Comorbidities are the presence of two or more medical conditions in addition to the primary disease.  Individuals with diabetes may also suffer from other conditions including: heart disease; stroke; hypertension; eye disease; kidney disease, nervous system disease, and non-traumatic lower limb amputations. These comorbid conditions can impact treatment for people with diabetes. 

How can diabetes lead to comorbidities?

High blood sugar from diabetes causes damage to blood vessels. When glucose (sugar) accumulates in the blood, the excess glucose can attach to proteins in the vessels and alter their normal structure. This damage can lead to heart, kidney, and nervous system diseases. In fact, according to the 2011 National Diabetes Fact Sheet, diabetes is the leading cause of kidney disease. In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease. 

Additionally, diabetes is the leading cause of blindness among adults aged 20-74. The high blood glucose levels can damage blood vessels in the eyes.  New blood vessels grow that are weaker and may leak or burst.  This condition is called diabetic retinopathy.  Advanced diabetic retinopathy can lead to severe vision loss.  From 2005-2008, an estimated 29 percent of people with diabetes aged 40 years or older had diabetic retinopathy.

A more disturbing statistic is that heart disease is noted on 68 percent of diabetes-related death certificates among people 65 years or older in 2004.  Stroke was noted in 16% of diabetes-related death certificates for the same age range. This suggests a strong association between poor heart health and diabetes.  People with diabetes have a higher risk of getting heart disease. Adults with diabetes have a two to four times higher heart disease death rate than those without diabetes.

If left uncontrolled, high blood glucose levels can lead to diabetic neuropathy.  This nervous system condition can have a wide variety of symptoms from numbness and tingling in the lower limbs to impaired sensation and pain in the hands and feet. As high blood glucose continues to alter the normal structure of vessels, circulation problems can greatly affect the body's ability to heal itself.  A tiny cut on the foot can lead to a non-traumatic lower limb amputation!  More than 60 percent of non-traumatic lower limb amputations occur in people with diabetes.

Statistics Source: For more information go to the National Center for Chronic Disease Prevention and Health Promotion. National Diabetes Fact Sheet 2011


Factors Contributing to Comorbidities: A State by State Glance

National Center for Chronic Disease Prevention and Promotion’s Behavioral Risk Factor Surveillance System (BRFSS) tracks the following health risk behaviors by state: 

          Overweight and Obesity (BMI)
          Healthcare Access/Coverage
          Fruits and Vegetables
          Physical Activity
          Cholesterol Awareness
          Heavy Alcohol Consumption
          Tobacco Use



Obesity increases the risk of getting diabetes. Trust for America’s Health, a non-profit, non-partisan organization, has a number of obesity facts divided by state:

           Adult and Childhood Obesity Rates by State
           2007 Obesity Rates, Percentage of Children age 10-17 by State
           2009 Obesity Rates, Percentage of High School Students by State