Diabetes Rages, but Research and Treatments Offer Hope
For National Diabetes Awareness Month: the recent gains and continuing challenges
In recent years, our nation has scored significant victories in its battle with diabetes. The number of new cases has started to fall after decades of increases. The rate of serious diabetes-related complications — heart attacks, strokes, amputations — has dropped. And we've gotten better at finding ways to get high-risk patients to make modest, but significant, lifestyle changes that can slow or reverse the health impact of this disease.
Still, since it's National Diabetes Awareness Month, it's worth noting that despite all the gains, no one says the battle is over. The damage diabetes does to Americans — estimated at more than $320 billion annually — is simply far too great.
"We can't get too excited,'' said Edward Gregg, a leading investigator for the U.S. Centers for Disease Control and Prevention (CDC). "The burden is still high and will be for the foreseeable future.''
Diabetes is a disease in which the body's inability to produce any, or enough, insulin causes increased blood sugar levels. Type 1 diabetes, where the body does not produce insulin, is usually diagnosed in childhood and makes up about 5 percent of diabetes cases. Type 2 diabetes occurs when the body does not use insulin properly.
In the U.S., more than 29 million adults have diabetes and one-fourth are not even aware of it. Another 86 million are considered pre-diabetic. Diabetes accounts for 20 percent of the country's health care spending and is the leading cause of kidney failure, leg amputations and adult-onset blindness.
Aging Population Faces Increased Diabetes Risk
While the number of new cases of diabetes has decreased in recent years, it is difficult to say with certainty whether that trend will continue. In some population groups, notably blacks and Hispanics, the number of new cases is still going up.
In addition, the aging of America means more people will be vulnerable. "As the Baby Boomers age, they happen to be moving right into the age range where diabetes risk is the highest,'' Gregg said.
Researchers say that one promising advance is the increasing awareness among experts that diabetes involves multiple metabolic disturbances and cannot be simply defined as a given blood glucose level. Genetics and environment can play differing roles.
An obese Caucasian, an African American or an American of Asian descent with little visible body fat may all have similar blood glucose levels, but each needs a different response. Instead of a one-size-fits-all approach, health care providers are aiming to individualize diabetes treatment.
"Ten years ago, there weren't many options,'' said Dr. Drew Bremer, a top diabetes researcher at the National Institutes of Health. "As a field, we are evolving and going beyond looking just at glucose numbers and focus(ing) on the entire patient."
One example of this change is the emergence of new classes of drugs to lower glucose. There are now eight major classes of medications and many were developed in just the last 20 years. Research through large-scale studies is underway to find the best choices of old and new medications. But translating results into new therapies will take several years.
New Diabetes Research Shows Promise
Other new research continues to reveal new potential pathways for fighting the disease, but also sheds light on the risks posed by diabetes. Among the recent developments are connections between diabetes and the following:
- Stress There is increased interest in the role stress plays in the progression of diabetes. Researchers are looking at the impact on blood sugar levels of cortisol —a hormone released in times of stress. An important question is whether this is a significant factor in diabetes for people of color, who are known to have higher cortisol levels.
- Coffee Does coffee have a role in preventing diabetes? Previous studies have shown a slightly reduced risk of diabetes associated with coffee. Researchers don't think caffeine is the cause and they are looking at how the body breaks down coffee to see what may be the source of the protective benefits.
- Depression It has been linked to poor outcomes with diabetes. When you're struggling to just get out of bed in the morning, the added burden of eating right and exercising can prove beyond reach. Researchers are exploring how to treat diabetes and depression together instead of as separate entities.
- Liver cancer Rates of liver cancer have tripled in the U.S. since the 1970s and new research shows a significant increased risk of the disease for those with diabetes.
The Diabetes Prevention Program
One success story from the latest research on diabetes is the Diabetes Prevention Program, which is a major multicenter clinical research study. It's a year-long course for those who are prediabetic that stresses increased physical activity and better food choices.
The goals for participants are not drastic: to lose 5 to 7 percent of their body weight and take part in 150 minutes of moderate exercise, like walking, each week. Studies repeated throughout the country and the world show such programs can significantly reduce the risk of participants becoming diabetic.
In 2010, Congress authorized the CDC to scale up the Diabetes Prevention Program across the country. This year, the program received a powerful endorsement when the U.S. Department of Health and Human Services announced it would start paying for Medicare recipients who take part.
'I Was Determined Not to Get Diabetes'
What does the Diabetes Prevention Program look like?
It's people gathering for a class each week at a local clinic, YMCA or religious institution. They learn how to watch their diets and find ways to increase their physical activity. After four months of weekly meetings, the classes meet less often for the rest of the year. It's a simple formula, but one that works.
"I was dropping a pound a week. In 20 weeks, I dropped 25 pounds. I thought: 'Isn't that the coolest thing?''' said Juliet Mitchell, a coach and a participant in the Diabetes Prevention Program at her church in Minneapolis. That program is run by Stairstep Foundation, a nonprofit that works with area African American churches.
Sylvia Amos, Stairstep Foundation's program director and a member of the diabetes prevention class at her church, lost 30 pounds. Among her strategies were simple tweaks in food choices: salsa on baked potatoes, not sour cream; baked chicken, not fried and greens cooked with turkey, not pork, fat.
Another participant, Linda Spencer, saw the damage diabetes did to family members including an uncle who had to have part of his leg amputated. It's hard exercising when you don't want to or not eating the foods you like, she said. But it's not as hard as living with diabetes.
"I was determined not to get diabetes,'' Spencer said. "You have to keep focused on the big picture. You will go through a lot more if you get diabetes than what you are going through now. I didn't want that for me."