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Diabetes - the impending epidemic
After attending several medical conferences, I couldn't help
but notice the concern physicians are expressing with regard
to the rising numbers of people developing diabetes,
particularly type 2 diabetes. From heart and kidney
specialists to family doctors, it seems that health care
professionals across North America are bracing themselves
for an epidemic. In 1999, Health Canada earmarked $115
million for development of a national diabetes surveillance
program, and several other diabetes-related initiatives to
be implemented over 5 years.
This impending epidemic is not solely attributable to aging
baby boomers. While it is true that people over 45 are at
greatest risk for developing type 2 diabetes, studies show
that we also have an alarmingly high amount of obese
children in North America, and obesity is closely related
with the development of type 2 diabetes. A completed study
of obesity in 688 school children in North Carolina showed
that 7% of those children already have 3 of the leading risk
factors for heart disease and type 2 diabetes. Experts
believe that in subsequent years many of these children,
both in Canada and the United States, will join the ranks of
adults over the age of 45 who develop type 2 diabetes. And
the good news? This rise in diabetes is preventable - we can
do something about it.
There are 2 main types of diabetes: type 1, type 2. In type
1 diabetes people don't make insulin, whereas in type 2
diabetes people become resistant over time to the action of
insulin, so their bodies make too much. Eventually, the
elevated levels of insulin are not enough and they develop
type 2 diabetes.
One of the biggest problems with type 2 diabetes is the
complications associated with it. "People who have type
2 diabetes are at increased risk of having a heart attack.
They are also at increased risk for stroke, kidney failure,
nerve damage causing numbness, impotence and
blindness," said Dr. Sheldon Tobe of Sunnybrook &
Women's Hospital in Toronto. Very often people with type 2
diabetes have other risk factors such as high blood
pressure, high levels of bad cholesterol (high LDL, low HDL)
and blood sugar levels that must be brought down.
These complications occur because diabetes causes the small
blood vessels to become more rigid and stiff and the large
blood vessels to loose their smooth surface. The small blood
vessels can no longer deliver blood to their vital organs
and tissues that relied on their blood supply starve for
oxygen and die. "This happens in the eyes and nerves,
leading to blindness and loss of sensation," Dr. Tobe
said.
The kidneys can become filled with material and their blood
vessels damaged causing the kidneys to age prematurely. A
kidney's usual lifespan of 120 years is shortened
dramatically and once there is detectable protein in the
urine - called proteinuria - the kidney lifespan may be less
than 10 years, particularly if there is high blood pressure
and the patient is not adequately treated.
And there is a very real risk of heart attack. "The
blood vessels to the heart become rough and cracked like a
rusting pipe," Dr. Tobe said. "Eventually blood
may clot inside the vessel, leading to a sudden loss of
blood flow and a heart attack."
"The complications associated with type 2 diabetes are
very costly, both in human and financial terms," said
Catherine Adair, who is with the Canadian Diabetes
Foundation. "We estimate that the Canadian Health Care
system spends $9 billion annually on diabetes and its
related complications," she said.
Yet, as studies show, obesity and sedentary lifestyle are 2
of the biggest risk factors for type 2 diabetes - these are
things that we can influence through our diets and
lifestyles. "The most important message to get out is
that diabetes and its complications can be delayed or
prevented altogether through tight management of blood sugar
levels," Ms. Adair said. Appropriate blood sugar levels
can be achieved through healthy eating, weight control,
exercise, stress reduction, and medication. Of these, diet
and medication are perhaps the most important factors.
"Some people can control their blood sugar levels
without medication. But if medication is recommended it must
be taken," said Ms. Adair.
However, no one wants to take a lot of pills, and some
people are concerned about side effects. "If people
could get their metabolic profiles under control, medication
would largely not be necessary. Until they do however, and
they have risk factors, they are adding on risk day after
day, which the medications can address," Dr. Tobe said.
"These agents work very well with a minimum of side
effects. In fact the side effect profiles are trivial
compared to the consequences of diabetes that these drugs
prevent," he said. Once on medication, the problems are
being addressed and, over time, the benefits accrue just
like interest in the bank. "The earlier we find a
problem and treat it, the greater the long term benefit to
the patient," Dr. Tobe said.
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