The diabetes “epidemic” takes its toll

March 21, 2017
Historically, the term “epidemic” has been generally used for communicable or infectious diseases, so when we began to hear about the “diabetes epidemic” a number of years ago, some of us may have thought the term was being used for dramatic effect. Today, few would deny that type 1 and type 2 diabetes do indeed constitute an epidemic in North America and the world.

The raw numbers, as reported by Dr. Jack Zakowski in one of this issue’s two Continuing Education stories (pp. 8-18), tell the story in stark terms. The number of people with diagnosed diabetes in North America is projected to increase from 44.3 million in 2015 to 60.5 million in 2040. In the world, the number is expected to increase from about 415 million in 2015 to almost 642 million in 2040. Aside from the incalculable human cost, this has the potential to disrupt the health systems—and economies—of even prosperous, developed nations. It might overwhelm developing nations, and it could add to social and political unrest in vulnerable societies.

A recent article by Claudia Buck in the Sacramento Bee contained some sobering, if not shocking, statistics about diabetes in California. She reports that as many as 55 percent of California’s adults either have diagnosed diabetes or blood-sugar levels that put them at risk. One-third of adults between 18 and 39 in California either have diabetes or prediabetes.

Buck also reports that the rising prices of insulin are forcing low-income people to “stretch out” their doses by halving them or skipping every other day—or to stop using insulin completely. Some, she reports, are returning to an older type of insulin, NPH (isophane insulin), which is less expensive but also less effective.

Into this sea of bad news wades the National Institutes of Health (NIH), with some alarming statistics about a phenomenon that is already alarming enough: that young people, teens, and even children are developing type 2 (noninsulin-dependent) diabetes at an increasing-rate. According to the NIH, young people with type 2 seem to be developing complications more often than their peers with type 1 diabetes. According to an NIH- and CDC-funded study:

  • For youth with type 2 diabetes, nearly 20 percent developed a sign of
    kidney disease by the end of the study, compared to about six percent of youth with type 1 diabetes.
  • For youth with type 2, about 18 percent developed nerve disease, versus about nine percent with type 1.
  • For youth with type 2, about nine percent developed eye disease, compared to about six percent of youth with type 1.
  • Measures for two risk factors for heart disease (hypertension and arterial stiffness) were greater for youth with type 2 but close to equal for a third risk factor (cardiovascular autonomic neuropathy).
  • By age 21, about one-third of study participants with type 1 diabetes and about three-fourths of participants with type 2 had at least one complication from diabetes or were at high risk for a complication.

The role of the clinical lab is clear in this gathering storm: screening, diagnostics, and clinical monitoring of diabetes are key to controlling and eventually reversing the epidemic. More than ever, the lab will be at the forefront in giving clinicians the information they need to manage their patients with diabetes and prediabetes. Point-of-care diagnostics also are likely to play an increasingly important role.

The lab can also play a role in educating the public.

How can you, working with your larger institutions, help to make your community more aware of the dangers of diabetes, the relevant screenings, and the lifestyle and diet changes that can help people to avoid or delay diabetes, or to manage it?