Rav­aging health de­mo­graphic: Di­a­betes is silent scourge

The Washington Times Weekly - - National - By Joyce Howard Price

The preva­lence of di­a­betes has more than dou­bled in the United States since 1990, fed by a com­bi­na­tion of ris­ing obe­sity, lifestyle changes and ge­net­ics, spe­cial­ists say.

There are an es­ti­mated 20.8 mil­lion di­a­bet­ics in the coun­try to­day, and the pres­i­dent of the Amer­i­can Di­a­betes As­so­ci­a­tion says there could be as many as 100 mil­lion in the com­ing decades.

“I don’t dis­count a [Cen­ters for Dis­ease Con­trol and Pre­ven­tion] pre­dic­tion that one in three Amer­i­cans born in 2000 will wind up with di­a­betes,” says Dr. Larry C. Deeb, a pe­di­atric en­docri­nol­o­gist who serves as the as­so­ci­a­tion’s pres­i­dent. He is also the di­rec­tor of the Di­a­betes Cen­ter at Tal­la­has­see Me­mo­rial Hospi­tal in Florida.

There is lit­tle rea­son for op­ti­mism about a de­crease in new di­a­betes cases. About 7 per­cent of the U.S. pop­u­la­tion has the dis­ease, in which the body ei­ther doesn’t make enough in­sulin or can’t use in­sulin as well as it should.

More younger peo­ple are be­ing di­ag­nosed with di­a­betes, and the se­nior pop­u­la­tion — which now ac­counts for 40 per­cent of cases — is ex­pected to dou­ble in less than 20 years.

Di­a­bet­ics with volatile blood­glu­cose read­ings are at risk for a variety of se­ri­ous health prob­lems, such as high blood pres­sure, heart dis­ease, stroke, kid­ney fail­ure, blind­ness, limb am­pu­ta­tions, re­cur­ring in­fec­tions, im­po­tence, gum dis­ease and nerve dam­age. Some re­cent re­search has linked di­a­betes to an in­creased risk for Parkin­son’s dis­ease and Alzheimer’s.

The rate of car­diac dis­ease mor­tal­ity among di­a­bet­ics is two to four times greater than among non­di­a­bet­ics, and the risk of stroke among di­a­bet­ics is two to four times higher than among non­di­a­bet­ics, the Amer­i­can Di­a­betes As­so­ci­a­tion says. Grow­ing ‘epi­demic’

The 2005 fed­eral es­ti­mate of 20.8 mil­lion di­a­bet­ics in­cludes 14.6 mil­lion di­ag­nosed cases and 6.2 mil­lion un­di­ag­nosed cases, ac­cord­ing to Jeff Lan­cashire, a spokesman for the Na­tional Cen­ter for Health Sta­tis­tics (NCHS), which is part of the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC). The num­ber of di­ag­nosed cases rose from 6.7 mil­lion in 1990, ac­cord­ing to the CDC.

What’s more, NCHS says di­a­betes is the only ma­jor dis­ease be­sides Alzheimer’s with a death rate that con­tin­ues to rise. Di­a­betes deaths have climbed 22 per­cent since 1990.

About 54 mil­lion Amer­i­cans, in­clud­ing 2 mil­lion ado­les­cents, are clas­si­fied as “pre-di­a­betic,” ac­cord­ing to the Amer­i­can Di­a­betes As­so­ci­a­tion. Al­though the CDC says the fig­ure is some­what lower, its es­ti­mate is still a stag­ger­ing 41 mil­lion.

Pre-di­a­betes raises the risk for de­vel­op­ing Type 2 di­a­betes, the most com­mon form, as well as for heart dis­ease and stroke. Some Type 2 di­a­bet­ics are able to con­trol their blood-sugar lev­els by watch­ing what they eat. Some take pills such as glu­cophage, which is de­signed to lower blood sugar, while oth­ers may need both in­sulin and pills.

Dr. Alan Ja­cob­son, se­nior vice pres­i­dent of the Joslin Di­a­betes Cen­ter in Bos­ton, an af­fil­i­ate of Har­vard Med­i­cal School, and oth­ers use terms such as “epi­demic” or “ex­plo­sion” to char­ac­ter­ize the re­cent growth in Type 2 di­a­betes. That form of the dis­ease pre­dom- inantly af­flicts over­weight adults, but is also af­fect­ing grow­ing num­bers of heavy chil­dren. Fed­eral of­fi­cials call Type 2 di­a­betes the na­tion’s fastest-grow­ing health prob­lem.

“Type 2 is driven by lifestyle,” in­clud­ing fac­tors such as weight gain caused by con­sump­tion of high­calo­rie and high-fat foods and a lack of ex­er­cise, Dr. Ja­cob­son says.

In the past, a per­son tended to reach the mid-40s be­fore de­vel­op­ing Type 2 di­a­betes. “But now more kids are obese, so they are get­ting di­a­betes. More 35-year-old men are obese, so they are get­ting di­a­betes,” he says.

“Eighty per­cent of Type 2 di­a­bet­ics are over­weight,” says Lalita Kaul, a pro­fes­sor of nu­tri­tion at Howard Univer­sity Med­i­cal School and a na­tional spokes­woman for the Amer­i­can Di­etetic As­so­ci­a­tion. “We’re see­ing Type 2 in younger and younger peo­ple, and it’s ris­ing.”

Dr. Ja­cob­son de­scribes Type 2 di­a­betes as a meta­bolic con­di­tion as­so­ci­ated with a mod­i­fied lifestyle, in which peo­ple have gone from “be­ing hunters and gath­er­ers to be­com­ing more seden­tary.”

“Whether you drive a truck or sit at a desk, the shift to Type 2 di­a­betes is oc­cur­ring in mas­sive quan­ti­ties,” he says.

Doc­tors stress the need for both im­proved diet and ex­er­cise to con­trol di­a­betes.

“When it comes to weight loss, diet’s role is 90 per­cent and ex­er­cise, 10 per­cent. But in main­tain­ing one’s weight, the two fac­tors have a 50-50 role,” says Dr. Scott Isaacs, med­i­cal di­rec­tor of At­lanta’s In­tel­li­gent Health Cen­ter, a com­pre­hen­sive di­a­betes treat­ment cen­ter.

If a per­son is over­weight, he says, “los­ing 5 [per­cent] to 10 per­cent of your body weight” can help pre­vent get­ting Type 2 di­a­betes Type 1 on rise

While most at­ten­tion has fo­cused on the sharp rise in Type 2 di­a­betes, Type 1 di­a­betes has been “in­creas­ing at 3 per­cent a year for the past few decades,” says Dr. Lori Laf­fel, chief of pe­di­atric and ado­les­cent di­a­betes at Joslin.

Type 1 di­a­bet­ics are re­quired to take in­sulin, ei­ther through daily in­jec­tions or through a de­vice called an in­sulin pump that con­tin­u­ously de­liv­ers the vi­tal hor­mone to the body. Pa­tients with Type 1 must have in­sulin be­cause of a shut­down of the pan­creas, which makes it in­ca­pable of pro­duc­ing the sub­stance the body needs to me­tab­o­lize sugar.

His­tor­i­cally, chil­dren and ado­les­cents have been pri­mar­ily af­fected by Type 1 di­a­betes. This form of the dis­ease still ac­counts for be­tween 75 per­cent to 80 per- cent of all di­a­betes cases among Amer­i­can youth, Dr. Laf­fel says.

“We know we’re get­ting many more kids with Type 1,” she says. While “in­creases may be lev­el­ing off for teens, many young chil­dren, ages 5,6 and 7, are get­ting Type 1,” she says.

The New York-based Ju­ve­nile

Di­a­betes Re­search Foun­da­tion (JDRF) es­ti­mates that 3 mil­lion Amer­i­cans have Type 1 di­a­betes, group spokesman Peter Cleary says.

Al­though obe­sity pri­mar­ily has been as­so­ci­ated with in­creas­ing risk for Type 2 di­a­betes, it also is linked with in­creased risk for com­pli­ca­tions in Type 1 di­a­bet­ics, such as kid­ney dis­ease and car­dio­vas­cu­lar dis­ease.

Both Type 1 and Type 2 di­a­betes com­bine ge­netic pre­dis­po­si­tion and en­vi­ron­men­tal fac­tors, Dr. Laf­fel and Dr. Ja­cob­son say.

“Eighty per­cent of pa­tients di­ag­nosed with Type 2 have a fam­ily his­tory [of di­a­betes]; 20 per­cent of those di­ag­nosed with Type 1 have a fam­ily his­tory of the dis­ease,” Dr. Laf­fel says.

As for Type 2, she says, a per­son may have ge­netic pre­dis­po­si­tions to be “in­sulin-re­sis­tant” and for the beta cells in their pan­creas to be un­able to pro­duce enough in­sulin.

“Both Type 1 and Type 2 have ge­netic risks. The ge­netic link­age could be greater with Type 2,” Dr. Ja­cob­son says. Hope for the fu­ture

Di­a­bet­ics to­day can avoid dev­as­tat­ing med­i­cal prob­lems, which once were com­mon­place, by reg­u­larly check­ing their blood-sugar lev­els through­out the day to en­sure they are within nor­mal range.

How­ever, the JDRF says con­trol prob­lems are es­pe­cially bad for Type 1 di­a­bet­ics. The group points out that some stud­ies have shown that even Type 1 di­a­bet­ics who ag­gres­sively mon­i­tor their blood­sugar lev­els — mea­sur­ing it an av­er­age of nine times per day — found them­selves in the nor­mal range less than a third of the time.

While the out­look for mod­er­a­tion of Type 2 di­a­betes is poor be­cause of chang­ing de­mo­graph­ics and un­healthy life­styles, there are some en­cour­ag­ing signs.

Ev­i­den­ceindi­cat­esthatType2­di­a­betes can be pre­vented in those at risk by a healthy diet and ex­er­cise.

Miss Kaul says that over the past 25 years, 70 per­cent of her pa­tients at risk of di­a­betes have avoided it by con­trol­ling their blood sugar with diet and lifestyle ad­just­ments.

Vi­tal in th­ese ef­forts, she says, is eat­ing five or more serv­ings of fruits and veg­eta­bles daily; eat­ing less sat­u­rated fat and us­ing health­ier cook­ing oils; re­duc­ing in­take of sugar and desserts; eat­ing more whole grains; con­sum­ing salmon and other fish rich in fatty acids a few times weekly; and avoid­ing pre­pared foods high in salt, which can in­crease blood pres­sure.

No one is fore­cast­ing a cure for di­a­betes any­time soon. But Mr. Cleary says cur­ing di­a­betes is JDRF’s ob­jec­tive. The group hopes to reach that goal through ac­cel­er­ated fund­ing of re­search to de- velop an ar­ti­fi­cial pan­creas for in­sulin-de­pen­dent di­a­bet­ics.

The JDRF says an ar­ti­fi­cial pan­creas would en­able a di­a­betic who re­quires in­sulin to main­tain nor­mal blood-glu­cose lev­els by au­to­mat­i­cally pro­vid­ing the right amount of in­sulin at the right time, just as the pan­creas does in peo­ple with­out di­a­betes.

Ad­vo­cates for em­bry­onic stem­cell re­search, which is op­posed by some on moral grounds, ar­gue that di­a­bet­ics could be a group to ben­e­fit from such re­search, since adult stem cells can­not be used to re­place dam­aged tis­sue in the pan­creas, which trig­gers the dis­ease.

De­spi­ter­is­ing­di­a­betescaseloads and deaths, fed­eral re­search fund­ing is be­ing re­duced. Sup­port for di­a­betes from the Na­tional In­sti­tutes of Health re­mained at $1.06 bil­lion in­fis­cal2005and2006,butwill­drop to $1.05 bil­lion in fis­cal 2007.

“We are dis­traught at the fed­eral cuts,” Dr. Deeb says. “We must keep in­vest­ing in di­a­betes re­search, or Amer­ica will get fur­ther and fur­ther be­hind” in bat­tling the dis­ease.

“Fac­ing the prospect of hav­ing 100 mil­lion Amer­i­cans with di­a­betes in the fore­see­able fu­ture, we have to make an in­vest­ment.”

Re­searchers Amy Baskerville and John Sopko con­trib­uted to this ar­ti­cle.

The Wash­ing­ton Times

Di­a­betes pa­tients, ris­ing in num­bers, check their blood-sugar lev­els sev­eral times a day by draw­ing a drop of blood and test­ing it.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.