Mortality per 1000 person-years*
35 29.9
30
25
20
19.2
23.0
Diabetes No Diabetes
15
11.5
10
6.3
5
11.0
7.1 3.6
0
Men
Women
Men
Women
All heart disease Ischemic heart disease
Hospitalization Costs for Chronic Complications of Diabetes in the US
Ophthalmic Others disease
Renal disease
Neurologic disease
Peripheral vascular disease
17
DM
Non-DM
4 Women
% of Deaths
Mortality in People with Diabetes Causes of Death
50
40
30
20
10
0
Ischemic Other Diabetes Cancer Stroke Infection Other heart heart
Fasting Glucose
2-Hour Post Glucose Load
Diabetes Mellitus
>7.0 (>126)

>11.1 (>200)
Impaired Glucose Tolerance
>7.8 (>140) to <11.1 (<200)
Impaired Fasting Glucose
Prevalence of Diabetes in Adult Population (Aged >20 years) by Year and Region
Percent
9 8 7 6 5 4 3 2 1 0
Developed
1995
2000
2025
Developing
World
King H et al. Diabetes Care 1998;21:1414-1431.
-20.4%
(P=0.12)
Survival Post-MI in Diabetic and Nondiabetic Men and Women: Minnesota Heart Survey
Survival (%) Survival (%)
MEN 100
No diabetes
80
n=1628
60 Diabetes
>6.1 (>110) to <7.0 (<126)
Values are mmol/L (mg/dl)
Adapted from World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: World Health Organization:1999:52.
Total costs 12 billion US $
CVD accounts for 64% of total costs
Cardiovascular disease
American Diabetes Association. Economic Consequences of Diabetes Mellitus in the US in 1997. Alexandria, VA: American Diabetes Association, 1998:1-14.
Framingham Study: DM and CHD Mortality 20-Year Follow-up
Annual CHD Deaths per 1000 Persons
18
16
17
14
12
10
8
6
8
4
2
0
Men
Kannel WB, McGee DL. JAMA 1979;241:2035-2038.
disease disease
Geiss LS et al. In: Diabetes in America. 2nd ed. 1995; chap 11.
Mortality Due to Heart Disease in Men and Women with or without Diabetes (US)
Rate per 1000 person-years
Diabetes 20
17.0
15
14.2
10
6.8 7.6
5
Nondiabetes
Men, cohort 1* Men, cohort 2** Women, cohort 1* Women, cohort 2** 7.4
4.2 2.4 1.9
0
-16.6%
*Age-adjusted Adapted from Gu K et al. Diabetes Care 1998;21:1138-1145.
Trends in Mortality Rates for Ischemic Heart Disease in NHANES Subjects with and without Diabetes*
(P=0.46)
+10.7%
(P=0.76)
-43.8%
(P<0.001)
*Defined in 1971-1975, followed up through 1982-1984. **Defined in 1982-1984, followed up through 1992-1993. Gu K et al. JAMA 1999;281:1291-1297.
n=228
40
WOMEN 100
No diabetes
80
n=568
60
Diabetes
40
n=156
0 0 20 40 60 80 Months Post-MI
Epidemiology of Insulin Resistance, Diabetes Mellitus, and Coronary Heart Disease
Steven Haffner, MD
Criteria for the Diagnosis of Diabetes Mellitus and Hyperglycemia Plasma Glucose Concentration