Diabetes complications drastically drop even as prevalence rises

In the midst of the diabetes epidemic, a glimmer of good news: Heart attacks, strokes and other complications from the disease are plummeting.

Over the past two decades, the rates of heart attacks and strokes among diabetics fell by more than 60 percent, a new federal study shows. The research also confirms earlier reports of drastic declines in diabetes-related kidney failure and amputations.

The drop is mainly attributed to better screening, medicines and care. The improvements came even as the number of U.S. adults with diabetes more than tripled in those 20 years.

"It is great news," said Dr. John Buse, a University of North Carolina diabetes specialist. "The prognosis for folks with diabetes has improved dramatically over the last two decades, at least for those with good access to care," Buse said in an email.    

The Centers for Disease Control and Prevention research is published in the New England Journal of Medicine.

Diabetes is a disease in which sugar builds up in the blood. The most common form is tied to obesity, and the number of diabetics has ballooned with the rise in obesity. Today, roughly 1 in 10 U.S. adults has the disease, and it is the nation's seventh leading cause of death, according to the CDC.

The obese are already at higher risk for heart attacks and strokes. But diabetics seem to have more narrowing of their blood vessels — a condition that can further foster those problems.

In the 1990s, key studies showed that diabetics could keep their blood sugar, blood pressure and cholesterol under control. The research suggested that vision and heart problems, leg and foot amputations and other diabetes complications were not necessarily inevitable.

Meanwhile, insurance programs expanded coverage of blood sugar monitors and diabetes treatment. Gradually, larger numbers of diabetics were diagnosed earlier and with milder disease.

For the new study, the CDC tallied complication rates from 1990 to 2010 for diabetics ages 20 or older.

During that time, the heart attack rate fell 68 percent, from 141 to 45.5 per 10,000 diabetics, according to hospital records.

The decline was so great that, despite the growing ranks of diabetics, the actual number hospitalized with heart attacks dropped from more than 140,000 to about 136,000.

The stroke rate fell less dramatically — but still declined by more than half, finishing at 53 per 10,000. The heart attack and stroke rates for diabetics are essentially even now, lead author Edward Gregg noted.

The researchers saw declines in heart attack and stroke rates for non-diabetics as well, but those improvements weren't nearly as big as they were for diabetics.

Amputation rates also fell by more than half. However, like strokes, the actual number increased over the two decades.

The growth in the number of diabetics "wiped out most of the gains" from the declining rates, so the number who ended up in the hospital for strokes or amputations swelled, said Dr. Robert Gabbay, of Boston's Joslin Diabetes Center.

The study also found that the rate of kidney failure dropped by 28 percent. But that wasn't true for all ages — the rate for those 65 and older actually increased. That could be a sign diabetics are living longer — long enough to get kidney disease, Gregg speculated.

The Associated Press