Q How do people die from diabetes?

A People who have diabetes cannot regulate their blood sugar levels and, if the disease is not tightly controlled, blood sugar can spike to abnormally high levels, a condition called hyperglycemia, or dip below normal, a condition called hypoglycemia.

Both these conditions are potentially life-threatening and can lead to coma and death if the patient does not seek medical treatment.

But complications resulting from the disease are a more common cause of death.

Heart disease strikes people with diabetes at significantly higher rates than those without diabetes, "and we don't fully know why", said Dr Robert Gabbay, chief medical officer at Joslin Diabetes Centre in Boston.

People with diabetes develop heart disease at younger ages and are nearly twice as likely to die of heart attack or stroke as people who do not have diabetes.

Those with Type 2 diabetes, which is the more common form of the disease, are also more likely to have elevated cholesterol, high blood pressure and obesity, Dr Gabbay said, all risk factors for cardiovascular disease.

"The good news," he said, "is that a lot of treatments, like those for lowering cholesterol, are even more effective at lowering risk in people with diabetes than in people without."

Some new classes of medications used for Type 2 diabetes have also been shown to reduce cardiovascular risk, he said.

People with Type 1 diabetes are also at increased risk for heart disease, though the reasons are less clear.

Both types of diabetes can also lead to other long-term complications, like kidney disease, that may result in premature death.

Problems like vision loss, nerve damage and infections that may lead to amputations can increase the likelihood of injuries and accidents.

Good disease management starting early in the disease process helps people avoid some of these complications, Dr Gabbay said.

NYTIMES