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April 30, 2001
Contact: Mary Kay Sones
CDC to introduce book on diabetes in women
Diabetes is a serious and costly disease that touches almost every family in America. Women
are especially burdened by diabetes, and today the Centers for Disease Control and Prevention
(CDC) will release the first major publication to address the unique impact diabetes has on
women as they progress through the stages of life.
"Diabetes and Women's Health Across the Life Stages: A Public Health Perspective"
will be introduced at the opening session of CDC's annual diabetes conference this week in
Seattle. The monograph will focus on the specific issues that make diabetes a serious women's
health issue such as puberty and hormonal changes during adolescence; childbearing and
contraception in the reproductive years; menopause and access to health care in the middle
years; and poverty and disability in the elder years.
As a follow-up to the publication of the monograph, CDC is currently forming a task force
to develop a national action plan that will raise public awareness and outline programs to
prevent and control diabetes in women.
"Diabetes is unique to women because of its potential to affect the health of a mother
as well as her unborn child," said Dr. Frank Vinicor, director of CDC's diabetes program.
"For a woman with diabetes, each phase of her life brings new challenges and new risks.
Developing this monograph has been one of the most exciting things we've done in the diabetes
program, and we hope it will define diabetes as an important women's health issue."
Another highlight of the conference will be a presentation by Dr. Bill Hagopian, Pacific
Northwest Research Institute, who is leading a groundbreaking project in Washington state that
involves testing more than 170,000 dried blood spot samples which were collected from newborn
infants. The samples will be studied as a screening mechanism to assess the risk for type 1
(juvenile-onset) diabetes. According to Dr. Vinicor this is the first program of its kind in
the history of diabetes research and will ultimately lead to early diabetes detection and
prevention trials. The Washington State study is set to begin concurrently with the diabetes
Other serious and pressing diabetes issues that will be addressed include the increasing
rates of obesity across the nation and its effect on type 2 diabetes; the emergence of type 2
diabetes among youth; and the impact of diabetes on African Americans, Hispanic and Latino
Americans, American Indians, and Asian Americans will be among the topics discussed at the
Approximately 800,000 new cases of diabetes are diagnosed each year. The two most common
types of diabetes are type 1, (previously called juvenile-onset) and type 2 (previously called
adult-onset). Between 90-95 percent of cases are type 2, and older age, obesity, and family
history are the main risk factors. Diabetes is the seventh leading cause of death in this
country and a major contributor to such health problems as heart disease, stroke, blindness,
kidney disease, and non-traumatic leg and foot amputations.
"Earlier this year, CDC released data showing that diabetes had increased a stunning 6
percent in one year (1998-1999), and that increase, coupled with the increasing rates of
obesity, signal trouble on the horizon for the overall health of our nation and the state of
our health care delivery system. This conference will open the door for discussions on how to
meet these challenges," Vinicor said.
The conference will be held at the Double Tree Hotel, Seattle Airport, April 30-May 3.
Among those attending will be local, state, federal and territorial governmental agencies and
health professionals and diabetes partners from the private sector. For more information on
the conference and other diabetes topics, please visit CDC's web site at http://www.cdc.gov/diabetes or call toll free
CDC protects people's health and safety by preventing and controlling diseases and
injuries; enhances health decisions by providing credible information on critical health
issues; and promotes healthy living through strong partnerships with local, national, and
Diabetes and Women's Health Across the Life Stages: A Public Health Perspective
Diabetes is a serious health condition that affects women in all life stages. It is also
unique to women because it can impact on the health of both a mother and her unborn children.
With the increasing life span of women and the rapid growth of minority populations in the
United States, the number of women at high risk for diabetes and its complications will
continue to increase, placing added demands on the health care delivery system. Diabetes
and Women's Health Across the Life Stages: A Public Health Perspective examines the
challenges and risks of diabetes in each stage of a woman's life.
- Of the 15.7 million people with diabetes in the United States, more than half (8.1
million) are women. Minority racial and ethnic groups are the hardest hit by the disease.
The prevalence of diabetes is at least 2-4 times higher among black, Hispanic, American
Indian, and Asian Pacific Islander women than among white women.
- About 90-95 percent of women with diabetes have type 2 (formerly called adult-onset)
diabetes. Type 2 diabetes usually develops after age 40 and occurs when the body's cells
become resistant to insulin. Insulin is a hormone secreted by the pancreas that allows
glucose (sugar) to enter the body's cells and be converted to energy. Type 1 diabetes
(formerly juvenile-onset) occurs because the pancreas makes little or no insulin.
- Social, economic, and political barriers sometimes block high quality care and easy
access to health care for women with diabetes.
- Social and economic issues will leave many older women with diabetes living alone and
poor. Poverty is also a major concern for women of childbearing age who have diabetes.
- Women with diabetes have a lower life expectancy than women without diabetes.
- The risk of heart disease, the most common complication of diabetes, is more serious
among women than men. Among people with diabetes who have had a heart attack, women have
lower survival rates and a poorer quality of life then men.
- Women are at greater risk from blindness due to diabetes than men.
- All parts of society–public and private–are more effective when they work together
long-term to address the public health issues of reducing the burden of diabetes among
For more information visit: www.cdc.gov/diabetes
or call toll free 1- 877-CDC-DIAB.
The Adolescent Years (10-17 years)
- Most adolescents aged 10-17 years with diabetes have type 1, an autoimmune form of the
disease in which the pancreas produces little or no insulin. Without insulin, fat and
sugar remain in the blood and eventually can damage vital organs.
- Physiological and psychological changes in puberty make diabetes management and control
- About 61,500 girls younger than 20 years have type 1 diabetes; 92 percent are white, 4
percent are black, and 4 percent are Hispanic or Asian American.
- Acute complications such as ketoacidosis (acid build-up in the blood) or hypoglycemia
(extremely low blood sugar) are more common than chronic complications among adolescent
girls with type 1 diabetes. In one study of 9-16-year-olds with diabetes who were
monitored for 8 years, 30 percent of girls had had at least one episode of ketoacidosis
and 21 percent had had at least one episode of hypoglycemia. If not treated, both can lead
to coma and death.
- The mortality rate among girls with type 1 diabetes is nearly 5 times greater than the
mortality rate of the general population of girls aged 10-19 years. Girls seem to have a
significantly greater risk of dying than boys at the onset of type 1 diabetes.
- By age 20, 40 percent to 60 percent of people with diabetes have retinopathy, or
diabetic eye disease. Retinopathy can lead to blindness if untreated. The risk to develop
proliferative retinopathy—the most severe form—is higher for girls.
- Current evidence suggests that eating disorders may be significantly higher among young
women with type 1 diabetes than among young women in the general population.
- The incidence of type 2 diabetes appears to be increasing among both girls and boys,
particularly in some racial and ethnic minority groups. Formerly called adult-onset
diabetes, type 2 diabetes normally develops after age 40. Unlike type 1, type 2 diabetes
is linked to obesity and physical inactivity and occurs when the body loses its ability to
use insulin. Complications from type 2 closely resemble those associated with type 1
- The increased prevalence of obesity among adolescent girls may play a role in the
10-fold increase in type 2 diabetes among adolescents beginning in the 1990s.
The Reproductive Years (18-44 years)
- About 1.85 million women of reproductive age (18-44 years) have diabetes; about 500,000
of them do not know they have the disease. Women of minority racial and ethnic origins are
2-3 times more likely than non-Hispanic white women to have diabetes.
- Type 2 diabetes accounts for the majority of diabetes cases identified during this life
stage. Most women with type 1 diabetes were diagnosed during childhood or adolescence.
- From 1990 to1998, diabetes rates increased 70 percent for women aged 30-39.
- Reproductive-aged women with type 2 diabetes have fewer years of education, lower
incomes, and are less likely than women without diabetes to be employed.
- Death rates for women aged 25-44 with diabetes are more than 3 times the rate for women
- Between 2.5 percent and 4 percent of women in the United States develop gestational
diabetes during pregnancy. This type of diabetes results from the body's resistance to the
action of insulin. The increased resistance during pregnancy is caused by hormones
produced by the placenta.
- Gestational diabetes usually ends after the baby is born, but women with gestational
diabetes have up to a 45 percent risk of recurrence with the next pregnancy and up to a 63
percent risk of developing type 2 diabetes later in life.
- Increasing numbers of women, especially nonwhite women, are at risk of having
pregnancies complicated by diabetes. American Indian women have considerably higher rates
of gestational diabetes than the national average. For instance, prevalence for Zuni
Indian mothers is 15.1 percent and for Navajo Indian women the rate is 10.4 percent among
mothers aged 30-39 years.
- Although expectant mothers with diabetes can and do have normal, healthy pregnancies and
deliveries, they are at greater risk for complications such as preeclampsia, Caesarean
section, and infections.
- The intergenerational effect of diabetes during pregnancy has long-term effects on the
metabolism and health of the child born of that pregnancy. Children of a mother with
diabetes have up to a 10-fold increased risk of becoming obese during childhood as well as
developing glucose intolerance in puberty–both risk factors for type 2 diabetes.
The Middle Years (45-64 years)
- By 2010, the number of women in midlife (ages 45-64) is expected to grow from about 27
million to 41 million. Women in this stage of life are more vulnerable to major chronic
diseases such as diabetes.
- Nearly all women aged 45-64 years with diabetes have type 2 diabetes.
- The prevalence of diabetes has been increasing steadily in all demographic groups for
several decades. Prevalence rates for women aged 45-55 years were less than 2 percent in
the 1960s, but rose consistently in the 1980s and 1990s. In the early 1990s the overall
rate was about 6 percent for women aged 45-64 years.
- For middle-aged women, type 2 diabetes is at least twice as common among nonwhites as
among whites. Among women aged 50-59 years the prevalence was 23 percent for blacks, 24
percent for Mexican Americans and 9.7 percent for whites.
- American Indian women, are particularly vulnerable to diabetes. One study found that 70
percent of Pima Indian women 45-64 years old have diabetes. An estimated 41 percent of
Navajo women in the same age group have diabetes.
- Middle-aged women with type 2 diabetes are less likely than women without diabetes to be
married (58.3 percent versus 72.2 percent); more likely to be widowed (15.6 percent versus
9.4 percent), or divorced or separated (19.3 percent versus 14.5 percent).
- Overall, middle-aged women with type 2 diabetes have less education, lower income, and
are less likely to be employed than women without diabetes. More than half of women 45-64
years old with diabetes have an annual family income of less than $20,000, and 28.5
percent have less than $10,000. This compares with 30.5 percent and 11.3 percent
respectively for women without diabetes.
- Diabetes is a leading cause of death among middle-aged American women. In 1996, diabetes
ranked fifth among white women, fourth among black and American Indian women, and third
among Hispanic women aged 45-64 years.
- Coronary heart disease is an important cause of illness among middle-aged women with
diabetes and rates are 3-7 times higher among women 45-64 years old with diabetes than
women without diabetes.
The Elder Years (65 + years)
- The number of women aged 65 and older is expected to grow from approximately 20 million
in 1995 to 23 million in 2010. Because women live an average of 7 years longer than men,
there are nearly twice as many older women as older men, thus elderly women with diabetes
outnumber elderly men with diabetes in the United States.
- About 4.5 million women aged 60 years and older have diabetes and one quarter, or
- 1.2 million, do not know they have the disease. Most elderly women with diabetes have
type 2 diabetes.
- Between 1980 and 1994, the number of recognized new cases of diabetes among women aged
65 years and older increased from 97,000 to 181,000 (45.7 percent).
- Obesity, weight gain, and physical inactivity are the major risk factors for type 2
diabetes among women. Among people aged 65 years and older who have diabetes, 70.4 percent
of women are 20 percent over their desired weight, compared with 38.2 percent of men, and
25 percent are obese (50 percent over their desired weight).
- Among women aged 60-74 years, 33 percent of black or Mexican American women have
diabetes compared with 16 percent of white women. Among American Indian women,
approximately 32 percent over the age of 65 years have diabetes.
- By the age of 65 years, women have half the income of men and are twice as likely to
live in poverty. Almost half (47.7 percent) of elderly women with diabetes have an annual
income of less than $10,000 compared with 31 percent of women without diabetes.
- Chronological age interacts with diabetes to accelerate diabetes complications such as
heart disease, stroke, kidney disease, and blindness. Elderly women with diabetes are at
particularly high risk for heart disease, visual problems (cataracts and glaucoma),
hypergylcemia (extremely high blood sugar) or hypoglcemia (extremely low blood sugar), and
- Diabetes is one of the leading underlying causes of death among women aged 65 years and
older. The death rate for diabetes increases with age. Elderly black women have twice the
rate of death from diabetes as elderly white women, and elderly Mexican American women
have almost four times the rate.