Diabetes: Underrated, Insidious and Deadly
- Yet another article that mentions obesity but fails to mention the
relationship between diabetes and intra-body POPs (persistent organic
pollutants; comment with cites follows news article. -Teresa
- - - -
Diabetes: Underrated, Insidious and Deadly
By TARA PARKER-POPE
July 1, 2008
*July 1, 2008*
A Growing Menace
In a set of recent focus groups, participants were asked to rank the
severity of various health problems, including cancer, heart disease and
On a scale of 1 to 10, cancer and heart disease consistently ranked as
9s and 10s. But diabetes scored only 4s and 5s.
"The general consensus seems to be, 'There's medication,' 'Look how good
people look with diabetes' or 'I've never heard of anybody dying of
diabetes,' " said Larry Hausner, chief executive of the American
Diabetes Association, which held the focus groups. "There was so little
understanding about everything that dealt with diabetes."
But diabetes is anything but minor. It wreaks havoc on the entire body,
affecting everything from hearing and vision to sexual function, mental
health and sleep. It is the leading cause of blindness, amputations and
kidney failure, and it can triple the risk for heart attack and stroke.
"It is a disease that does have the ability to eat you alive," said Dr.
John B. Buse, a professor at the University of North Carolina School of
Medicine who is the diabetes association's president for medicine and
science. "It can be just awful --- it's almost unimaginable how bad it
Diabetes results when the body cannot use blood sugar as energy, either
because it has too little insulin or because it cannot use insulin. Type
2 diabetes, which accounts for 90 to 95 percent of cases, typically
develops later in life and is associated with obesity and lack of
exercise. Type 1 diabetes, which is often diagnosed in children, occurs
when the immune system mistakenly destroys cells that make the insulin.
The disconnect between perception and reality is particularly worrisome
at a time when national diabetes rates are surging. Just last week, the
Centers for Disease Control and Prevention announced that the number of
Americans with diabetes had grown to about 24 million, or 8 percent of
the population. Almost 25 percent of those aged 60 and older had
diabetes in 2007. And the C.D.C. estimates that 57 million people have
abnormal blood sugar levels that qualify as pre-diabetes.
To be sure, diabetes is treatable, and an array of new medications and
monitoring tools have dramatically improved the quality of care. But
keeping the illness in check requires constant vigilance and expensive
care, along with lifestyle changes like losing weight, exercising
regularly and watching your carbohydrates.
Dr. Buse says patients who are focused on their disease and who have
access to regular medical care have a good chance of living out a normal
life span without developing a diabetes-related disability.
But some patients say they are too busy to take better care of
themselves, and many low-income patients can't afford regular care. Even
people with health insurance struggle to keep up with the co-payments
for frequent doctor visits and multiple medications.
And to make matters worse, diabetes is associated with numerous other
health problems. Last week, for example, The Journal of the American
Medical Association reported that people with depression were at higher
risk for Type 2 diabetes, and vice versa.
That is not surprising: according to data published last year in the
journal Diabetes Care, depression tends to interfere with a patient's
self-care, which requires glucose monitoring, medications, dietary
changes and exercise.
Ultimately, diabetes can take a toll from head to toe. In the brain, it
raises the risk not only for depression but also for sleep problems and
stroke. It endangers vision and dental health. This month, The Annals of
Internal Medicine is reporting that the disease more than doubles the
risk of hearing loss.
Moving down the body, diabetes can lead to liver and kidney disease,
along with serious gastrointestinal complications like paralysis of the
stomach and loss of bowel control. Last year the journal Diabetes Care
reported that in a sample of nearly 3,000 patients with diabetes, 70
percent had nonalcohol fatty liver disease.
Poor circulation and a loss of feeling in the extremities, called
neuropathy, can lead to severe ulcers and infections; each year in the
United States, there are about 86,000 diabetes-related amputations.
Diabetes can also take a toll on relationships. By some estimates, 50
percent to 80 percent of men with diabetes suffer from erectile
dysfunction. Experts say women with diabetes often lose their libidos or
suffer from vaginal dryness.
The challenge for doctors is to convince patients that diabetes is a
major health threat. For years, the message from the American Diabetes
Association has been one of reassurance that the disease is treatable.
Now, beginning in 2009, the association plans to reframe its message to
better communicate the seriousness of the disease.
"Our communication strategy is going to be that diabetes has deadly
consequences, and that the A.D.A. is here to change the future of
diabetes," said Mr. Hausner, a former executive with the Leukemia and
Lymphoma Society who came to the association 10 months ago. "It's the
word 'deadly' that was the potentially controversial word for the
organization. In the past, people said, 'We don't want to get anybody
The new strategy is not a scare tactic, he added. Prevention and hope
will still be part of the message.
"It's not that we don't want people to have hope," he said. "We want
people to understand this is serious."
Comment by Teresa Binstock:
A series of studies by DH Lee and colleagues uses CDC data from US
populations. Findings describe associations among flame retardents,
persistent organic pollutants (POPs), diabetes, insulin resistance, and
metabolic syndrome. For instance, obese people with low blood-levels of
POPs were less likely to develop diabetes than were slim people with
elevated levels of POPs.
1. Association of Brominated Flame Retardants with Diabetes and
Metabolic syndrome in the United States Population: 2003-2004.
Diabetes Care. 2008 Jun 16.
2. Association between serum concentrations of persistent organic
pollutants and insulin resistance among nondiabetic adults: results from
the National Health and Nutrition Examination Survey 1999-2002.
Diabetes Care. 2007 Mar;30(3):622-8.
3. A strong dose-response relation between serum concentrations of
persistent organic pollutants and diabetes: results from the National
Health and Examination Survey 1999-2002.
Diabetes Care. 2006 Jul;29(7):1638-44.
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