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Diabetes: a new look at a killer disease - Special Section - Statistical Data Included
Ebony, March, 2002 by Kevin Chappell
ON the diabetes front, there is good news and bad news. The good news is that doctors and researchers know more than ever about the disease that affects more than 16 million Americans, and they are using that knowledge to help people with diabetes live longer, healthier lives.
The bad news is that most of us are not heeding their medical advice. As a result, the rate of, and complications from, diabetes--which is highly controllable and recently found to be many times preventable--have skyrocketed to historic highs. In fact, even with all of the medical advances, diabetes has become such a national concern that U.S. Surgeon General David Satcher recently called it "one of the most serious health challenges facing the United States."
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Since 1990, there has been a mind-boggling 49 percent increase in the number of people with diabetes. Last year alone, more than 800,000 new cases of diabetes were diagnosed, the most ever in a 12-month period. The disease has become the leading cause of heart attacks, strokes, kidney failure, blindness and amputations, costing the United States more than $100 billion each year. In fact, complications from diabetes now is responsible for killing more people each year than AIDS and breast cancer combined. And while stem cell advances offer promise down the road, experts don't expect a cure within the next 10 years.
For Blacks, the picture is even bleaker. More than 2 million African-Americans--1 in 10--have diabetes, and of those affected, more are likely to develop complications and experience greater disability from those complications than any other race. As a result, the death rate for Blacks with diabetes is 27 percent higher than it is for Whites.
Diabetes occurs when the body is unable to produce or respond to insulin, a hormone that allows blood glucose (blood sugar) to enter the cells of the body and generate the body's energy. There are two major types of diabetes: insulin-dependent or Type 1 diabetes, and noninsulin-dependent or Type 2 diabetes. Type 2 is more prevalent in African-Americans and adults over 45, accounting for up to 95 percent of eases. Type 1 diabetes usually, but not always, affects children and young adults.
Warning signs of diabetes include excessive thirst, frequent urination, extreme hunger, irritability, unexplained weight loss, tingling in fingers or toes, nausea, fatigue and vomiting. The disease can be detected through a routine blood test. If treated properly, Type 2 diabetes sometimes can be completely controlled with changes in diet and exercise. And even if medication is needed, complications almost always can be avoided or minimized.
"Most people with diabetes can control it," says nurse Janice B. Harris, program director of the diabetes self-management program at Howard University Hospital. "Monitoring their food intake, their activity and taking their medication, if needed, will have a direct impact on their blood-sugar level, and they are in direct control of that. It is a self-managed condition, one which involves behavior change. Unfortunately, most of these behaviors have been set since childhood, and are difficult to change."
It's that slow change in behavior that Dr. Gail Nunlee-Bland, chair of the endocrinology department at Howard University Hospital, says results in only about a third of her patients closely adhering to her medical advice. "Sometimes African-Americans think diabetes is inevitable. In our community, it's just so prevalent that we think it's a part of life," she says. "But in reality, we do have some control. We don't have to have the complications involved with diabetes."
Increasingly, researchers are concluding that control over diabetes starts with controlling weight gain. Recent evidence from several studies indicates that obesity and weight gain are associated with an increased risk of diabetes. In 2000, the prevalence of obesity in Americans increased from 18.9 percent to 19.8 percent, and the prevalence of diabetes increased from 6.9 percent to 7.3 percent. The prevalence of both combined increased to 2.9 percent. Various studies have concluded that obesity continues to increase among U.S. adults, and as a result has become a major risk factor for diabetes.
Obesity is also the main contributing risk factor to the rising numbers of diabetes cases within minority populations, especially African-Americans. Many facets of daily living can contribute to excessive weight gain, including poor diet and a tack of physical activity. Experts say psychological, cultural and economic factors can interfere with proper meal planning and engaging in an active lifestyle.
Both obesity and diabetes are largely preventable. In a recent clinical trial, lifestyle changes significantly reduced the risk of diabetes in middle-aged, overweight subjects. After a modest (4.7 percent) weight loss, those in the intervention group had a 58 percent reduction in incidence of diabetes over four years. Moreover, blood pressure and cholesterol levels, among other things, also improved significantly.
