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November 9, 2006

Diabetes epidemic: Cases could reach 330 million by 2025

Every day in America, 810 people die from diabetes and another 4,100 cases of the disease are diagnosed. Every day 230 lose a limb, 120 learn they need dialysis and 55 go blind, all because of diabetes.

“These things are preventable,” Linda Siminerio, executive director of the University of Pittsburgh Diabetes Institute, told an audience Oct. 26 at a UPMC Health Plan lecture, “Diabetes: The Emerging Epidemic.”

Statistics from the Centers for Disease Control and Prevention show that a white child born in 2003 has a 1 in 3 chance of getting diabetes in his or her lifetime. That figure rises to 1 in 2 for black or Hispanic children, Siminerio said, urging those who are native American, African American, Asian or Hispanic to pay special heed to their increased risk.

“Diabetes is really, really one of the big problems for the U.S. and for the world,” said Siminerio. “It truly is an epidemic.”

Worldwide, diabetes has risen from 30 million cases in 1985 to 135 million a decade later, and 194 million in 2003. Incidence of diabetes is projected to rise to 330 million by 2025, she said. And the World Health Organization is predicting an increase of 165 percent worldwide in the next decade.

“This is the world’s problem, not just the United States’,” she said, noting that India has the highest incidence of the disease, followed by China and the United States.

There are two types of diabetes, Siminerio explained. Both involve how the body responds to blood sugar. When food is digested, it’s broken down into sugar in the intestines and sent into the bloodstream. As blood sugar rises, the brain sends the message to the pancreas to make insulin and the glucose is sent into fat, liver and muscle cells for storage or to be used as energy.

Type 1 diabetes, (commonly known as “juvenile diabetes” because it’s the type most children with diabetes have) is an autoimmune disease in which the body attacks and destroys its own insulin-producing islet cells in the pancreas. Those with Type 1 diabetes need insulin by injection to survive because the cells can’t be revived once they are destroyed.

Type 2 diabetes is insulin resistance, Siminerio explained. Food is digested and the pancreas makes insulin, but the cells push the sugar back into the bloodstream. The pancreas works harder and eventually gets worn out. Various medications exist to treat insulin resistance, some of which help the pancreas make more insulin, while others work at the liver level, she said.

Nationally, there’s been a 20 percent increase in diabetes cases in America in the past 20 years. But the most alarming fact, Siminerio said, is that diabetes increasingly is striking younger people. There has been a 70 percent increase of what once was considered a senior citizen’s disease among the 30-39 age group, she said.

Employers and insurers are among those most concerned about the impact of the diabetes epidemic. “Medicaid, Medicare and the health care system are going to pay the price for diabetes,” she said.

Rapid changes in society have fueled the rise in diabetes, Siminerio said. A generation ago, children occupied themselves playing ball, riding bikes or roller skating; now they play computer games.

Eating choices also play a role: People eat more junk food and processed foods. Today’s school cafeterias may offer Starbucks cappuccino loaded with whipped cream or other sugar-laden treats. Most kids drink two cans of sugary beverages from vending machines each school day, Siminerio said.

“Our environment has changed,” she said, and our genes simply haven’t caught up to a more sedentary lifestyle. The effects are evident in rising rates of Type 2 diabetes in children. Siminerio, a 27-year veteran of the Children’s Hospital diabetes center, said that a decade ago it was unheard of to see Type 2 diabetes in children. Now, some 200-300 of the 2,000 patients tracked at the center have Type 2, she said. And the numbers are even higher in areas with higher concentrations of non-white children, she said.

“It’s an adult disease that kids are getting at age 10, 11 or 12,” she said. And the earlier onset can lead to its own problems. “These kids are getting the disease so early, the rates for complications for the disease when they get to be in their 20s or 30s are going to be phenomenal,” she said.

Employers and health care providers are concerned about the future costs and what it will mean to productivity and health care costs.

Diabetes cost Americans $132 billion in direct costs in 2002 and the number has risen since then, she said. Many employers are seeking workplace interventions to keep employees healthy in order to avoid some of these costs.

Several studies have changed the way people think about diabetes and its treatment. Pitt researchers in the Diabetes Complication and Control Trial divided more than 1,400 diabetics at 28 sites around the nation into groups that received either standard care or intensive care.

Those in the intensive care group got multiple insulin shots per day, regular glucose testing, close monitoring of diet and plenty of support to keep their blood sugar at or near a normal range. The 10-year study was ended early because it was found that keeping blood sugars close to normal dramatically reduced the risk of complications from diabetes. Siminerio said the study found decreases of 76 percent in blindness, 56 percent in kidney disease and 60 percent in nerve disease complications in those who received the intensive diabetes management.

Another study focused on those with pre-diabetes (sometimes called borderline diabetes) to determine what interventions might prevent the onset of diabetes. The study divided subjects into groups that received a standard care regimen, one that received medication, and one that received lifestyle interventions that included 150 minutes of physical activity each week.

This study also was stopped early when it found a 31 percent reduction in the onset of diabetes for those who received medication, but a 58 percent decrease for those in the lifestyle intervention group.

Getting more active and losing weight were key to the reduction in onset of diabetes, Siminerio said. The lesson learned: “People need to get physically active and lose a little bit of weight.” She added that losing as little as 7 percent of one’s body weight makes a difference.

Siminerio said it’s important for people who have or are at risk for diabetes to advocate for themselves in order to get the best care. Because most diabetes cases are managed by patients’ primary care physicians, the reality is that doctors don’t have time to remember everything that needs to be attended to in what typically is a 10-minute visit.

“People who know more about diabetes get better care,” she said, adding that UPMC offers classes on diabetes management and a toll-free line 800/533-8762, for more information on the disease.

—Kimberly K. Barlow

Filed under: Feature,Volume 39 Issue 6

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