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Diabetes Epidemic: An Uphill Battle That Can Be Won
< Nov. 07, 2007 > -- News from the diabetes front seems to grow more discouraging by the day.
Rates of the disease, fueled by obesity and sedentary lifestyles, have risen unchecked in the United States, with diabetes now affecting about seven percent of the population. That is an estimated 20.8 million adults and children, according to the American Diabetes Association (ADA).
Federal projections estimate that by 2050, some 48 million Americans will have type 2 diabetes. And the disease will bring with it complications such as blindness, hearing loss, kidney disease, nervous system disorders, and amputations of extremities.
"Studies have suggested that for the first time in history, the generation of people born in 2000 is probably going to have shorter life expectancy than their parents," says Dr. Sue Kirkman, vice president of clinical affairs for the American Diabetes Association.
What is worse, one of the most promising medicines for treating type 2 diabetes, Avandia®, now appears to increase a person's risk of heart attack and heart failure, according to recent studies.
Still, with November designated American Diabetes Month, medical experts say the fight against diabetes can be won - if everyone decides to do what is best for themselves and their families. It will not be easy.
The finding on Avandia calls into question the safety of the entire class of drugs known as thiazolidinediones. For now, Avandia - and other thiazolidinediones such as Actos®, - remains on the market. But in August, the US Food and Drug Administration (FDA) mandated stricter labeling, including "black box" warnings, for the medications.
A black box warning is a prominent medication-label alert for high risk prescription drugs that may cause serious injuries or death.
Medical experts recommend that each person discuss the risks and rewards of using Avandia with their physician.
"Every patient is different," states Dr. Kirkman. "Every patient has different risk factors. Every patient has reasons why one medicine might be better for them than another."
But medicines are only part of the solution. A better response would be drastic changes to American lifestyles, starting with improved diets and more exercise, to avoid type 2 diabetes in the first place.
"The statistics are pretty gloomy, but we also know people who are at risk for diabetes can do a lot to prevent it from coming on," Dr. Kirkman encourages. "There's a lot people can do to try and control their fate."
The Diabetes Epidemic
Diabetes comes in two types. The most common form, type 2, or what used to be called adult-onset diabetes, occurs when either the body does not produce enough of the hormone insulin or the cells ignore the insulin. The body needs insulin to transport sugar in the blood to cells for energy.
Being overweight, an unhealthy diet, and lack of exercise are common contributors to this form of the disease.
Type 1 diabetes, usually diagnosed in children and young adults, occurs when the body is not capable of producing insulin.
Researchers reviewing data from the National Health Interview Survey found that from 1990 to 2005, cases of diabetes increased 4.6 percent each year. They rose from 26.4 cases per 1,000 people to 54.5 per 1,000 people in the most recent year available.
The diabetes epidemic has grave implications for America, says Martha Funnell, a clinical nurse specialist for the University of Michigan and a past president of the ADA. Health care costs are expected to soar as more people with diabetes complications fill doctors' offices and emergency rooms.
Even the US economy will be affected as potentially healthy people find themselves unable to work. "You're losing folks in the prime of their years, and that has an impact on society and our economy," Funnell says.
Fortunately, there are steps that can be taken, both large and small, to help fight diabetes.
On the large-scale side, Dr. Kirkman says, governments should spend more money on physical education in schools and on public transportation, instead of new road construction.
"We know people who take public transportation are more physically active," she says. "Do we choose to encourage that?"
"On a more personal level, people can make healthy lifestyle choices and help pass those choices along to their children," Funnell says. "But is anyone listening and willing to try?"
"The messages are those same old 'eat healthy and exercise,' and we hear those to the point where we think, 'Yeah, yeah, yeah, everybody knows we need to do these things," Funnell says.
However, even small measures - standing more often during the day or walking during a lunch break or eating an apple instead of ice cream - can help make a difference.
"Maybe it would seem to outsiders as a small step, but it's just taking that one step and the next step and the next," Funnell says. "Like global warming, it's saying, What can I do for myself and my family this week, this month, this year, that will make a difference?"
Always consult your physician for more information.
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Marc Onigman knew something was wrong when he looked up to check departing flights on an airport monitor and could not read a thing.
Onigman, a 57-year-old Boston resident, and his wife were sitting at Logan International Airport in 1999, waiting to board a flight for London.
"It was blurry," Onigman recalled. "I had been traveling a lot at the time, and I knew I should have been able to read that monitor. I looked around, and I couldn't really see letters on signs."
He turned to his wife and told her, "I have a problem." They never boarded the plane.
Instead, they went to a doctor, where Onigman was diagnosed with type 2 diabetes. The blurred vision was a symptom of his disease.
"I was pretty surprised," he said of his initial reaction. "I thought, This is not great news."
But the more Onigman, who works as a salesman in the health and fitness field, thought about it, the more it made sense. "I'm relatively out of shape, overweight, all of the classic indicators for type 2 adult onset, unfortunately," he says.
There is also a history of diabetes in his family. His grandmother died from diabetes in 1955, his father had it, and his children Julie and Michael both have type 1 diabetes.
The doctor put Onigman on oral medications to control his diabetes, and he responded well. "My number quickly came down, and since then I've had it pretty under control with the oral drugs and a stepped-up fitness program," he says.
That fitness program includes some strength training, and Onigman just bought a pedometer. He is shooting for 12,500 steps a day.
"I just try to be more active," says Onigman. "I try to stand up more. When I'm in the airport, I don't sit and wait. I try to get up and walk around.
"You burn twice as many calories when you're standing up as when you're sitting down. Look at any public area where people can stand and people can sit. The larger people are always the ones sitting," he says.
Onigman also tries to watch what he eats, but that's a tougher challenge.
"I travel a lot, and I don't have a lot of willpower," he said. "It's hard to do. The choices aren't made easy when you go out to eat. The healthy options aren't at the top of the menu."
And sometimes the US food industry just flat-out disgusts Onigman with its offerings, like a pizza chain's recent introduction of an Oreo pizza.
"We were sitting there watching the ad on TV, and I looked at my wife and she looked at me, and we said, 'That's a Saturday Night Live joke, they've got to be kidding,' " he says. "But they weren't."
Still, Onigman tries to do his best. But he's starting to feel numbness in his feet - a complication of diabetes that can lead to amputation - and is worried about other problems that might occur if he does not take proper care of himself.
"If you don't keep your blood sugar under control, you're going to have problems," he says. "There aren't a lot of articles about people who live to be 81 who are type 2 and didn't do anything about it. I'm sure if that had happened, someone would have written about it. Once you're diagnosed with type 2, you'd better darned well do something about it."
Always consult your physician for more information.
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