Diabetes

DIABETES MELLITUS IS a condition of high blood glucose (sugar) levels and poor glucose control, with type 1 diabetes being a disease of insufficient production of insulin, a hormone that lowers glucose levels, and type 2 diabetes, the predominant form making up 90 to 95 percent of all diabetes, being a disease of insulin resistance mostly related to obesity. Diabetes currently afflicts approximately 21 million Americans, with an additional 41 million people that have prediabetes. Globally, it is estimated that over 150 million people have diabetes, with international prevalence expected to double by 2025. For Americans born in the year 2000, it is estimated that approximately one in three people will develop diabetes over their lifetime. The American Diabetes Association (ADA) estimates that diabetes costs society $132 billion annually in the United States alone, with the economic [Page 268]burden expected to increase to $192 billion by 2020. Although the CDC lists diabetes as the sixth leading cause of death in the United States with 74,000 deaths in 2003, the mortality burden attributed to diabetes is underestimated as diabetes is also recognized to be a strong causal contributor to other leading causes of death, such as coronary heart disease and stroke, doubling the risk of cardiovascular death in men and by three and a half times in women. Diabetes has also been linked with excess cancer risk, as diabetes is associated with a 20 to 30 percent increased risk of total cancers, particularly increasing the risk of digestive system cancers such as pancreatic, colorectal, liver, stomach, and kidney cancers, but lowering the risk of prostate cancer. Diabetes is also known to be under-reported as a cause of mortality on death certificates when a patient with diabetes dies of cancer. There are many established lifestyle factors in common for preventing both diabetes and cancers—notably preventing weight gain, increasing physical activity, and avoiding smoking. Additionally, decreasing intake of red meats, high-glycemic foods, and trans fats, while increasing the intake of cereal fiber, whole grains, coffee, polyunsaturated fats, and moderate alcohol consumption, may help to prevent type 2 diabetes. It is estimated that 91 percent of all type 2 diabetes is preventable by lifestyle modifications of exercise, weight control, and diet.