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Care of diabetics improving

Kidney failures and hospitalizations are far fewer since the mid-1990s

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SAN DIEGO — Far fewer Americans with diabetes are ending up in emergency rooms or developing kidney failure — a sign that diabetes care has improved dramatically over the last decade, the government reported Saturday.

The federal Centers for Disease Control and Prevention said the rate of people with diabetes who need hospitalization or develop kidney failure has dropped about a third since the mid-1990s.

However, a separate study raises concern that doctors may be missing opportunities to diagnose and treat kids with Type 1 diabetes, who need insulin to survive. Many children were misclassified as Type 2, the diabetes linked to obesity, possibly because their weight problems are throwing doctors off track.

Both studies were presented at an American Diabetes Association meeting in San Diego Saturday.

From 1994 to 2002, the rate of diabetes-related hospitalizations fell from 55 to 36 per 1,000 diabetics. Similarly, the rate of diabetes patients with kidney failure dropped from 327 to 229 per 100,000 population between 1996 and 2002.

Researchers used two sources of information. The kidney failure rates came from a national database of people who had dialysis or transplants in the last decade. The hospitalization rates were based on figures from big hospitals across the country.

"We are at last improving the quality of life for diabetics," said Alan , president of the diabetes association and professor at Vanderbilt University Medical Center, who had no role in the study.

The number of people with both types of diabetes has tripled over the past two decades to an estimated 18 million Americans, but more than 90 percent have Type 2. It is the sixth leading cause of death, and complications can include heart, kidney and nerve disease, eye damage and limb amputation.

Doctors have urged people with diabetes to control their blood sugar and blood pressure to avoid or delay kidney failure, which often requires a transplant or dialysis, in which a machine cleans the blood of wastes normally filtered by the kidneys.

"We've been working really hard to make diabetes a more common household word and to educate people with diabetes to reduce their risk factors," said Nilka Rios Burrows, an epidemiologist at the CDC's diabetes division.

About 130,000 diabetics underwent dialysis or kidney transplant in 2000. The new research suggests that many more have avoided those drastic measures by controlling their blood sugar.

In another study presented at the meeting, researchers found that one out of three children diagnosed with Type 2 diabetes were found to be Type 1 after they were given a more sensitive test that is not commonly used in doctors' offices.

Diabetes treatment differs depending on the type. Type 1 patients cannot make insulin and need to get this hormone, which regulates blood sugar levels, through shots or a pump. Those with the more common Type 2, linked to obesity, often can't effectively use the insulin their bodies make. They are advised to lose weight, eat a healthy diet and exercise, and sometimes drugs are prescribed.

Researchers led by Dr. Diana Petitti of Kaiser Permanente of Southern California, a large health insurer, looked at medical records of 2,868 children and adolescents diagnosed with Type 1 or Type 2 diabetes by their health care providers in 2001-2002.

The patients went to one of six participating U.S. medical centers to be given a highly sensitive biochemical test. Researchers compared the results and found that 31 percent of children who had been diagnosed with Type 2 actually were Type 1, according to the test.

Specialists say the finding raises questions about whether young diabetics are getting proper treatment and whether this test should be more available to doctors.

Childhood obesity has become more prevalent in the United States, raising the risk of diabetes and many other diseases. An estimated 210,000 young people have diabetes.

"What we're finding is that diabetes is much more complicated than we thought," Petitti said.

The study was funded by the CDC and the National Institutes of Health.