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Stampede of Diabetes as U.S. Races to Obesity
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Studies show HIV-infected individuals have higher rates of diabetes than in the general population.
NY Times
December 23, 2003
By JANE E. BRODY
Many people seem to think they don't have to worry about a preventable disease that does not, at the outset at least, have serious consequences and that can be treated.
One such disease was long called adult-onset diabetes. There are two things wrong here: first, this disease does indeed have very serious consequences despite the availability of numerous drug therapies, and second, it is no longer an ailment that occurs almost exclusively in adults.
And so the name has been changed to Type 2 diabetes to distinguish it from the far less common kind of diabetes (Type 1) that nearly always starts in childhood or adolescence and has a different origin. Because so many Americans eat too much and move too little, the nation is now in the throes of an epidemic of Type 2 diabetes that has spilled over into the childhood years.
Diabetes is a disorder of blood sugar regulation. In both types glucose builds up in the blood to damaging levels and spills into the urine. You may hear people with diabetes say they "have sugar" or "sugar disease." Specialized cells in the pancreas produce the hormone insulin that has the job of moving the blood glucose into cells where it can be used for energy or stored to meet future energy needs.
In Type 1 diabetes, a form of autoimmune disease, these cells fail to produce adequate amounts of insulin. But in Type 2 diabetes, although the body typically produces enough insulin at first, body cells are resistant to its action. As blood glucose levels rise, the pancreas is forced to work overtime to produce even more insulin. Eventually the pancreatic cells may wear out, causing an insufficiency of insulin that resembles Type 1 diabetes.
A Costly Disease
Everything you eat sooner or later can be converted into glucose. But carbohydrates (the simple sugars like the table sugar sucrose, corn syrup, honey, etc.) and refined starches like white bread and pastries are most rapidly converted into glucose, causing a spike in blood sugar that demands immediate insulin action. Eating sugary foods and other simple carbohydrates does not cause diabetes, but once it develops it is usually necessary to limit — but not eliminate — consumption of such foods.
Type 2 diabetes is no longer considered a benign disease. It can and often does result in debilitating, life-threatening disorders. Both kinds of diabetes greatly increase a person's risk of heart disease, stroke, kidney failure and blindness, as well as circulatory disorders that can result in amputations. Experts estimate that this disease and its consequences add up to $100 billion a year in medical costs.
Some 17 million Americans have diabetes (more than 90 percent of them Type 2), with about a third of these people unaware of their disorder and its potentially serious consequences. Another 16 million, with a condition called prediabetes, are on their way to developing it. Worldwide, 194 million people have diabetes, which seems to accompany rising affluence.
The incidence of diabetes has been rising in recent years, in children as well as in adults. Considering only diagnosed cases in adults, the prevalence rose 40 percent in the 1990's, from 4.9 percent to 6.9 percent of adults. By 2050, unless current trends are reversed, experts predict a further increase of 165 percent.
Even more disturbing is a new estimate of the lifetime risk of developing diabetes among boys and girls born in the year 2000. An analysis published in October in The Journal of the American Medical Association by scientists at the Centers for Disease Control and Prevention predicts the following for those born in 2000:
--32.8 percent of boys and 36.5 percent of girls will develop diabetes during their lifetimes.
--Among non-Hispanic blacks, 40.2 percent of boys and 49 percent of girls, and among Hispanics, 45.4 percent of boys and 52.5 percent of girls face the same fate.
--Among all those in whom diabetes is diagnosed at age 40, men will lose 11.6 years of life and 18.6 years of quality life and women will lose 14.3 years of life and 22 years of quality life as a result of the disease.
In other words, more than one in three whites and about two in five blacks and one in two Hispanics are destined to develop diabetes unless some drastic changes occur.
The reason for this frightening prospect is all too obvious: Americans are too fat and too sedentary. Being overweight, and especially the accumulation of fat around the waist, can cause insulin resistance and is the primary risk factor for Type 2 diabetes. About three-fourths of people with Type 2 diabetes also have high blood pressure, which further increases their risk of cardiovascular and kidney diseases.
A family history of diabetes is common among those with Type 2 diabetes, so if your parents or grandparents had it, consider that a clue to your risk and take action now to prevent it. When a former colleague of mine, seriously obese for his entire adult life, was told he was on the verge of developing diabetes, he finally started taking his weight seriously and lost 100 pounds through a sensible diet and exercise. As a result, he lived in good health to a ripe old age.
At first diabetes may produce few or no noticeable symptoms, which typically develop slowly over a period of years. But the condition is readily suspected through a routine urine or blood test and confirmed by a glucose tolerance test. A blood test for diabetes should be done at least once every three years for people 45 and older and starting at 30 for those considered at high risk.
Symptoms, when they become apparent, may include excessive thirst, frequent urination, fatigue, hunger soon after eating, blurred vision, slow healing of wounds and numbness or tingling in the hands and feet. Women with diabetes may experience repeated or stubborn urinary tract or vaginal yeast infections.
Treatment and Control
Once diabetes or prediabetes is diagnosed, the first order of treatment is weight loss, if necessary, and regular physical exercise. Both increase insulin sensitivity. Since people with diabetes are highly susceptible to cardiac and blood vessel diseases, controlling consumption of artery-damaging saturated fats and trans fats is as important as watching the intake of sugars and refined carbohydrates.
Since dietary fiber, both soluble and insoluble, slows the absorption of carbohydrates, people with diabetes are encouraged to consume mostly whole grains, along with vegetables,
unsweetened fruit and low-fat protein and dairy foods. Fiber supplements often help, too. Consult the glycemic index of foods to learn which foods are most likely to cause spikes in blood sugar.
In addition to diet and exercise, most people with established Type 2 diabetes require oral medication to help control blood sugar levels.
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