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Chapter 1: Diabetes Mellitus: A Pandemic in the Making
It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.
Sir Arthur Conan Doyle, British mystery author & physician (1859–1930)
On December 20, 2006, the General Assembly of the United Nations passed resolution 61/225, the United Nations World Diabetes Day Resolution, designating November 14 as World Diabetes Day. On October 29, 2010, the President of the United States, Barack Obama, declared November 2010 as National Diabetes Month in the United States.1
Diabetes mellitus2 is an array of diseases that have a common symptom— abnormally high blood glucose levels. Diabetes mellitus is a noncommunicable disease. It is not transmitted from person to person by viruses or bacteria as is HIV or cholera. Diabetes mellitus is a chronic, costly, and often debilitating disease. This will be our working definition of diabetes mellitus until later in the book where we shall learn more specifics about the disease. The President, in his Proclamation, uses the terms type 1 and type 2 diabetes. By the end of Chapter 6, you will fully understand both these terms.3 In this chapter we will learn about the extent of the diabetes problem both in the United States and globally. Later in this chapter we will learn of a related pandemic in the making—obesity and overweight. Finally, we will describe the connections between the diabetes and obesity/overweight pandemics.
Diabetes Prevalence and Cost in the United States
A Dire Prediction Based on Alarming Data
The4 Centers for Disease Control and Prevention (CDC) estimated that as of 2008 there were as many as 18.1 million Americans who had been diagnosed with diabetes (8 in 100 Americans). This number is presumed low because it is estimated that 6.0 million cases remain undetected. Thus, 10 in 100 adult Americans actually had the disease in 2008 1. Between 1980 and 2008, the number of diagnosed diabetic Americans has nearly tripled.
An analysis of this data according to age, gender, and race is revealing. All of the following data derived from the CDC is for civilian, noninstitutionalized individuals with diagnosed diabetes.
Figure 1.1 shows the age-adjusted percentage of diagnosed cases of diabetes by sex. You may notice that percentages were similar for males and females until 1999, at which time the percentage for males with diabetes began to increase at a greater rate than for females.
As you can see from Figure 1.2, the number of white diabetics increased 104% in the period 1980–2008; that of blacks increased 91% and of Asians/Pacific Islanders 62%. Blacks were diagnosed with diabetes at consistently higher percentages than whites and Asians. All races increased in percentage from 1980 to 2008. For Hispanics (Fig. 1.3), the largest increase in percentage was for Mexican/Mexican-Americans, 42.2%. All Hispanic groups, Puerto Ricans, Mexican/Mexican-Americans, and Cubans had percentages that significantly increased from 1997 to 2008.
Most alarming are the statistics presented in Figure 1.4. The CDC estimates that by the middle of this century the total number of diagnosed cases of diabetes will increase to between 1 in 3 and 1 in 5 Americans. These ratios correspond to 61–102 million Americans in 2050 assuming a total US population of 306.3 million adult persons 2. This estimate is based on an aging population—with increased age, there is a greater likelihood of developing diabetes; increases in minority groups—minority groups have a higher prevalence of diabetes; longer life spans of people diagnosed with diabetes mellitus; and the exclusion in most studies of people younger than 18 years—an age bracket in which there have been significant increases in diabetes cases. This study also assumes 4.5–5.2% of the total population of Americans as having undiagnosed diabetes, which itself maybe an underestimated statistic. A poorer diet, overeating, and a sedentary lifestyle add credence to the prediction that by 2050 the number of cases of diabetes will at least triple.
Additional support for this prediction derives from the estimate 3 that in 2010 there were 67 million Americans (90% undiagnosed) who had prediabetes. Prediabetes (defined in Chapter 6) is the precursor to full blown diabetes.
Summary Box 1.1
- Diabetes mellitus is a noncommunicable disease that causes abnormally high blood glucose levels.
- Diabetes has a high prevalence in the United States across all racial groups.
- Projections of the increase in diabetes by 2050 are alarming.
The Increase of Diabetes in Youths
The statistics shown in Figure 1.5 with respect to children and adolescents are quite scary. The increase in diabetes cases is occurring in greater prevalence in younger persons. In 1980, the percentage of diagnosed diabetics under the age of 45 years was 0.6%. The increase began in 1986, and gradually has increased since 1986 to 1.4% in 2008. Also shown in this figure is that the greatest increases over time have occurred in the 65–74 age bracket.
Data shows 4, 5 that hospitalizations for diabetes increased 102% for young adults, 30–39 years between the 14-year period, 1993–2006. This alarming data suggests that diabetes is occurring at a younger age. Over the same period, charges for hospitalizations for diabetes increased 220%.
Additional data from Search for Diabetes in Youth 6 shows th...
