National Diabetes and Women's Health Initiatives

The Centers for Disease Control and Prevention (CDC), the American Diabetes Association (ADA), the American Public Health Association (APHA), and the Association of State and Territorial Health Officials (ASTHO) cosponsor the National Public Health Initiative on Diabetes and Women's Health. The initiative has three phases: a report, an action plan, and a national conference.

Diabetes is a serious health condition that affects women in all life stages. It is unique to women because it can affect 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. This will place 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 type 2 diabetes; the prevalence is at least 2-4 times higher among black, Hispanic, American Indian, and Asian Pacific Islander women than among white women. About 90 to 95 percent of women with diabetes have type 2 diabetes (formerly called adult-onset).

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 called juvenile-onset) occurs because the pancreas makes little or no insulin. 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 than men. Children exposed to diabetes in the womb have a greater likelihood of becoming obese during childhood and adolescence and for developing type 2 diabetes, later in life. Women with diabetes have a shorter life expectancy than women without diabetes, and women are at greater risk of blindness from diabetes than men.

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. All parts of society—public and private—have a role in addressing the public health issues of reducing the burden of diabetes among women.

The Adolescent Years (10-17) Most adolescents aged 10-19 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. Acute complications such as ketoacidosis (acid buildup in the blood) or hypoglycemia (extremely low blood sugar) are more common than chronic complications among adolescent girls with type 1 diabetes. The rate of death among girls with type 1 diabetes is nearly 5 times greater than the general population of girls aged 10-17 years. 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. 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 usually 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 diabetes. The increased prevalence of obesity among adolescent girls may play a role in the 10-fold increase in type 2 diabetes among adolescents in the 1990s. Physical and mental changes during puberty make diabetes management and control harder.

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