Diabetes grows as silent scourge

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 blood-glucose 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 predominantly 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 high-calorie 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.

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