Diabetes is more than just a devastating disease; it is a widespread epidemic currently affecting more than one in five older Americans, and it is exceptionally expensive. The cost of treatment for type 2 diabetics increased 32% from 2002 to 2007, when estimated diabetes expenses in the US totaled $116 billion in direct medical costs and $58 billion in indirect costs (disability, work loss, premature death). This is 10% of all dollars spent on health care in the US, with expenditures for people with diabetes more than two times higher than health care expenditures for non-diabetics.

This news is even more unwelcome in an unsteady economy where consumers are already concerned about the cost and availability of health care. A new Kaiser Family Foundation poll reports that half of American households cut back on health care as a result of financial concerns in the past year, with 16% reporting having postponed treatment for severe health problems — for instance, foregoing visits to the doctor for chronic illnesses like diabetes.

IT’S WORSE THAN IT SEEMS…

What’s occurring today is just the beginning, warns global economist and nutritionist Barry Popkin, PhD, director of the University of North Carolina’s Inter-Disciplinary Obesity Center. Diabetes was the seventh leading cause of death listed on US death certificates in 2006, a number he believes is, in all probability, “grossly understated” given the rapid changes in diet and body composition of the average American.

Meanwhile, rather than focusing on prevention of diabetes, which is highly possible for the majority of people, mainstream medicine continues to accentuate delivery of more expensive crisis management treatment, with a selection of pills and insulin that help manage, but do not cure the disease. Insurance companies are more likely to pay the very expensive cost of treating devastating complications, such as loss of sight or kidney damage, and for costly heart surgeries and amputations, than to pay the considerably modest cost of rigorous disease management or prevention with programs such as fitness trainers and dietetic education. Doing so would save money, as well as time and suffering. This short-sighted strategy backfires, individually and for our health care system as a whole, warns Dr. Popkin.

DOES PREVENTION ALLEVIATE THE PROBLEM?

The US Centers for Disease Control and Prevention assure that prevention really does work.

In the Diabetes Prevention Program study, lifestyle interventions reduced the development of diabetes in high risk people by 58% over a period of three years — and an even more impressive 71% in adults age 60 and older. In contrast, Metformin, the diabetes drug compared in this study to the lifestyle intervention, reduced diabetes risk only half as much.

•Comprehensive foot care programs can decrease amputation rates by 45% to 85%.
•Blood pressure management lessens the risk of heart disease and stroke in people with diabetes by 33% to 50%, and the risk of microvascular complications (eye, kidney and nerve diseases) by about 33%.
•Lowering blood pressure can minimize the decline in kidney function in people with premature diabetic kidney disease 30% to 70%.
•Identifying and treating diabetic eye disease with laser therapy can reduce the development of acute vision loss by about 50% to 60%.
•Managing LDL cholesterol can reduce cardiovascular complications by 20% to 50%.

The CDC claims that interventions to prevent or postpone pre-diabetes from advancing to type 2 diabetes can be practical and cost-effective. Dr. Popkin and I discussed how to shift the medical standard from one that reacts to crises to actually preventing them.

WHAT MUST CHANGE

It bores people to hear the same advice repeatedly, but the way to solve the issue of diabetes essentially has little to do with medical professionals or procedures. It has to take place at home. Americans at risk must resolve their weight issues. A primary cause for type 2 diabetes is obesity — one-third of American adults are obese whereas 17% of children are overweight or obese. Dr. Popkin’s book, The World Is Fat, describes how our lifestyle changes since World War II have produced the double epidemics of obesity and diabetes. We need to establish better eating habits and exercise programs, specifically…

Minimize snacking and sodas. Food and beverage companies sell an ever-growing number of high-calorie sodas and sweetened teas, sugary fruit juices, vitamin and energy drinks. The top 40% of consumers purchasing these beverages consume 760 calories per day from them, observes Dr. Popkin. Don’t fall for seductive marketing – instead, drink healthful and calorie-free water, or if you prefer something sweeter, enjoy a cup of tea or coffee with a bit of sugar. Satisfy hunger between meals by snacking on an apple, a few walnuts, or a handful of baby carrots rather than resorting to processed snacks, even supposedly healthy ones like granola and energy bars, which Dr. Popkin points out are typically stuffed with calories and fats.

Monitor portion control. At Cornell University, 85 nutrition experts were invited to an ice cream social where they were given bowls of various sizes. Interestingly, the experts who were given the bigger bowls served themselves almost a third more ice cream. The lesson: Keep a close eye on portion sizes. Use smaller plates and choose sensible serving sizes. If you’re eating meat for instance, this means three ounces (the size of a deck of cards) rather than the usual eight or more.

Determine ground rules prior to eating. In a current study of all-you-can-eat Chinese buffets, researchers found that overweight or obese diners more often choose large plates, chew less and eat everything they served themselves, which can lead to overeating. Especially if you are eating out, set ground rules in advance to make sure you’re aware of what and how you eat. For example, decide beforehand that you will drink water rather than a soft drink… Pass on dessert… Order salmon instead of prime rib… Eat slowly… And ask for a to-go container instead of cleaning your plate.

GET ACTIVE

Our armchair-and-TV culture is a major issue in the diabetes epidemic, with less than one-third of American adults participating in regular leisurely physical activity. In fact, one study found every two hours of television watched each day is associated with a 14% increase in diabetes. Luckily, most of us already own the solution — a pair of tennis shoes. There’s no need to join a gym or work up a heavy sweat. The research suggests that 43% of new cases of type 2 diabetes may be prevented by 30 or more minutes of brisk walking a day and less than 10 hours of watching TV per week.

PRACTICE GOOD DIABETES SELF-CARE

If you are at high risk for diabetes or currently have the disease, take essential steps to manage it. Working with medical professionals, carefully monitor and control levels of blood glucose, blood pressure and blood lipids, and stay on top of other preventive care practices (e.g., foot exams and eye screening), all of which help prevent potentially dangerous complications. If your doctor has prescribed insulin or other medication, take it exactly as prescribed and do not miss doses.

Individually, people pay a gigantic price — physically, emotionally and financially — for lifestyle choices that have encouraged diabetes. Our national budget is negatively affected as well. It’s in everyone’s best interest to bring this disease under control.

Source(s):

Barry Popkin, PhD, director of the Inter-Disciplinary Obesity Center and the division of Nutrition Epidemiology, University of North Carolina, Chapel Hill, North Carolina. Dr. Popkin is author of The World Is Fat (Avery).