Diabetes — one of America’s most common ailments — is listed seventh among the leading causes of death behind heart disease, cancer, lower chronic respiratory disease, accidents, strokes and Alzheimer’s disease. 

The longstanding question has been, why so low on the list?

More than 29 million people, or nearly 1 in every 10 Americans, have diabetes with numbers not only climbing but soaring. More than a quarter of people 65 and older already have diabetes with 86 million Americans 20 and older having pre-diabetes, a precursor to the full-fledged condition, the American Diabetes Association reports.

And if this trend continues, 1 of every 3 Americans could have diabetes by 2050, the U.S. Centers for Disease Control and Prevention says. 

But a study published Jan. 25, in PLOS One stands to characterize diabetes’ impact on death statistics more accurately and the news isn’t encouraging: it’s actually the third leading cause of death in the United States.

Completed by the Boston University School of Public Health and the University of Pennsylvania, the study used two large health databases to show that diabetes has been hiding in the statistical weeds when it comes to its impact on mortality. 

The condition characterized by high blood sugar levels often isn’t the immediate cause of death but clearly is a contributing factor in many more deaths than previously thought — in fact, up to three times as many deaths.

Directly listed as a cause of death in fewer than 4 percent of deaths, diabetes actually was an attributable cause of death for 11.5 percent of Americans, the study says. That would make it the third leading cause of death, behind heart disease and cancer, based on 2010 mortality data used in the study. The same would hold for 2014.

The problem is, diabetes often isn’t listed on death certificates, despite causing various disorders including cardiovascular and kidney disease, with links to stroke and some cancers, among others. 

If prediabetes is considered in the risk category, up to 14 percent of American deaths can be linked to diabetes, the study showed. “These results demonstrate that diabetes is a major feature on the landscape of American mortality and reinforce the need for robust population-level interventions aimed at diabetes prevention and care.” 

Patricia L. Bononi, medical director of Allegheny Health Network’s Center for Diabetes, said the study results are no real surprise.

“Of all the people who died, those with diabetes had a higher risk of dying in the study period than those without diabetes,” she said. “Death certificates aren’t always accurate. You have to give one cause of death, and if it is heart attack, the cause of that heart attack, or a contributing factor in that heart attack, could be diabetes.”

One clear statistic that stands out in the study, she said, involves diabetes’ involvement in a high percent of deaths of people with obesity. 

For all groups of people analyzed, 8.5 percent had diabetes, but 23.7 percent of those who died had diabetes, with the number climbing to 30.5 percent among African Americans and nearly 40 percent for those who were obese. That’s nearly double the number of those who were not obese at the time of death.

Dr. Bononi has been leading efforts, under a $6 million grant in November from the Richard King Mellon Foundation, to create “robust interventions” for people with diabetes through a holistic approach and team concept, with notable results in the just three months.

Some patients participating in her program recorded dramatic swings from high blood-sugar levels to ones in or near the normal range.

Without the intense intervention, a patient typically might visit a doctor three or four times a year, maybe 20 minutes at a time. “....That’s a total of one hour of face-to-face time with your doctor,” Dr. Bononi said. “Diabetes places a lot of demands on the patient in managing his or her own disease, which requires daily evaluation of many variables, including medicines, doses, food and exercise.

“Any way that a patient can get support is positive,” she said.

With the goal of avoiding the statistic in question.

David Templeton: dtempleton@post-gazette.com or 412-263-1578.

First Published: February 6, 2017, 5:00 a.m.