Diabetes hits ‘epidemic’ proportions
William Herman has spent decades researching diabetes, treating patients grappling with complications from it and trying to educate people on how to prevent it. During those same years, he has witnessed instances of the disease grow virtually unabated.
“It really is an epidemic, both in the U.S. and globally,” said Herman, director of the University of Michigan’s Center for Diabetes Translational Research and a consultant to the World Health Organization.
The statistics are staggering. More than 29 million Americans, or 9.3 percent of the population, have diabetes — but a quarter of them don’t realize it, according to the Centers for Disease Control and Prevention. And 86 million Americans have pre-diabetes, which is marked by higher-than-normal blood-sugar levels and puts them at an elevated risk of developing diabetes. The WHO estimates that nearly 350 million people worldwide have the condition.
Year after year, diabetes exacts a huge human and economic toll. Those who have it are at a higher risk of heart disease, stroke, kidney failure and blindness, and of losing toes, feet and legs to amputation. The risk of death for adults with diabetes is 50 percent higher than it is for adults without the disease, according to the CDC.
“The costs of diabetes are enormous, and they are growing,” Herman said. “People with diabetes account for a substantial portion of the total cost of health care in the United States.”
Medical expenses tend to be twice as high, on average, for people with diabetes than for those without the disease. Collectively, it costs the health system an estimated $250 billion a year, including major amounts of lost work and productivity. That includes billions spent on inpatient care, doctor’s visits, medication and supplies, such as glucose monitoring strips. The American Diabetes Association estimates that treating patients with the disease accounts for more than $1 of every $5 spent on health care in the United States.
“It has affected all segments of the population,” said Edward Gregg, chief of the epidemiology and statistics branch of the CDC’s diabetes division. “But it hasn’t affected everyone equally.”
The risks generally increase with age, but a growing number of people younger than 20 are diagnosed with diabetes. Asian-Americans, African-Americans, Hispanics and Native Americans all have higher rates of the disease than whites, and those who live in areas of extreme poverty have been hit particularly hard.
The CDC found that diabetes diagnoses increased between 1995 and 2010 in every state, including by 50 percent or more in 42 states. During that period, the number of cases in the country more than doubled.
Despite the immense number of people who have diabetes, it has not triggered national alarm. Other illnesses, such as cancer and Alzheimer’s disease, often garner more attention. One reason is that people with diabetes sometimes go years before they experience any decline in their quality of life. When complications surface, they often do so gradually and manifest in various ways. People don’t always recognize diabetes as the source of severe health problems.
In fact, the CDC says diabetes is underreported as a cause of death, even though it is the seventh-leading cause of death in the United States. For instance, the numbers of people listed as dying each year from heart disease and stroke are larger than they are for diabetes, but many of those people had diabetes as an underlying condition.
Before the nation can turn the tide of the epidemic, society must recognize diabetes as the pervasive killer it is, said Marjorie Cypress, a nurse practitioner for ABQ Health Partners in New Mexico and president of health care and education for the ADA.
“We have to convince people this is a serious disease,” she said. “It really needs to be a big push on every level.”
The overwhelming majority of diabetes cases — as many as 95 percent — involve the Type 2 form of the disease. It occurs when the pancreas can no longer make enough of a hormone called insulin, and the body cannot effectively use the insulin being produced — a condition known as insulin resistance. The result is a build-up of glucose levels in the blood, which over time can harm the kidneys, eyes, nerves and heart.
Early symptoms can include frequent urination, excessive thirst, persistent fatigue and a tingling or numbness in the hands or feet. Or there may be no symptoms until long after someone has developed diabetes, which is one reason doctors have placed a growing emphasis on early screening.
Although genetics play a role in a person’s risk for the disease, the increase in diabetes diagnoses is largely attributable to lifestyle changes, Gregg said. The disease is closely associated with high blood pressure and cholesterol, poor diets, obesity and a lack of exercise. The good news is that improvements in diet and lifestyle can go a long way toward delaying or preventing the disease. The trick is to help people find effective ways to change their habits.
“Lifestyle interventions have been shown to be very effective when targeted at people with very high risk for diabetes,” Herman said. “The major opportunity going forward is to get those interventions into routine clinical practice.”