Type 2 Diabetes, Growing with Our Waistlines

During the 1990s the United States suffered a silent, yet dramatic public health crisis. It was what the Centers for Disease Control (CDC) refers to as "the twin epidemics of diabetes and obesity."

In that decade, there was a 49 percent increase in the number of Americans 18 years of age and older suffering from diabetes. The CDC estimates that 16 million Americans have diabetes and that the number will increase by 165 percent over the next 50 years. 

At the same time the percentage of obese adults (more than 30 pounds overweight) grew from 12 percent of the population to nearly 20 percent. With more than 80 percent of Type 2 diabetes sufferers also diagnosed as being overweight, it is clear that as we become a heavier nation we stand the risk of becoming more susceptible to diabetes. 

What is Diabetes?

Diabetes affects the level of glucose or sugar in the bloodstream. As the main source of nutrition for the body, glucose must be exchanged from our blood to our cells.  The proper amount of insulin, which is created in the pancreas, must be present for this exchange to occur. 

Diabetes is classified as Type 1 or Type 2. In Type 1, insulin-producing cells are damaged or destroyed by the body’s own immune system. The resulting absence or insufficient amount of insulin prevents the glucose from getting into the cells. Recent research has shown that the cause of Type 1 before age 20 is usually genetic. In adults Type 1 is usually brought on by a combination of genetics and lifestyle.  

Type 2 afflicts 90 to 95 percent of sufferers. People with Type 2 usually have enough insulin in their blood stream, but for unknown reasons the body does not use the insulin effectively or overeating has caused glucose levels to rise to a point where the insulin is not fully effective. 

Long-term complications from diabetes include eye and kidney problems as well as heart disease, stroke and poor circulation.

Who is at risk?

The onset of Type 2 is usually linked to changes in the metabolic rate of people over 40. Obesity, inactivity, family history, being a member of a racial minority group (African and Native American particularly), prior diagnoses of gestational diabetes in women and older age are all contributing factors to the development of Type 2. However, during the 1990s, as Americans became heavier, the number of people ages 30-39 with Type 2 diabetes grew by 70 percent. 

It is important to remember, however, that not all overweight people will contract diabetes and not all people with Type 2 diabetes are overweight.

Preventing or Delaying Type 2 Diabetes

There is no absolute way of preventing diabetes, but studies done in this country and in Finland indicate that even modest to moderate lifestyle changes will delay the onset of Type 2 diabetes.

“Walking for 30 minutes each day, coupled with a modest decrease in caloric intake are all that it takes to hold off Type 2 diabetes,” said Stuart R. Chipkin, MD., chief of Endocrinology and Diabetes at Baystate Medical Center in Springfield, MA, and a member of the Committee on Nutrition of the Massachusetts Medical Society.  “Some people may eventually develop diabetes no matter what, but even modest intervention in lifestyle can delay the onset for years.”

One of the factors making Type 2 diabetes so dangerous is that it is possible for it to develop without the presence of any obvious symptoms. Dr. Chipkin says that it's critically important to relay your personal and family medical history to your physician so that the appropriate diagnostic and preventive steps can be taken.

Managing Type 2 Diabetes

There is no cure for diabetes. However, the American Diabetes Association (ADA) believes that long-term complications may be delayed through development of a management plan developed by a team of health care providers consisting of your physician and others.  The plan may include the following:

• Medication - Your physician may prescribe oral diabetes medications as part of your treatment.  
• Proper nutrition - The ADA encourages consultation with a dietician to develop a meal program that properly balances nutrients to help keep blood sugar levels down and weight at the appropriate level  
• Regular exercise and weight loss – Both usually lower blood sugar and may help insulin work better.

The important things to remember about Type 2 diabetes is that with proper diet and exercise it may be avoided and that treatment is available that can help sufferers lead long and healthy lives if they adhere to the basic principles of their management plan.  For more information about diabetes, its symptoms and treatment, log on to the web site of the American Diabetes Association at www.diabetes.org.

-- David Graves

This article is provided as a public service by the Massachusetts Medical Society to offer information about ways to attain good health. For more information, contact Robyn Alie, MMS Department of Public Health and Education, ralie@mms.org, 781-434-7371.