Epidemiology of Diabetes Complications: Changing Trends Over Ten Years

Reviewed by Joelle Escoffery, PhD

Epidemiological data from the past ten years have demonstrated some encouraging findings in the area of diabetes complications, including a decline in the incidence of individual risk for microvascular complications, a decrease in lower-extremity amputations, and a decrease in several risk factors for diabetic complications. The observed decrease in risk factors (eg, hypertension and dyslipidemia in particular) is likely due to recent treatment advances, as they parallel a sharp decline in cardiovascular mortality in the general population. However, the decline in cardiovascular mortality observed in the general population is attenuated among people with diabetes. Furthermore, the decrease in individual risk for complications is offset by a population increase in type 2 diabetes, which will ultimately lead to a leveling, or even an increase, in the prevalence of diabetes complications. In terms of acute complications, available treatment options such as insulin analogs and widespread insulin pump use, coupled with a more favorable climate for supply reimbursement, have made tight control more likely.  With tight control comes increased risk of hypoglycemia, especially among those who are young, have lower A1C levels, have diabetes of longer duration, and have hypoglycemia unawareness.