Diabetes Prevention Challenge Continues
Diabetes care in the US has seen medical advances in the last decade, but there is still much that could improve in the way of preventing the disease, according to a report in the Annals of Internal Medicine.
The new report was conducted by researchers at the Centers for Disease Control and Prevention (CDC).
"There has been kind of a mixed message in the last five to seven years," says report co-author Dr. K. M. Venkat Narayan, chief of the CDC Diabetes Epidemiology and Statistics Branch in the Division of Diabetes Translation.
"There have been good improvements in some areas, which tell us it is possible to improve things, but there is still a job that is left undone," says Dr. Narayan.
"What this report shows is that the application of good treatment to prevent complications in these people has improved in the last five to 10 years," he adds.
Diabetes affects an estimated 18 million people in the US (90 percent to 95 percent have type 2 diabetes). About 13 million persons have been diagnosed with diabetes, but 5.2 million are unaware they have the disease.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the American Diabetes Association, those affected include:
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9.3 million US women (8.7 percent of all women)
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8.7 million US men (8.7 percent of all men)
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206,000 people under age 20
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8.6 million adults over age 60
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2.7 million African Americans (11.4 percent of all African Americans)
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2 million Hispanic/Latino Americans (8.2 percent of all Hispanic/Latino Americans)
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12.5 million Caucasian Americans (8.2 percent of all Caucasian Americans)
According to the most recent statistics, diabetes was the sixth leading cause of death, and the fifth leading cause of death from disease.
Diabetes costs $90 billion annually in direct medical costs. It costs $40 billion annually in indirect costs (loss of work, disability, and loss of life).
Over the past 10 years, control of cholesterol among diabetics has improved substantially. There have also been small improvements in yearly eye and foot examinations, all important components of the regular care of diabetes.
"The discouraging news is that blood pressure control and blood sugar control have remained fairly constant," says Dr. Narayan. "It has not changed in the last five to seven years."
While there actually was a slight improvement in blood sugar control found, it was not statistically significant.
In addition, two in five people with diabetes have poor control of their cholesterol, one in three has poor blood-pressure control, and one in five has poor control of blood-sugar levels, explains Dr. Narayan.
"There are good treatments available, which can prevent a lot of long-term complications, such as cardiovascular disease, heart attacks, stroke, kidney disease, amputations, and blindness," notes Dr. Narayan.
He also says there are many national programs aimed at preventing diabetes, as well as promoting better care for those with the disease.
"Diabetes is a major cause of complications, unnecessary sickness, and death, but [by] applying what we know, a lot can be achieved," he says. "There has been a lot of positive improvement, but it's no time for being complacent."
One expert thinks the healthcare system is not set up to prevent diabetes and its complications.
"This is a trend that has existed for several years that we look at with consternation," says Dr. Robert Rizza, a professor of medicine at the Mayo Clinic and president of the American Diabetes Association.
Treatment of diabetes is a complex process, Dr. Rizza says. It takes the patient, physician, and the community working together to provide successful treatment.
"This is not a matter of 'take a pill and go home,'" he remarks.
Caring effectively for diabetes is a team effort that also has to include the healthcare systems, health insurers, and government, says Dr. Rizza. "Keeping patients healthy saves the community and the nation hundreds of thousands of dollars by preventing complications."
"We as a nation are struggling with that concept," says Dr. Rizza. "We still tend to treat say, heart attacks, and 50 to 60 percent of people who have heart attacks have diabetes. "We are treating the heart attack, but we are not treating the cause."
Diabetes is the number one cause of blindness, kidney failure, amputations, and nerve disease in America, says Dr. Rizza.
"But again, we treat those things rather than put in place the systems of health care to be sure that patients don't get these complications," he says. "We haven't figured it out yet."
Society needs to focus more on preventing diabetes and its complications, says Dr. Rizza. "There needs to be positive incentives to patients and the healthcare system to do a better job in preventing the disease and, once you have the disease, preventing its complications."
Dr. Rizza strongly recommended improving fitness. "If you stay lean and fit throughout your life, you have a 95 percent chance of never getting diabetes," he says. "It's almost entirely preventable."
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.
Many of the strategies that produce successful weight loss and maintenance help prevent obesity.
Experts say improving eating habits and increasing physical activity play a vital role in preventing obesity.
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.
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.
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.
Balance the food “checkbook.” Taking in more calories than are expended for energy will result in weight gain. Regularly monitor weight.
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.
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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