published Thursday, February 9th, 2012

Cleaveland: The scourge of diabetes

By Cliff Cleveland

The middle-aged male had tried to maintain his job despite repeated setbacks related to his long-standing Type 2 diabetes. He never feels well. His kidney function is compromised. His legs are without feeling from the knees down. In the past year, he has undergone partial amputations of both feet. I learned of his tragic story in January.

Almost 26 million Americans have diabetes. An estimated one-quarter of these individuals are undiagnosed. Eighty million Americans are at risk of developing diabetes. One-third of children born in 2000 are predicted to develop diabetes during their lifetimes. From 1980 to 2010, the incidence of diagnosed diabetes almost tripled. In 2010, diabetes accounted for a 10th of health-care expenditures.

The consequences of diabetes can be complex: visual and nervous system impairment, increased risk of coronary and arterial disease, kidney failure, and loss of limbs. Health costs for a diabetic person are more than double those of an unaffected person. When kidneys fail, long-term dialysis imposes major additional costs. The financial burdens associated with diabetes hit uninsured and poor Americans especially hard. Educational attainment and job prospects are diminished and life expectancies shortened for affected people.

Type I diabetes, an auto-immune condition associated with failing insulin production, accounts for 5 percent of cases. Diabetes occurs in an estimated 15 percent of pregnancies, usually disappearing following delivery. Type 2 diabetes, previously designated adult-onset diabetes, is now recognized across the age spectrum. Type 2 accounts for more than 90 percent of diabetic cases. Heredity plays a role in the disease's development. Weight excess is the principal driving force in creating insulin resistance, which underlies Type 2 disease.

Prevention is by far the most cost-effective means of reversing a rising tide of Type 2 diabetes. Because of the role of weight excess in diabetes, diet is the logical starting point.

* Prenatal and infant care must emphasize proper feeding of children. Kindergarten and school lunches must be nutritionally sound, recognizing that healthful diets are more costly. Healthful diets must be emphasized in each year of schooling.

* The active engagement of media is crucial. Television programs aimed at children should not include ads for sugary treats. Public-service announcements should emphasize affordable, nutritional food. Moderation in food and drink must be highlighted in advertisements.

* Sugary drinks pose a special problem in combating weigh excess. Carbonated soft drinks, fruit punch, sports drinks and tea present the body with "empty calories": rapidly absorbed sugars with little nutritional benefit and short-term relief of hunger. We consume approximately 45 gallons of sweetened drinks per capita each year. A 12-ounce can of a carbonated drink may contain 10 to 12 teaspoons of sugar. One serving daily can add up to 60 pounds of sugar to the yearly diet, along with several pounds of weight.

* An excise tax on sugary drinks deserves careful consideration. Y. Claire Wang and colleagues in the January issue of Health Affairs discuss the effects of a penny-per-ounce tax on sweetened drinks. Their model estimates that the tax would reduce consumption of drinks by 15 percent. This, in turn, would prevent over a 10-year period an estimated 95,000 coronary-related events, 8,000 strokes, and 35,000 premature deaths. The tax would save $17 billion in health costs and raise $13 billion that could be applied to research and treatment of patients. Although several state legislatures have debated such legislation, no state has ratified it. Intense lobbying makes this problematic.

Research will produce advances in diabetic therapy, which will be costly. In the meantime, the road to prevention beckons.

Email Clif Cleaveland at

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