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The "Obesity" (Diabetes) Epidemic.

April 6, 2009

Matthew Vasey, MD




Diabetes is a disease of the body's metabolism characterized by reduced utilization of sugars with a compensatory utilization of proteins and fats. It is the result of an absolute or relative shortage of the hormone insulin. There are two predominant types, type 1 and type 2. About 10% of those with diabetes are type 1, also called "insulin dependent diabetes mellitus" which most commonly develops quickly, prior to your teenage years. The other 90% are type 2, also called "non-insulin dependent diabetes mellitus" which most commonly develops in overweight people in their thirties and beyond. There are other types termed "pre-diabetes" for those who do not yet meet criteria for type 2 and "gestational diabetes" which can occur in pregnancy.

Insulin is a hormone that is required for the appropriate management of sugars in your blood that enter during digestion with nearly every bite of food. In type 1, the body does not make insulin. In type 2, the body makes insulin however, for what can be a variety of reasons it is no longer effective, the major one of which is unhealthy lifestyle (6 ).

To recap, in type 1, you don't have insulin but your body is able to respond to it ergo insulin injections to maintain healthy blood sugar levels. In type 2, you had insulin, your body used to respond to it, but now not so well. A lifetime of increased insulin secretion causes either your pancreas to stop making it, or your tissues to stop responding to it. In essence there is an acquired exhaustion of, or insensitivity to insulin. Medications other than insulin injections are initially required to maintain healthy blood sugar levels.

A group of doctors studied 84,941 nurses initially without diabetes for 16 years. During that time, 3300 new cases of type 2 diabetes developed. (6) That's potentially four people per every one hundred Facebook.com friends that will develop type 2 diabetes in their lifetime. They found that being overweight or obese was the single most important predictor for developing type 2 diabetes. They concluded that the majority of type 2 diabetes could be prevented by the adoption of a healthier lifestyle. (6) Their specific recommendations include weight loss, regular exercise, healthy diet, abstinence from smoking and yes, regular consumption of a limited amount of alcohol (less than 10 g, which is less than either one beer, one glass of wine, or one shot, not all three together). (6)

While the cause of type 1 is largely unknown, type 2 - lifestyle diabetes is getting so common in the United States that it is predicted that by 2050, 7% percent of Americans will have type 2 diabetes (1). In 2002, an estimated $132 billion was spent on diabetes (5). Diabetes expenses represented 10% of all health care costs in 2002. (5) So what is all that money spent on? Well, those with type 2 diabetes are at risk for a lot of health issues including: heart disease, blindness, kidney failure, amputations, fractures, depression, and reduction in brain function. (4)

It is important for those without diabetes to understand the importance of prevention. It is equally important for those with diabetes to understand the potentially serious nature of their illness and the need to take control of their diabetes. Routine eye examinations are important as there are effective treatments if warranted to prevent blindness (3). Understanding good foot care can delay or prevent foot and limb amputations. (8) Routine urine tests to watch for kidney damage as there are very effective medications for delaying harmful changes that precipitate the need for dialysis therapy. (2) Perhaps most importantly, diligent heart and blood vessel protective measures can prevent or delay heart related diabetes deaths. (9) Alarmingly, A study of 80,000 diabetic patients revealed that only 4% patients had achieved the recommended levels for A1C (a measure of blood sugar), cholesterol and blood pressure. (7) Such a low percentage is tragic as all these measures are easily managed with safe medications.

Dealing with any medical illness can be a challenge. The most important thing a person can do is to educate themselves about their disease, not to ignore it. There are a lot of great therapies that exist for people with diabetes. Have a close relationship with a doctor who can help put you in control of your diabetes, be proactive. Lifestyle choices play a significant role in the development of type 2 diabetes and should inspire those without the disease to continue on their path of prevention.

REFERENCES:
1. Boyle JP, Honeycutt AA, Narayan KM, et al. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care. 2001;24(11):1936-1940.
2. Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. The microalbuminuria captopril study group. Diabetologia 1996; 39:587.
3. Correctable visual impairment among persons with diabetes - United States. 1999-2004. MMWR Morb Mortal Weekly Report 2006; 55:1169.
4. Goff DC Jr, Gerstein HC Ginsberg HN, et al. Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rational for the action to control cardiovascular risk in diabetes (ACCORD) trial. American Journal of Cardiology. 2007;99:4i-20i.
5. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the U.S. in 2002. Diabetes Care. 2003.;26(3):917-932.
6. Hu F, Manson J, Stampfer M, et al. Diet, lifestyle and the risk of type 2 diabetes mellitus in women. New England Journal of Medicine. 2001;345(11):790-797.
7. Jackson GL, Edelman D, Weinberger M. Simultaneous control of intermediate diabetes outcomes among veterans affairs primary care patients. Journal of General Internal Medicine. 2006;21:1050.
8. Standards of medical care in diabetes - 2008. Diabetes Care 2008;31 Supp 1:S12.
9. Yudkin JS. How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. British Medical Journal. 1993;306:1313.


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