Treating Type 2 Diabetes: Today and Tomorrow - Episode 1
Jennifer B. Green, MD, and Dennis Bruemmer, MD, PhD, discuss the increasing prevalence of type 2 diabetes around the world, and the populations facing higher risk.
Jennifer B. Green, MD: Hi, everyone. Welcome to this HCPLive® Peers & Perspectives presentation titled “Treating Type 2 Diabetes: Today and Tomorrow.” I’m Dr Jennifer Green. I’m a professor of medicine in the division of endocrinology at Duke University in North Carolina. I’m joined today by a friend and colleague, Dennis Bruemmer, professor of medicine at the Cleveland Clinic Lerner School of Medicine in Ohio. Welcome, Dennis.
I’m really excited for today’s conversation. We have a whole host of topics to cover related to recent developments in type 2 diabetes, so we may as well dive right in. Every lecture or conference that I attend on type 2 diabetes always touches a little on the increasing prevalence of type 2 diabetes around the world. Would you like to make any comments about what we’ve seen happen in the last decade or so regarding the prevalence of type 2 diabetes and any particular populations that may be affected to markedly greater degrees than others?
Dennis Bruemmer, MD, PhD: Jennifer, thank you so much for having me today. I’m really excited about this opportunity to discuss with you what we as endocrinology and cardiology colleagues find important about diabetes management, where we stand, where we go from here, and how we best treat this condition.
With respect to your question, when we discuss the prevalence of type 2 diabetes, one of the most disturbing trends that I see is the increased prevalence of prediabetes among adolescents. There’s a recent journal article published in JAMA [Journal of the American Medical Association] Pediatrics that outlined that 18% of adolescents, teenagers in the United States have a diagnosis of prediabetes. That’s about 1 out of every 5 kids faced with that. As you know, the risk of progression from prediabetes to type 2 diabetes is quite high. But in terms of magnitude of what we’re discussing and being faced with as physicians is, in the United States, half the population has either a diagnosis of prediabetes or overt type 2 diabetes. This is a huge problem that we’re dealing with. We’ve just begun to understand the magnitude of the problem, and we obviously have a lot of work to do to tackle it.
Jennifer B. Green, MD: I agree. I think along those same lines, we’ve just seen the USPSTF [United States Preventive Services Task Force] recommend that essentially all adults begin screening for diabetes, or even prediabetes, at the age of 35, which is 10 years younger than the ADA [American Diabetes Association] recommendations. There’s increasing recognition that many younger people have type 2 diabetes. And we’ve known all along that an enormous number of people have prediabetes, or frank diabetes, and are unaware of that. The screening practices recommended by the USPSTF will probably uncover a number of cases and individuals who will hopefully benefit from intervention at that time.
I really appreciate that you brought up the increasing concern about type 2 diabetes in youth. Interestingly, what we’ve seen in our local institution’s patient population is an increase in the rates at which we’re diagnosing type 2 diabetes in youth and adolescents, particularly during the COVID-19 pandemic. That may have something to do with decreased activity, interruptions in access to health care, kids not going to school, and kids eating differently. That’s reflecting what we’re seeing in the adult population, so there will be very serious implications from a diabetes perspective in young people in this country.
The other thing I want to make sure I mention before we move on, because we have a lot to talk about, is that when people develop type 2 diabetes at a young age, you would tend to think that because those individuals are young, they’re at lower risk of complications. Unfortunately, the opposite is true. When individuals develop type 2 diabetes at young ages, they tend to have their complications progress very rapidly. We’ve seen in some nice publications recently in Diabetes Care that young people who have established chronic kidney disease or heart disease have very significantly attenuated life expectancy, so this is a major epidemic with very serious implications for care in this country and elsewhere moving forward.
Dennis Bruemmer, MD, PhD: To add to that discussion, the disparities are becoming a major concern. The African American population is 60% more likely to be diagnosed with type 2 diabetes. And looking at young African American males in particular, their risk for myocardial infarction is substantially higher. Essentially all types of cardiovascular complications that we see become more frequent. This is a big area in which we need to be working.
Jennifer B. Green, MD: Right. And it’s not all bad news. We know that we have very effective interventions to reduce the risk of these complications once someone is diagnosed with diabetes, and we have a number of ways to reduce the risk of progression from prediabetes to diabetes in individuals who are at risk. But awareness is the key.
We know that diabetes unfortunately has an adverse impact on quality of life, but strategies designed to reduce the risk of complications are going to be of critical importance in minimizing that adverse impact. That follows along with what we’ve been talking about, but it can be very costly to do that. Cost considerations can be very complex. There are costs associated with diabetes prevention and treatment, but if those things aren’t implemented effectively, the societal costs will be far greater. We need to think very carefully about costs and weigh the costs of care vs the costs of complications, particularly in young people and populations who are, as you mentioned, disproportionately affected.
Thank you, Dr Bruemmer. And I’d like to thank everyone for watching this HCPLive® Peers & Perspectives. If you enjoyed the content, please subscribe to the e-newsletters to receive upcoming Peers & Perspectives and other great content right in your inbox. Thank you very much.
Transcript edited for clarity.