- The Washington Times - Sunday, January 7, 2007

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.

“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 percent 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 blood-sugar 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.

Evidence indicates that Type 2 diabetes 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 develop 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 stem-cell 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.

Despite rising diabetes caseloads and deaths, federal research funding is being reduced. Support for diabetes from the National Institutes of Health remained at $1.06 billion in fiscal 2005 and 2006, but will drop 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.

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