An epidemiological model for diabetes mellitus in the United States: five major complications.

Diabetes mellitus affects almost 5.5 million Americans each year. An estimated additional 5 million individuals may have diabetes, but remain undetected. Individuals with diabetes are at high risk for the development of micro- and macrovascular disease, diabetic coma and adverse outcome of pregnancy. The rate at which these complications develop are now partially identifiable for the United States. For 5 potentially preventable complications (retinopathy, adverse outcome of pregnancy, vascular disease, nephropathy and diabetic coma) the morbidity and mortality rates can now be calculated. There exist 50,000 cases of blindness due to diabetes with an additional 5800 new cases each year. Adverse outcome of diabetic pregnancy occurs in over 18,000 births each year, with as many as 4500 related perinatal deaths. Each year 40,000 diabetics are required to have a lower extremity amputation. Of the already 70,000 diabetics who have had an amputation, 25,000 will die this year. End stage renal disease affects 4000 diabetics each year. During the same time period, of the 7500 existing cases of end stage renal disease, 2000 will result in mortality cases. Diabetic coma (DKA and HHNK) accounts for 67,400 hospitalizations and results in 3600 deaths each year. Together these complications and those associated with cardiovascular disease account for 323,000 deaths with diabetes as the underlying or contributing cause in the United States.