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The Diabetes Epidemic:Keys to Prevention, Guide to Therapy

The Diabetes Epidemic:Keys to Prevention, Guide to Therapy

Diabetes is epidemic! The numbers
are truly alarming. In 1997, official data
showed that 16 million people in the
United States had diabetes. Approximately
1 million had type 1 disease,
and 10.4 million had type 2 disease; the
remainder had undiagnosed diabetes.1
If these numbers are projected out
against an annual increase in disease
prevalence of about 3.5%, it means that
by the year 2028, 50 million people will
have diabetes. However, the actual rate
is closer to 7% each year. As such, approximately
100 million Americans--
roughly 1 of every 4--will have diabetes
by 2028.

What factors underlie this epidemic?
What strategies can we infer
from the causative factors to help us
better prevent and manage diabetes?
The answers to those questions are
the focus of this article.

A BRIEF HISTORY LESSON
Thousands of years ago, humans
were hunter-gatherers. Survival depended
on one's ability to keep moving.
With intermittent availability of food,
those individuals who burned calories
efficiently could, perhaps, go a few extra
days without eating--or travel a few
more miles to find sustenance. One benefit
to this lifestyle: the genetic defects
that manifest in type 2 diabetes--insulin
resistance and defective beta-cell function--
were either never expressed (because
few people lived beyond age 20)
or were not expressed until older age.

Today, of course, most of us have
ample food and lifestyles that require
significantly less physical activity. In
this setting, it is no surprise that more
than 50% of Americans are now obese.
Obesity is a direct cause of insulin resistance.
(If a person has a normal insulin-
producing mechanism, diabetes
will not develop.) We now see type 2
diabetes in children who are overweight
and who lack outlets or motivation
for physical activity. Computers,
video games, and dearth of physical
education programs in many schools
have contributed to this phenomenon.

The aging of the general population
is another factor in the increase in diabetes
cases. As a person gets older, the
beta cell has more opportunity to fail.

Need for lifestyle changes. Given
the factors that underlie the diabetes
epidemic, it is obvious that the first and
best place to start preventing and managing
diabetes is with lifestyle changes.
We need to simulate the old huntergatherer
state (ie, intermittent starvation,
marginal food availability, and the
need to keep moving). The data are
now irrefutable that people who regularly
engage in exercise (such as walking)
and who control their diet can:

  • Prevent or slow the onset of type 2
    diabetes if they are at risk or have impaired
    glucose tolerance (Table 1).2-4
  • Improve their clinical status if they already
    have type 2 diabetes.

Given the time constraints of office
practice, it is particularly difficult
for primary care clinicians to spend
the appropriate amount of time motivating
and educating patients about
the importance of diet and exercise.
Diabetes educators and/or classes that
allow the patient to return as often as
necessary can help him or her achieve
established goals.

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