The Great Diabetes Epidemic

March 27, 2015
Taken from the March/April 2015 issue of the Women's Health Activist Newsletter.

Now compare that response to the lack of public outcry about the 281,400 deaths in 2010 from a different epidemic: Diabetes mellitus! That number is about the population of Toledo, Ohio, but the nation has not yet truly mobilized to address this very real threat.

In 1994, the head of the Centers for Disease Control and Prevention’s (CDC) diabetes program declared that diabetes had reached epidemic proportions and should be considered as a major public health problem. Yet, in the last 20 years, we have failed to apply a dedicated and focused public health approach to diabetes; as a result, Type 2 Diabetes’ incidence has tripled, and deaths and serious complications have skyrocketed.

As of 2012, almost 30 million people in the U.S. were thought to have Type 2 Diabetes — more than 9 percent of the population.1 Over one-quarter (27 percent) of those individuals have not been diagnosed and are not in treatment.2 An additional 86 million have pre-diabetes and are at-risk for developing diabetes (up from 79 million in 2010); of these, 90 percent are unaware of their condition, and 5 to 10 percent will progress to full diabetes annually.3

Diabetes occurs when the body either does not make enough insulin or cannot use it effectively. Type 2 Diabetes is the gateway to many serious complications, as the excess blood sugar (hyperglycemia) results in progressive damage to large and small blood vessels. The resulting common and debilitating complications include heart disease, stroke, and the “BAD Complications” (Blindness, Amputations of lower extremities, and Dialysis due to kidney failure). Diabetes is responsible for about half of all new U.S. cases of BAD complications. The economic burden of diabetes and pre-diabetes is huge: an estimated $322 billion.4

That’s the bad news. The good news is that we can fight this epidemic and prevent or delay Type 2 Diabetes; with early diagnosis and optimal treatment, diabetic complications can also be delayed and prevented.

The personal and economic costs of Type 2 Diabetes highlight the need to commit the public and political will — and resources — to deal with the burden and address both social and individual risk factors. We know what to do; we just haven’t done it yet. We can reverse the epidemic’s tide, but, to do so, we must change our approach. As four distinguished endocrinologists noted recently, “As diabetes develops, we are currently wasting about the first 10 years of the [disease’s] natural history. If we found pre-diabetes and early diabetes [by screening] and treated it more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications.”5

Type 2 Diabetes is a non-contagious epidemic and a societal problem — not just an individual health condition. As with most U.S. health problems, it disproportionately impacts those who are disenfranchised. While diabetes can strike anyone, some are at greater risk: people of color; low-income individuals; and those who lack access to information, support, and health care. People are most at-risk when they lack access to healthy foods, recreational opportunities, and health care information and services.

For that reason, a successful approach to eradicating Type 2 Diabetes includes:

  1. Screening all adults, starting with seniors and then focusing on those over age 45;
  2. Developing state population-based diabetes registries and reporting all new cases to those databases;
  3. Raising awareness about diabetes in pre-school, schools, and throughout the community;
  4. Implementing broad-based community diabetes prevention and control programs to identify and help treat Type 2 Diabetes in the community;
  5. Offering accessible, affordable prevention activities in every community (e.g. the “Diabetes Prevention Program”);
  6. Establishing “Community Diabetes Care and Self-Management Centers” to help individuals and health care providers address all aspects of diabetes, and prevent its complications.

Here are some actions you can take:

  1. Learn what diabetes’ impact is on your state and county at the CDC’s website (http://www.cdc.gov/diabetes/data); share this information with your elected officials and local public health officials, and ask them what their current and future plans are to address the epidemic.
  2. Advocate for your community to address the problems that increase risk — lack of access to health information and services, healthy food, and physical activity — by implementing effective prevention efforts.
  3. Support programs that screen community members for diabetes and connect them to health care to reduce their risk and access needed medical services.

Despite spending a third of a trillion dollars on diabetes treatment annually, our current approach is not working. We need to take an aggressive public health approach, with universal screening to find pre-diabetes and early diabetes, provision of optimal care for patients; and addressing the social and community factors that increase people’s risk for the disease. Working together we can make diabetes a preventable disease!

Dr. Gilbert H. Friedell, M.D. is an Emeritus Professor of Behavioral Science at the University of Kentucky.

Mr. J. Isaac Joyner, MPH has been an active member of health departments in South Carolina, Texas, and Kentucky. They are the co-authors of "The Great Diabetes Epidemic: A Manifesto for Control and Prevention', Butler Books, October, 2014.

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References

1. American Diabetes Association, Statistics About Diabetes. Available online at: http://www.diabetes.org/diabetes-basics/statistics

2. American Diabetes Association, Statistics About Diabetes. Available online at: http://www.diabetes.org/diabetes-basics/statistics

3. American Diabetes Association, Statistics About Diabetes. Available online at: http://www.diabetes.org/diabetes-basics/statistics

4. Dall TM, Yang W, Halder P, et al., “The Economic Burden of Elevated Blood Glucose Levels in 2012: Diagnosed and Undiagnosed Diabetes, Gestational Diabetes Mellitus, and Prediabetes,” Diabetes Care 2014; 37(12): 3172-3179. doi: 10.2337/dc14-1036. Available online at: http://care.diabetesjournals.org/content/37/12/3172.full

5. Phillips L, Ratner R, Buse J, et al., “We Can Change the Natural History of Type 2 Diabetes,” Diabetes Care 2014; 37(10): 2668-2676. doi: 10.2337/dc14-0817. Available online at: http://care.diabetesjournals.org/content/37/10/2668.abstract?sid=0f07eba8-84ae-4468-8006-5c900ed79215