Currently, there are about 25 million Americans with diabetes. Of those, 1.5 million have type 1 diabetes, formerly called juvenile onset diabetes, and 23.5 million have type 2, formerly called adult onset diabetes. Unless Americans drastically change their dietary and exercise habits, diabetes may play a major role in nearly 90 percent of all patients seen by U.S. physicians in the next five to 10 years and could force healthcare costs to climb dramatically.
In the future, the large group of individuals at risk for type 2 diabetes should be classified in such a way that their condition may be more easily recognized and treated, so as to lessen their chance of becoming type 2 diabetics. In short, they should be classified as having either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) – both of which have fasting blood glucose levels above normal but below that which is considered diabetes.
Simple prescription for change
In common, such individuals are most often overweight or obese. Treatment is straightforward:
- Lose from 5 to 10 percent of initial body weight.
- Decrease intake of fatty foods.
- Increase exercise, such as walking 60 minutes daily, five days a week.
Without treatment, such individuals have a 30 percent chance of developing overt type 2 diabetes within five years. Additionally, if they have first-degree relatives (mother, father, sister or brother) with type 1 diabetes, then individuals with IFG or IGT double their risk and have a 60 percent chance of developing type 2 diabetes.
We are looking at more than doubling or tripling the current 25 million people in the United States who currently have diabetes!
Possible setbacks to improving health
In theory, testing and prescribing sound simple, but in practice they are nearly impossible to achieve for millions of people. Although small groups of well-financed health care professionals have been very successful in normalizing IGT patients, there exists neither the money nor the supply of health care professionals to accomplish this task throughout the U.S. population.
Other roadblocks include: the fast food industry and restaurants that promote “more food for the buck,” the widespread habit of snacking while sitting at a computer, the playing of video games, individuals living according to lower economic standards, and the increasing cost of “healthy” foods.
Does this mean we will see the doubling or tripling of type 2 diabetes in the near future? The answer is probably “yes.” However, I hope the information contained in this article will help inform the public, and especially dietitians and physicians. Any individuals who are overweight or obese should be tested. With the help of a knowledgeable medical community, those individuals can begin necessary lifestyle changes to substantially lessen their likelihood of developing diabetes.
The diabetes “tsunami” is a very difficult problem to successfully address. But the alternative is a U.S. medical profession that is overwhelmed by type 2 diabetes in 5 to 10 years.
DR. ROBERT S. BAR is professor emeritus in the Department of Internal Medicine at the University of Iowa College of Medicine