MMS Physician Focus: May 2010
By David M. Harlan, M.D.
An epidemic is a widespread occurrence of a disease at a
specific time, typically involving infectious disease. Examples
include polio in the 1930s, 40s, and 50s (until curtailed by
vaccine), and recently, AIDS and malaria, which still infect
millions, mostly in less developed nations. In the U.S., excellent
resources - public health policies, research and medical
facilities, and dedicated healthcare professionals -- have limited
the severity of potential epidemics. Witness the recent H1N1 swine
flu; our quick response probably minimized illness and death.
Yet despite our medical knowledge and prowess, we're in the
midst of a silent epidemic that shows no signs of easing, with no
end in sight. Indeed, it shows every indication of increasing.
Diabetes affects an estimated 24 million adults and children in
America. Each year, more than 1.5 million new cases are diagnosed
in people 20 years and older. By one estimate, diabetes will nearly
double in the next 25 years, reaching more than 44 million people.
And it's one of the nation's costliest diseases: including direct
and indirect medical costs and lost productivity, the annual cost
of diabetes approaches a staggering $220 billion, more than twice
the cost of all cancers combined.
Those numbers testify to the epidemic nature of this chronic
disease, making it a major public health crisis as much as a
personal medical condition.
Diabetes is a condition of too much glucose, or sugar, in the
blood. Glucose is the body's main ingredient for cell metabolism
and is regulated by insulin, a hormone produced by the pancreas.
Diabetes results when the body doesn't produce enough insulin, or
the body is resistant to insulin's activity.
Different types of diabetes exist. Type 1 diabetes (formerly
juvenile diabetes) results when the immune system kills the cells
in the pancreas that make insulin. Type 1 can occur at any age, but
is often found in children. Type 2 diabetes, accounting for more
than 90 percent of cases, occurs when the pancreas makes insulin
but not enough for the body to function properly. A third type,
gestational, develops during pregnancy when the mother's insulin
needs are high. Pre-diabetes is a condition where blood sugars are
elevated but not high enough to reach the threshold of diabetes.
Clinical studies have shown that those with pre-diabetes often
progress to develop the disease.
The most prevalent, Type 2, is insidious in onset. The few
symptoms (excessive thirst and urination, change in vision) can
develop so gradually that individuals don't recall noticing
anything. That's why there's so much undiagnosed diabetes. The
Centers for Disease Control estimates that nearly six million
people in the U.S. have diabetes and don't know it.
Untreated and uncontrolled, diabetes has devastating
consequences. It's the country's seventh leading cause of death and
a leading cause of blindness, kidney failure, amputations, and
premature mortality. Complications also include heart disease,
stroke, nervous system disease, eye and foot problems.
What causes diabetes? A strong genetic component exists for Type
1 and Type 2, but other factors, such as lifestyle (for example, a
sedentary lifestyle), behavior, and diet also play important roles
in Type 2. Scientists believe it's no accident that the rise in
Type 2 diabetes has gone hand in hand with soaring rates of
obesity.
Early diagnosis is important, so all patients should get
screened. Simple, painless tests can determine if a patient has
diabetes or pre-diabetes. If either is confirmed, basic steps and
behaviors can help control the condition, especially Type 2.
Clinical tests have shown that walking briskly for 30 minutes a day
five days a week, watching your diet, and losing body fat if you're
overweight, can prevent or delay the onset of Type 2. While there's
no cure for diabetes, the good news is that with proper diet,
exercise, and medication, it can be controlled. Diabetes need
not rule your existence.
Diabetes is often treated using a team approach: primary care
provider, specialists as needed (like eye specialists), and a
diabetes educator. The most critical member of that team, however,
is the patient. Only the patient can control diet,
exercise, and lifestyle and be vigilant with medications and
medical follow up.
Patients and providers together must recognize and attack this
all-too-silent epidemic. Only then can we reduce its incidence and
limit its devastating complications. To learn more, visit the
National Diabetes Information Clearinghouse at www.diabetes.niddk.nih.gov/.
For a special video by the Massachusetts Medical Society, visit www.physicianfocus.org
David M. Harlan, M.D., is Chief of Diabetes and Director of
the Diabetes Center of Excellence at the University of
Massachusetts Memorial Medical Center and a Professor of Medicine
at the University of Massachusetts Medical School in Worcester,
Mass. Physician Focus is a public service of the Massachusetts
Medical Society. Readers should use their own judgment when seeking
medical care and consult with their physician for treatment.
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