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Experts Release "State of Diabetes in America"
Despite the national epidemic of type 2 diabetes, two out of three Americans with the disease do not meet the target for blood sugar goals recommended by the American Association of Clinical Endocrinologists (AACE).
That finding is contained in the association's first-of-its-kind State of Diabetes in America report.
Researchers say that 84 percent of the 157,000 type 2 diabetics polled believe they are doing a good job of managing their diabetes by controlling their blood sugar.
More than 18 million Americans have diabetes, and type 2 diabetes accounts for 90 percent to 95 percent of all diagnosed cases. There are 1.2 million new cases diagnosed each year, the association states.
"Every 25 seconds someone in the United States is diagnosed with diabetes," says Vice Admiral Richard H. Carmona, the US Surgeon General. "It's the sixth-leading cause of death in the United States, costing thousands of lives and billions of dollars every year.
"We need to help Americans prevent diabetes, or we will risk being overwhelmed by the disease and the economic burden that will ensue," Dr. Carmona cautions.
Included in the report is a state-by-state breakdown of blood sugar levels. Mississippi residents are the worst at controlling blood sugar, with 72.8 percent of type 2 diabetics failing to meet blood sugar goals.
Those who have the best blood sugar control are in Montana, where only 55.2 percent of the type 2 diabetics are not managing their blood sugar, the report finds.
"It is time for us to get serious," says Dr. Jaime A. Davidson, the chair of the AACE Diabetes Mellitus Implementation Conference and a clinical associate professor of internal medicine at the University of Texas Southwestern Medical School. "This is an epidemic in this country and it's not going to get better unless we all work together."
Type 2 diabetes is a disease that typically progresses over time as the body loses its ability to process the hormone insulin and regulate blood sugar. Insulin is necessary for the body to use sugar for energy for cells. Common risk factors that contribute to diabetes include weight gain, poor diet, and lack of exercise.
Blood sugar is measured by a test called the A1C, which gauges average blood sugar levels over the past two to three months, according to the report.
The American College of Endocrinologists recommends an A1C target level of 6.5 percent or less. Every 1 percent increase above this target increases the risk of serious and possibly life-threatening diabetes-related complications such as stroke, heart attack, kidney problems, blindness, and amputation of limbs.
The first line of attack in keeping blood sugar within a normal range is diet and exercise. However, when diet and exercise do not work, one or more medications may be prescribed to help control blood sugar levels.
According to the results of the survey, 98 percent of people with type 2 diabetes believe blood sugar control is important. However, 61 percent were not aware of the A1C test. Even after they were told what it is, 51 percent didn't know their last A1C result.
To combat these problems, the AACE is launching a campaign designed to improve diabetes management.
The goal is to provide diabetics with tools to help them control blood sugar levels and give them an easy-to-understand roadmap for successful diabetes management. The campaign will help people with type 2 diabetes understand what they can do to get their blood sugar numbers down.
As part of its program, the AACE is encouraging Americans with type 2 diabetes to take an oath to better control blood sugar levels. Those interested can learn more and receive a free diabetes-friendly cookbook.
"People need to be diagnosed early and need early implementation of treatment," says Dr. Lawrence Blonde, director of the Ochsner Diabetes Clinical Research Unit, part of the Ochsner Clinic Foundation in New Orleans. "These include lifestyle measures - diet and exercise - and medications."
"Diabetes is a self-managed disease," Dr. Blonde adds. "People need self-management education."
Another health expert looks at the problem from a public health perspective.
"Diabetes in America is not just one crisis, but several crises rolled into one," says Dr. David L. Katz, an associate clinical professor of public health and director of the Prevention Research Center at Yale University School of Medicine.
According to Dr. Katz, diabetes is, first, a crisis of failed prevention.
"Impressive trials show that most type 2 diabetes is potentially preventable through healthful diet and physical activity patterns, as well as through judicious use of medication. Yet, we have skyrocketing rates of diabetes in the US," Dr. Katz notes.
Diabetes is also a crisis of public policy, Dr. Katz says.
"In the span of less than a generation, what used to be called adult onset diabetes is now routinely diagnosed as type 2 diabetes in children under the age of 10," he says. "This is due to changes in the prevailing activity patterns of our children, changes in their diets, and changes in how these factors are influenced in schools."
Diabetes is also a crisis of health management, Dr. Katz contends.
"Studies show that strict control of blood sugar can forestall the devastating consequences of diabetes," he says. "Yet this knowledge is not translating consistently into better disease management by health-care providers, or patients themselves."
And finally, diabetes is a crisis linked to economic disparities.
"The new report shows that poor glycemic control nationwide is not evenly distributed, but clustered disproportionately in states with high rates of poverty and large minority populations," Dr. Katz says.
The tragedy, according to Dr. Katz, is that we know how to prevent diabetes and have the tools to enhance control of the disease.
"Let us hope that by revealing to us all more clearly than ever the dangers we face, this sobering report does indeed create new opportunities to apply what we know," he says.
Always consult your physician for more information.
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Obesity is a chronic disease affecting increasing numbers of children and adolescents as well as adults.
Obesity rates among children in the US have doubled since 1980 and have tripled for adolescents. Fifteen percent of children aged six to 19 are considered overweight compared to over 60 percent of adults who are considered overweight or obese.
Earlier onset of type 2 diabetes, cardiovascular disease, and obesity-related depression in children and adolescents is being seen by healthcare professionals.
The longer a person is obese, the more significant obesity-related risk factors become. Given the chronic diseases and conditions associated with obesity and the fact that obesity is difficult to treat, prevention is extremely important.
A primary reason that prevention of obesity is so vital in children is because the likelihood of childhood obesity persisting into adulthood is thought to increase from about 20 percent at four years of age to 80 percent by adolescence.
Young people generally become overweight or obese because they do not get enough physical activity in combination with poor eating habits. Genetics and lifestyle also contribute to a child’s weight status.
Recommendations for prevention of overweight and obesity during childhood and adolescence include:
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Gradually work to change family eating habits and activity levels rather than focusing on a child’s weight.
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Be a role model. Parents who eat healthy foods and participate in physical activity set an example so that a child is more likely to do the same.
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Encourage physical activity. Children should have 60 minutes of moderate physical activity most days of the week. More than 60 minutes of activity may promote weight loss and subsequent maintenance.
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Reduce “screen” time in front of the television and computer to less than two hours daily.
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Encourage children to eat when hungry and to eat slowly.
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Avoid using food as a reward or withholding food as a punishment.
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Keep the refrigerator stocked with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks and snacks high in sugar and fat.
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Serve at least five servings of fruits and vegetables daily.
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Encourage children to drink water rather than beverages with added sugar, such as soft drinks, sports drinks, and fruit juice drinks.
Many of the strategies that produce successful weight loss and maintenance help prevent obesity in adults. Improving eating habits and increasing physical activity play a vital role in preventing obesity.
Recommendations for adults include:
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Eat five to nine servings of fruits and vegetables daily. A vegetable serving is one cup of raw vegetables or one-half cup of cooked vegetables or vegetable juice. A fruit serving is one piece of small to medium fresh fruit, one-half cup of canned or fresh fruit or fruit juice, or one-fourth cup of dried fruit.
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Choose whole grain foods such as brown rice and whole wheat bread. Avoid highly processed foods made with refined white sugar, flour, and saturated fat.
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Weigh and measure food in order to be able to gain an understanding of portion sizes. For example, a 3-ounce serving of meat is the size of a deck of cards. Avoid supersized menu items.
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Balance the food “checkbook.” Taking in more calories than are expended for energy will result in weight gain. Regularly monitor weight.
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Avoid foods that are high in “energy density,” or that have a lot of calories in a small amount of food. For example, a large cheeseburger with a large order of fries may have almost 1,000 calories and 30 or more grams of fat. By ordering a grilled chicken sandwich or a plain hamburger and a small salad with low-fat dressing, you can avoid hundreds of calories and eliminate much of the fat intake. For dessert, have fruit or a piece of angel food cake rather than the “death by chocolate” special or three pieces of home-made pie. Remember that much may be achieved with proper choices in serving sizes.
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Accumulate at least 30 minutes or more of moderate-intensity activity on most, or preferably all, days of the week. Examples of moderate intensity exercise are walking a 15-minute mile, or weeding and hoeing a garden. Look for opportunities during the day to perform even ten or 15 minutes of some type of activity, such as walking around the block or up and down a few flights of stairs.
Always consult your physician for more information.
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