Thursday, January 12, 2006
THE AMERICAN DIABETES EPIDEMIC
During recent years, doctors have grown alarmed by the explosive rise of diabetes in the U.S. Local, state and federal officials share that concern. Diabetes is growing quickly, even as other scourges such as heart disease and cancers are stable or in decline.
The Centers for Disease Control (CDC) reports that nearly 21 million Americans are believed to be diabetic, and the ranks of diabetics have swelled by a staggering 80 percent in the last decade.
Everyday, 4,100 people are diagnosed with the disease. This sharp rise in diabetes cases over the past decade has led the CDC to describe the situation as an epidemic.
And, according to the American Diabetes Association, approximately 6.2 million people are presently undiagnosed.
But this problem will only worsen. Another 41 million Americans are prediabetic; their blood sugar is high, and could reach the diabetic level if they do not alter their living habits.
In 2002, diabetes followed heart disease, cancer, stroke, chronic respiratory diseases and accidents as the leading causes of death in the U.S.
The American Diabetes Association says the disease could actually lower the average life expectancy of Americans for the first time in more than a century. Diabetes is thought to shave 5 to 10 years off a life.
But the death isn't the only concern. The degenerate quality of life associated with diabetes is of equal concern. A diabetic's final years can be downright miserable and agonizing.
As alarmed as health officials are about the present, they worry more about what's to come.
Doctors fear that, within a generation or so, a huge wave of new cases could overwhelm the public health system and engulf growing numbers of the young, creating a nation where hospitals are swamped by the effects of the disease.
Schools could be scrambling for resources while trying to accommodate diabetic children, and the work force could abound with the blind and the infirmed.
It's predicted that in coming years there will be too few hospitable beds for diabetics and the disease will place unsupportable drains on Medicaid and Medicare.
Right now, on any given day at certain New York hospitals, nearly half the patients are there for some illness related to diabetes.
One in three children born in the United States five years ago are expected to become diabetic in their lifetimes, according to a projection by the Centers for Disease Control and Prevention.
The forecast is even bleaker for Latinos: one in every two.
Type 2 diabetes, the predominant form of the disease which accounts for 90%-95% of all cases, is creeping into children, something almost unheard of two decades ago.
Diabetes has no cure. It is progressive and often fatal, and even while the patient lives, the assortment of medical complications it sets off can attack every major organ.
People typically have diabetes for 7 to 10 years before it is even diagnosed, and by that time it will often have begun to set off grievous consequences.
Many of the chronic problems related to diabetes arise from damage to the blood vessels. Among the disorders that plague diabetics are vision loss or blindness.
Other maladies include infection and gangrene — which sometimes require limb amputation — kidney failure, heart disease and stroke.
In fact, diabetes is the most common cause of adult kidney failure, amputation, and blindness among non-elderly adults in the US.
According to the Centers for Disease Control, diabetics are two to four times more likely than others to develop heart disease or have a stroke, and three times more likely to die of complications from flu or pneumonia.
Most diabetics suffer nervous-system damage and poor circulation, which can lead to amputations of toes, feet and entire legs; even a tiny cut on the foot can lead to gangrene because it will not be seen or felt.
Each of these symptoms is extremely expensive to treat. Diabetes is enormously burdensome for healthcare systems and governments.
Nationwide, the disease's cost just for 2002 — from medical bills to disability payments and lost workdays — was conservatively put by the American Diabetes Association at $132 billion.
All cancers, taken together, cost the country an estimated $171 billion a year.
The forces that are driving diabetes nationally are an aging population, a food supply riddled with sugars and fats, and a culture that promotes overeating and discourages exercise.
Type 2 diabetes has grown commensurately with obesity, and America is becoming fatter. Fully two-thirds of Americans are overweight or obese.
A federal program studied people around the country at high risk of getting diabetes, and concluded that 58 percent of new diabetes cases could be postponed by shifts in behavior — most notably, shedding pounds.
Since Type 2 is spurred by obesity and inactivity, it can possibly be prevented by eating less and exercising more. But doctors say that getting millions of people to change their behavior will require some kind of national crusade.
By all indications, such a crusade needs to begin immediately.
According to the Journal of the American Medical Association, about half of all deaths in the U.S. can be attributed to largely preventable behaviors and exposures. Tobacco use, poor diet, and physical inactivity account for the majority of preventable deaths.
Doctors anticipate that poor diet and physical inactivity may soon overtake tobacco as the leading cause of death in the U.S.
Unfortunately, resources for fighting diabetes have been largely diverted to other, less urgent diseases.
For years, public health authorities around the country have all but ignored chronic illnesses like diabetes, focusing instead on communicable diseases, which kill far fewer people.
For example, New York has just three people and a $950,000 budget to outwit diabetes, a disease soon expected to afflict more than a million people in the city.
On the other hand, Tuberculosis, which infected about 1,000 New Yorkers last year, gets $27 million and a staff of almost 400.
Apathy and ignorance, combined with powerful lobbying by the food industry, are the confluence of forces that have allowed the scourge that is diabetes to flourish.
It will require the dedicated and joint efforts of the medical community, schools, insurance companies, legislators, and even churches to inform and persuade the public of the risks at hand.
Our nation's economy will be burdened as tax dollars that should be allocated elsewhere are directed toward diabetes treatment in coming years.
And the human costs are exceptionally high as well.
People don't die quickly with diabetes, but can linger for years dying a long, slow death. The burden of caring for them often falls on their loved ones.
So even those not directly afflicted are still affected. That means there is something for everyone in this effort.
There is much to gain, and even more to lose, for the entire nation.