The huge burden of diabetes - and the rest of the story   (January 26, 2009)

The NIH has just released a press release about diabetes, New Survey Results Show Huge Burden of Diabetes. (The survey itself is published in Diabetes Care, A full accounting of diabetes and prediabetes in the U.S. population, 1988-1994 and 2005-2006. It included 7,267 people, who represented a national sample of persons age 12 years and older. It was done in 2005-2006, and included a comparison to earlier results from 1988-1994.)

For those of us who deal with diabetes every day, there's nothing surprising in the press release, but for folks who are unfamiliar with the impact of diabetes in the United States (and worldwide), it's an eye-opener:

* In the United States, nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed.

* An additional 30 percent of adults have pre-diabetes. [Folks with pre-diabetes are widely considered to be at high risk of developing full-fledged diabetes unless lifestyle changes are implemented.]

* Nearly one-third of those age 65 and older have the disease.

* The prevalence of diabetes, both diagnosed and undiagnosed, in non-Hispanic blacks and Mexican-Americans is about 70 to 80 percent higher than that of non-Hispanic whites. [Diabetes is not an equal-opportunity disease: although common in whites, it's even more common in American minorities, including blacks, Latinos, Native Americans, and Pacific Islanders.]

* Diabetes prevalence was virtually the same in men and women, as was the proportion of undiagnosed cases, but interestingly, pre-diabetes is "much higher" in men than in women (36 percent compared to 23 percent). [I don't understand the pre-diabetes sex discrepancy, nor did the authors, who stated "These observations currently lack explanation."]

Sadly, although the authors analyzed results by age, sex, and ethnicity, the published results of the survey do not include comparisons by weight or BMI -- in fact, "BMI" doesn't even show up in the published report in Diabetes Care. It would have been much more helpful to see if increasing weight led to increasing glucose levels, as might well be expected.

The press release continued with commentaries from key leaders in the government's activities to control diabetes:

"These findings have grave implications for our health care system, which is already struggling to provide care for millions of diabetes patients, many of whom belong to vulnerable groups, such as the elderly or minorities" said Griffin P. Rodgers, M.D., director of the NIDDK. "Of paramount importance is the need to curb the obesity epidemic, which is the main factor driving the rise in type 2 diabetes."

"Re-directing the trends in diabetes will require changing the nutritional and physical activity habits of people at risk, and also creative and substantial efforts by health systems and communities," said Ed Gregg, Ph.D., epidemiology and statistics branch chief in CDC's Division of Diabetes Translation.

"It's important to know if you have diabetes or pre-diabetes, because there's so much you can do to preserve your health," said Joanne Gallivan, M.S., R.D., director of the National Diabetes Education Program (NDEP) for the NIH. "You should talk to your health care professional about your risk. If your blood glucose is high but not high enough to be diagnosed as diabetes, losing a modest amount of weight and increasing physical activity will greatly lower your risk of getting type 2 diabetes. If you already have diabetes, controlling your blood glucose, blood pressure, and cholesterol will prevent or delay the complications of diabetes."

To which I can only add: "Amen."

I certainly hope that the media picks up this story and publicizes it widely: Diabetes is common, and growing more common as the problem of obesity continues expanding. But the rest of the story, not described in the survey results, is that diabetes, although potentially disabling and deadly, is controllable. And that's the real message that we have to get out to the world.