The diabetes epidemic

Americans increasingly fighting a disease many brought on themselves
By Peggy O'Farrell • pofarrell@enquirer.com •
October 25, 2010

A study from Cincinnati Children's Hospital Medical Center found a 10-fold increase in Type 2 diabetes among adolescents.

Authors of the study blamed an increase in obesity, and warned the spike in diabetes could have dire consequences as those youths hit adulthood.

That was in 1996.

The Cincinnati Children's study was one of the first that said America's weight problem was serious, and urged that calories be cut and physical activity increased.

Since then, the outlook has gotten worse for Americans. That was confirmed Friday in a report released by the Centers for Disease Control and Prevention that said cases of diabetes are projected to double - even triple - in the next 40 years. According to the report, 1 in 10 U.S. adults have diabetes. By 2050, as many as 1 in 3 could have the disease.

It's a disaster in the making, experts say, and it's a disaster Americans helped make themselves.

"Our society is engineered to make us unhealthy," said Lisa Simpson, a pediatrician and the director of the Child Policy Research Center at Cincinnati Children's. "Diabetes is just one of the consequences of decades of choices that have led to the obesity epidemic."

Since the 1970s, diabetes incidence has doubled, with most of that increase linked to obesity.

In 2007, 23.6 million Americans had diabetes, and about 90 percent was Type 2 diabetes, a metabolic disorder in which the body can't effectively use insulin to convert glucose into energy.

In Greater Cincinnati and Northern Kentucky, health-care professionals and researchers are trying to reverse the spike in Type 2 diabetes with aggressive outreach to people at risk for the disease and by focusing on teaching patients and their health-care providers how to tightly manage diabetes.

That means teaching people to exercise more, eat healthy and lose weight - three lessons many won't learn until their lives depend on it.

In 2008, diabetes' total economic impact, including lost productivity, added up to $187 billion.

That figure doesn't tell the whole story: Diabetes is the seventh-leading cause of death in the U.S., and a leading contributor to heart disease, stroke, blindness, kidney failure and a host of other ailments - all on the rise as baby boomers age.

To put it in perspective,
· diabetes kills about 72,000 Americans a year.
· Heart disease kills more than 630,000 Americans a year, and
· its economic impact is $316 billion –
· nine times the number of fatalities, but less than double the cost.

In 2004, 71,000 amputations were performed in the U.S. because of the damage done by diabetes.

Scientists have even identified a link between Type 2 diabetes and Alzheimer's disease.

In Type 2 diabetes, the body can't properly use the hormone insulin to convert glucose from food into energy. The glucose then builds up and begins damaging blood vessels.

Type 2 diabetes can take years to develop. Weight loss can prevent it, or reverse it once it develops.

Some people with Type 2 diabetes may need to inject insulin; others use medications that reduce the amount of glucose produced by the liver or increase the amount of insulin produced by the pancreas.

Those medications aren't cheap.

Gary Breeden, 63, of Dry Ridge injects insulin four times a day to help control his Type 2 diabetes, and also takes other medications for his heart and kidney disease.

The insulin alone costs him $1,000 a month.

"No one can afford that," Breeden said. His doctors help him out with free samples.

Breeden was diagnosed with Type 2 diabetes when he was in his "late 30s or early 40s," he said.

He ignored his doctor's advice to lose weight and eat better, and his diabetes spiraled out of control.

He now undergoes dialysis three days a week, and he's lost a leg and part of a foot to the disease. It's also done significant damage to his heart. He's had bypass surgery, and his heart function is at about 35 percent.

Doctors are used to seeing Type 2 diabetes in people Breeden's age. But an increasing number of Type 2 diabetes cases in children and teens has experts worried.

When the 1996 study came out from Cincinnati Children's, Type 2 diabetes was just appearing on the radar screen for pediatricians. The Cincinnati Children's study was one of the first looking at the incidence of the disease in white and African-American children; other studies looked at Native American and Canadian native
populations.

In the late 1980s and into the early 1990s, doctors at the Corryville hospital might diagnose two or three teenagers with Type 2 diabetes a year, said Larry Dolan, director of the hospital's endocrinology division. Today, they're making that diagnosis about 25 times a year, about 10 times as often. The increase seemed to happen
almost overnight, Dolan said.

"The big question is why all of a sudden did that change take place?" he asked.

The increase in obesity is one culprit, experts believe. Others also say that infants born to women who develop gestational diabetes are more at risk to develop Type 2 diabetes themselves.

While doctors are seeing more Type 2 diabetes in children and teens, Dolan won't call it an epidemic. Type 1 diabetes is still the predominant disease in children and teens.

"It's still a small percentage of kids who actually have Type 2 diabetes," he said. "It is a significant problem, and the numbers have increased significantly, and if we don't do something about it, the numbers will continue to increase, and the disease can have catastrophic effects on those individuals."

Dolan and his colleagues are trying to figure out the best way to manage diabetes in teens.

The problem, experts say, is that the longer youth live with the disease, the greater the risk they'll suffer serious consequences from it as they reach adulthood.

That could mean people who developed Type 2 diabetes as teens will be suffering heart attacks, amputations or kidney failure in their 30s and 40s.

That concerns Linda Hermiller, endocrinologist and director of the St. Elizabeth Healthcare Regional Diabetes Center in Covington.

"I often tell my patients, especially the younger ones who really aren't as focused on their diabetes as they need to be, '45-year-old you can't come back through time and tell 20-year-old you to fix this. It'll be too late. You can't undo the damage. You have to prevent it.' "

Something better than bypass

Researchers are looking for interventions that will stop Type 2 diabetes in its tracks.

Work at Cincinnati Children's Hospital Medical Center has shown that gastric bypass surgery, which causes weight loss by reducing the size of the stomach and limiting the calories the body can absorb, is an effective cure in teens.

At the University of Cincinnati, researchers are trying to discover why the surgery works and how they can get its effects in a less invasive and less expensive way.

UC, Children's and University Hospital teamed up earlier this year to form the Cincinnati Diabetes and Obesity Center, which aims to improve diabetes care and treatment in the region.

In Type 2 diabetes, cells stop communicating properly. Researchers Randy Seeley and Matthias Tschoep are trying to pinpoint where that breakdown happens and find a way to prevent it.

Weight loss is probably the most effective treatment, though it's not an easy one.

Taylor Sutton, 21, learned she had Type 2 diabetes when she was 12.

In middle school, her weight ballooned to over 300 pounds. Sutton, now a student at Ohio State University, had to take insulin and other medications. She dropped some weight and changed her diet.

But it wasn't until her freshman year in college that she got serious about treating it.

Since then, she's shed about 70 pounds and has made exercise a priority. Her weight is now at about 190, and she hopes to get to 160.

And her Type 2 diabetes is gone.

"I'm definitely a lot healthier now, and I'm able to do a lot more activities without feeling embarrassed," she said.

DiAnn Jones, 56, of Bond Hill, has lost 17 pounds since she signed for the Healthy Leadership Initiative Challenge at her church, New St. John Baptist in Avondale, at the end of June.

She learned she had Type 2 diabetes about eight years ago.

Through the initiative, sponsored by the Center for Closing the Health Gap, churches challenge their members to eat healthier and lose weight.

At Jones' church, that's meant adding a weekly exercise class for members and bringing in a nutritionist to help "make over" favorite recipes. They've also slimmed down their weekly church supper menus, she said.

Jones said her blood pressure has improved, and she's hopeful that one day her diabetes will just be a memory.

"My goal is to get off all my medications," she said.

The best treatment for Type 2 diabetes is prevention.

For most people, that means preventing obesity - and that's a tall order, said Cincinnati Children's Simpson.

A culture of easy weight

American culture makes gaining weight easy: Fast food is cheap and plentiful, and in many communities, it's difficult to get fresh fruits and vegetables and other healthy foods.

In suburban communities, there might not be sidewalks, making it difficult to walk or bike on errands.

In city neighborhoods, it might not be safe for children or adults to spend time outside playing or exercising, she said.

"We're at the end of the spectrum where it's easiest to do the wrong thing," Simpson said.

Initiatives are under way in Greater Cincinnati and Northern Kentucky are under way to help the region slim down.

Hamilton County Public Health has received almost $8 million in federal grants for two initiatives aimed at preventing obesity by helping communities set up community gardens or improve access to spaces for physical activity.

The health department is also working with local schools to make their food offerings, including vending machines, healthier.

The Center for Closing the Health Gap offers its "Do Right" and "Take One Step" initiatives.

The "Go Vibrant" initiative aims to help the region eat healthier and exercise more.

"We have to redesign the community so making the right choice is easier," Simpson said. "We have to make the choices doable, so families can not only find but afford healthier options."


http://news.cincinnati.com/article/20101025/EDIT03/10240356/1055/NEWS/The-diabetes-epidemic

http://bionutritionalresearch.olhblogspace.com

http://back2basicnutrition.com/