://diabetes.niddk.nih.gov/dm/pubs/comparingtests/index.aspx).
`
`Racial and ethnic differences in diagnosed diabetes among
`people aged 20 years or older, United States, 2010–2012
`
`Age-adjusted* percentage of people aged 20 years or older with
`diagnosed diabetes, by race/ethnicity, United States, 2010–2012
`
`Non-Hispanic whites
`
`Asian Americans
`
`Hispanics
`
`Non-Hispanic blacks
`
`American Indians/Alaska Natives
`
`7.6
`
`9.0
`
`12.8
`
`13.2
`
`15.9
`
`*Based on the 2000 U.S. standard population.
`Source: 2010–2012 National Health Interview Survey and 2012 Indian Health Service’s National Patient Information
`Reporting System.
`
`• Among Hispanic adults, the age-adjusted rate of diagnosed diabetes was 8.5% for Central and South
`Americans, 9.3% for Cubans, 13.9% for Mexican Americans, and 14.8% for Puerto Ricans.
`• Among Asian American adults, the age-adjusted rate of diagnosed diabetes was 4.4% for Chinese, 11.3%
`for Filipinos, 13.0% for Asian Indians, and 8.8% for other Asians.
`• Among American Indian and Alaska Native adults, the age-adjusted rate of diagnosed diabetes varied
`by region from 6.0% among Alaska Natives to 24.1% among American Indians in southern Arizona.
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`New Cases of Diagnosed Diabetes
`
`New cases of diagnosed diabetes among people aged 20 years or older,
`United States, 2012
`Number of new
`diabetes cases
`
`Rate of new diabetes cases
`per 1,000 (unadjusted)
`
`1.7 million
`
`Total
`20 years or older
`By age
` 3.6
`371,000
`20–44
`12.0
`892,000
`45–64
`11.5
`400,000
`65 years or older
`Source: 2010–2012 National Health Interview Survey, 2009–2012 National Health and Nutrition
`Examination Survey, and 2012 U.S. Census data.
`
` 7.8
`
`Prediabetes among people aged 20 years or older, United States, 2012
`• In 2009−2012, based on fasting glucose or A1C levels, 37% of U.S. adults aged 20 years or older had
`prediabetes (51% of those aged 65 years or older). Applying this percentage to the entire U.S. population
`in 2012 yields an estimated 86 million Americans aged 20 years or older with prediabetes.
`• On the basis of fasting glucose or A1C levels, and after adjusting for population age differences, the
`percentage of U.S. adults aged 20 years or older with prediabetes in 2009−2012 was similar for non-
`Hispanic whites (35%), non-Hispanic blacks (39%), and Hispanics (38%).
`
`Diagnosed diabetes among people younger than 20 years, United States, 2012
`• About 208,000 people younger than 20 years have diagnosed diabetes (type 1 or type 2). This represents
`0.25% of all people in this age group. Estimates of undiagnosed diabetes are not available for this age group.
`
`New cases of diagnosed diabetes among people younger than 20 years,
`United States, 2008–2009
`SEARCH for Diabetes in Youth is a multicenter study funded by CDC and NIH to examine diabetes (type
`1 and type 2) among children and adolescents in the United States. SEARCH findings for the communities
`studied include the following:
`• During 2008–2009, an estimated 18,436 people younger than 20 years in the United States were newly
`diagnosed with type 1 diabetes annually, and 5,089 people younger than 20 years were newly diagnosed
`with type 2 diabetes annually.
`• Compared with other groups, non-Hispanic white children and adolescents had the highest rate of new
`cases of type 1 diabetes.
`• While still uncommon, the rates of new cases of type 2 diabetes were greater among people aged 10–19
`years than in younger children, with higher rates among U.S. minority populations than in non-
`Hispanic whites.
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`Rate of new cases of type 1 and type 2 diabetes among people younger
`than 20 years, by age and race/ethnicity, 2008–2009
`50
`
`Type 1
`
`Type 2
`
`40
`
`30
`
`20
`
`10
`
`Rate (per 100,000 per year)
`
`API AIAN*
`
`API AIAN*
`
`0
`
`ALL NHW NHB H
`ALL NHW NHB H
`<10 years
`10–19 years
`* The American Indian/Alaska Native (AI/AN) youth who participated in the SEARCH study are not representative of
`all AI/AN youth in the United States. Thus, these rates cannot be generalized to all AI/AN youth nationwide.
`Source: SEARCH for Diabetes in Youth Study
`NHW=non-Hispanic whites; NHB=non-Hispanic blacks; H=Hispanics; API=Asians/Pacific Islanders;
`AIAN=American Indians/Alaska Natives.
`
`Managing diabetes
`
`Diabetes can be treated and managed by healthful eating, regular physical activity, and medications to
`lower blood glucose levels. Another critical part of diabetes management is reducing cardiovascular disease
`risk factors, such as high blood pressure, high lipid levels, and tobacco use. Patient education and self-care
`practices also are important aspects of disease management that help people with diabetes stay healthy.
`• People with type 1 diabetes must have insulin delivered by injection or a pump to survive.
`• Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and a
`program of regular physical activity, losing excess weight, and taking medications. Medications for each
`individual with diabetes will often change during the course of the disease. Insulin also is commonly
`used to control blood glucose in people with type 2 diabetes.
`• Blood glucose control reduces the risk of developing the eye, nerve, and kidney complications of diabetes.
`• Hypoglycemia or low blood glucose is a complication of diabetes treatment with insulin or certain oral
`medications that can have serious consequences such as seizures, unconsciousness, or death. Older
`patients with type 2 diabetes and children with type 1 diabetes are at particularly high risk for adverse
`outcomes associated with hypoglycemia.
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`• Individual blood glucose targets, with the selection of targets based on the potential risks and benefits to
`the patient, are encouraged for people with diabetes.
`• Self-management education or training focuses on self-care behaviors, such as healthy eating, being
`active, adhering to medications, learning coping skills, and monitoring blood glucose.
`• Many people with diabetes also need to take medications to control their blood pressure and to control
`their cholesterol.
`
`Treatment of diabetes among people aged 18 years or older with
`diagnosed diabetes, United States, 2010–2012
`Number of adults using
`Percentage using
`diabetes medication*
`diabetes medication
`(millions)
`(unadjusted)
`2.9
`14.0
`3.1
`14.7
`11.9
`56.9
`3.0
`14.4
`
`Insulin only
`Both insulin and oral medication
`Oral medication only
`Neither insulin nor oral medication
`
`*Does not add to the total number of adults with diagnosed diabetes because of the different data sources and methods used to obtain the
`estimates.
`Source: 2010–2012 National Health Interview Survey.
`
`Co-existing conditions and complications among people with
`diagnosed diabetes
`Diabetes can affect many parts of the body and is associated with serious complications, such as heart
`disease and stroke, blindness, kidney failure, and lower-limb amputation. Some complications, especially
`microvascular (e.g., eye, kidney, and nerve) disease, can be reduced with good glucose control. Also, early
`detection and treatment of complications can prevent progression, so monitoring with dilated eye exams,
`urine tests, and foot exams is essential. Because the risk of cardiovascular disease is increased in diabetes and
`prediabetes, blood pressure and lipid management, along with smoking cessation, are especially important.
`By working together, people with diagnosed diabetes, their support network, and their health care providers
`can reduce the occurrence of these and other complications.
`Hypoglycemia and hyperglycemic crisis
`Hypoglycemia
`• In 2011, about 282,000 emergency room visits for adults aged 18 years or older had hypoglycemia as the
`first-listed diagnosis and diabetes as another diagnosis.
`Hyperglycemic crisis
`• In 2011, about 175,000 emergency room visits for people of all ages had hyperglycemic crisis, e.g.,
`diabetic ketoacidosis and hyperglycemic hyperosmolar state, as the first-listed diagnosis.
`• In 2010, among adults aged 20 years or older, hyperglycemic crisis caused 2,361 deaths.
`
`High blood pressure
`• In 2009–2012, of adults aged 18 years or older with diagnosed diabetes, 71% had blood pressure greater
`than or equal to 140/90 millimeters of mercury or used prescription medications to lower high blood
`pressure.
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`High blood LDL cholesterol
`• In 2009–2012, of adults aged 18 years or older with diagnosed diabetes, 65% had blood LDL cholesterol
`greater than or equal to 100 mg/dl or used cholesterol-lowering medications.
`
`Heart disease and stroke
`• In 2003–2006, after adjusting for population age differences,
`cardiovascular disease death rates were about 1.7 times higher
`among adults aged 18 years or older with diagnosed diabetes
`than among adults without diagnosed diabetes.
`• In 2010, after adjusting for population age differences,
`hospitalization rates for heart attack were 1.8 times higher
`among adults aged 20 years or older with diagnosed diabetes
`than among adults without diagnosed diabetes.
`• In 2010, after adjusting for population age differences,
`hospitalization rates for stroke were 1.5 times higher among
`adults with diagnosed diabetes aged 20 years or older compared
`to those without diagnosed diabetes.
`
`Blindness and eye problems
`• In 2005–2008, of adults with diabetes aged 40 years
`or older, 4.2 million (28.5%) people had diabetic
`retinopathy, damage to the small blood vessels in the
`retina that may result in loss of vision.
`• In 2005–2008, of adults with diabetes aged 40 years
`or older, 655,000 (4.4%) had advanced diabetic
`retinopathy—with conditions such as clinically
`significant macular edema and proliferative diabetic
`retinopathy—that could lead to severe vision loss.
`
`Kidney disease
`• Diabetes was listed as the primary cause of kidney failure in 44% of all new cases in 2011.
`• In 2011, 49,677 people of all ages began treatment for kidney failure due to diabetes.
`• In 2011, a total of 228,924 people of all ages with kidney failure due to diabetes were living on chronic
`dialysis or with a kidney transplant.
`
`Amputations
`• In 2010, about 73,000 non-traumatic lower-limb
`amputations were performed in adults aged 20 years
`or older with diagnosed diabetes.
`• About 60% of non-traumatic lower-limb
`amputations among people aged 20 years or older
`occur in people with diagnosed diabetes.
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`Other conditions and complications
`• People with diabetes may have or develop other complications or conditions, such as nerve disease, non-
`alcoholic fatty liver disease, periodontal (gum) disease, hearing loss, erectile dysfunction, depression,
`and complications of pregnancy, among others.
`
`Deaths among people with diabetes, United States, 2010
`• Diabetes was the seventh leading cause of death in the United States in 2010 based on the 69,071
`death certificates in which diabetes was listed as the underlying cause of death. In 2010, diabetes was
`mentioned as a cause of death in a total of 234,051 certificates.
`• Diabetes may be underreported as a cause of death. Studies have found that only about 35% to 40% of
`people with diabetes who died had diabetes listed anywhere on the death certificate and about 10% to
`15% had it listed as the underlying cause of death.
`• In 2003–2006, after adjusting for population age differences, rates of death from all causes were about
`1.5 times higher among adults aged 18 years or older with diagnosed diabetes than among adults
`without diagnosed diabetes.
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`estimateD Diabetes costs in the UniteD states, 2012
`total (Direct anD inDirect)
`$ 245 billion
`
`Direct meDical costs
`$ 176 billion
`After adjusting for population age and sex differences, average medical expenditures
`among people with diagnosed diabetes were 2.3 times higher than people without diabetes.
`
`inDirect costs
`$ 69 billion
`(disability, work loss, premature death).
`
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`General Information
`
`What is diabetes?
`Diabetes is a group of diseases marked by high levels of blood glucose resulting from problems in how
`insulin is produced, how insulin works, or both. People with diabetes may develop serious complications
`such as heart disease, stroke, kidney failure, blindness, and premature death.
`
`Types of diabetes
`Type 1 diabetes was previously called insulin-
`dependent diabetes mellitus or juvenile-onset diabetes.
`Although disease onset can occur at any age, the peak
`age for diagnosis is in the mid-teens. Type 1 diabetes
`develops when the cells that produce the hormone
`insulin, known as the beta cells, in the pancreas are
`destroyed. This destruction is initiated or mediated by
`the body’s immune system and limits or completely
`eliminates the production and secretion of insulin, the
`hormone that is required to lower blood glucose levels.
`To survive, people with type 1 diabetes must have
`insulin delivered by injection or a pump. In adults,
`type 1 diabetes accounts for approximately 5% of all
`diagnosed cases of diabetes. There is no known way
`to prevent type 1 diabetes. Several clinical trials for
`preventing type 1 diabetes are currently in progress
`with additional studies being planned.
`Type 2 diabetes was previously called non–insulin-
`dependent diabetes mellitus or adult-onset diabetes
`because the peak age of onset is usually later than type
`1 diabetes. In adults, type 2 diabetes accounts for about
`90% to 95% of all diagnosed cases of diabetes. Type 2
`diabetes usually begins with insulin resistance, a disorder
`in which the cells primarily within the muscles, liver,
`and fat tissue do not use insulin properly. As the need
`for insulin rises, the beta cells in the pancreas gradually
`lose the ability to produce sufficient quantities of the
`hormone. The role of insulin resistance as opposed to beta cell dysfunction differs among individuals, with
`some having primarily insulin resistance and only a minor defect in insulin secretion, and others with slight
`insulin resistance and primarily a lack of insulin secretion.
`The risk for developing type 2 diabetes is associated with older age, obesity, family history of diabetes, history of
`gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans,
`Hispanics/Latinos, American Indians, some Asians, and Native Hawaiians or other Pacific Islanders are at
`particularly high risk for type 2 diabetes and its complications. Type 2 diabetes in children and adolescents,
`although uncommon, is being diagnosed more frequently among American Indians, African Americans,
`Hispanics/Latinos, Asians, and Pacific Islanders.
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`Gestational diabetes is a form of glucose intolerance diagnosed
`during the second or third trimester of pregnancy. During
`pregnancy, increasing blood glucose levels increase the risk for
`both mother and fetus and require treatment to reduce problems
`for the mother and infant. Treatment may include diet, regular
`physical activity, or insulin. Shortly after pregnancy, 5% to 10%
`of women with gestational diabetes continue to have high blood
`glucose levels and are diagnosed as having diabetes, usually type
`2. The risk factors for gestational diabetes are similar to those
`for type 2 diabetes. The occurrence of gestational diabetes itself
`is a risk factor for developing recurrent gestational diabetes
`with future pregnancies and subsequent development of type
`2 diabetes. Also, the children of women who had gestational
`diabetes during pregnancies may be at risk of developing obesity
`and diabetes.
`Other types of diabetes such as maturity-onset diabetes of youth
`or latent autoimmune diabetes in adults, among others, are caused
`by specific genetic conditions or from surgery, medications,
`infections, pancreatic disease, or other illnesses. Such types of
`diabetes account for 1% to 5% of all diagnosed cases.
`
`What is prediabetes?
`Prediabetes is a condition in which individuals have high blood glucose or hemoglobin A1C levels but not
`high enough to be classified as diabetes. People with prediabetes have an increased risk of developing type 2
`diabetes, heart disease, and stroke, but not everyone with prediabetes will progress to diabetes. The Diabetes
`Prevention Program, a large prevention study of people at high risk for diabetes, showed that lifestyle
`intervention that resulted in weight loss and increased physical activity in this population can prevent
`or delay type 2 diabetes and in some cases return blood glucose levels to within the normal range. Other
`international studies have shown similar results.
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`Acknowledgments
`
`The following organizations collaborated in compiling the information for this report:
`• Agency for Healthcare Research and Quality
`• American Association of Diabetes Educators
`• American Diabetes Association
`• Centers for Disease Control and Prevention, Division of Diabetes Translation
`• Centers for Disease Control and Prevention, National Center for Health Statistics
`• Centers for Medicare & Medicaid Services
`• U.S. Department of Veterans Affairs
`• U.S. Food and Drug Administration
`• Health Resources and Services Administration
`• JDRF
`• Indian Health Service, Division of Diabetes Treatment and Prevention
`• National Diabetes Education Program, a joint program of NIH and CDC
`• National Diabetes Information Clearinghouse
`• National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health
`• U.S. Department of Health and Human Services, Office of Minority Health
`
`Note
`This publication is not subject to copyright restrictions; please duplicate and distribute copies as desired.
`
`Citation
`Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its
`Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.
`
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`For Public Inquiries and Publications
`CDC-INFO Contact Center
`Telephone: 1-800-CDC-INFO (232-4636)
`1-888-232-6348 TTY
`E-Mail: www.cdc.gov/info
`In English, en español
`
`For Other Information
`Division of Diabetes Translation
`National Center for Chronic Disease Prevention and Health Promotion
`Centers for Disease Control and Prevention
`4770 Buford Highway NE, Mailstop F-73, Atlanta, GA 30341-3717
`
`Telephone: 770-488-5000; Web site: http://www.cdc.gov/diabetes
`
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