It seems the efforts to stop our nation’s type 2 diabetes epidemic may be working. After a 20-year increase in prevalence and incidence of diagnosed diabetes in the US, the number of those living with type 2 diabetes has stabilized. Even though, the incidence has decreased only in the Caucasian population. This equates to a, “35% decline of diabetes from 2008-2017.” The peak year of diagnosed new diabetes cases occurred in 2009. This trend is encouraging, but the diabetes burden remains high, both financially and emotionally. “Intervention, monitoring and treatment must continue”, are the words spoken from the Center for Disease Control and Prevention in Atlanta, Georgia. Innovative strategies -from diagnosis and treatment must continue to see a decline in the rate of type 2 diabetes in the US. There were no specific causes discussed about declining cases in type 2, but certain reasons are possible.
Some possible reasons in declining cases of type 2 diabetes in the US
- Trends of eating a lower intake of added sugars.
- Lower intake of sugar sweetened beverages including soda, energy drinks and fruit punch.
- Reduced intake of refined foods.
- Lower intake of ultra- processed and processed foods.
- Less total calorie intake.
- Home food preparation kits and fixed meal plans delivered.
- Use of portion plates, food scales, measuring cups and other devices.
- More awareness for increased physical activity.
- Ample available health care and preventative initiatives.
- Educational diabetes management programs covered by private health insurance and Medicare.
Where does obesity fit into diabetes incident?
Obesity is defined as, “weight that is higher than a healthy weight for a given height, or a condition characterized by the excessive increase of fat in the body.” Obesity is recognized as a chronic disease that has increased over the past 10 years. There is no single or simple solution to the obesity epidemic, everyone needs to work together to create an environment that supports a healthy lifestyle. In 2015-2016, the prevalence of obesity was 39.8% in the US or 93 million US adults. A strong factor in developing type 2 diabetes is obesity.
What could lead to obesity?
The combination includes:
- Behavior- binge eating disorder-BED, bulimia, night eating disorder
- Diet- poor choices, empty calories, portion size
- Inactivity- too much sitting
- Medications- steroids, mental health medications for anxiety, depression, bipolar disorder
- Education- lack of higher education
- Economics-lack of money
- Community resources- no-sidewalks, bicycle lanes, public parks, high crime rates
- Environment- life revolves around food, food as a reward
- Sleep patterns-poor sleep quality, sleep apnea, not enough sleep
- Family history
Additionally, body mass index (BMI) is an indicator and screening tool of body fatness. The guidelines are as follows. Underweight-less than 18.5. Normal weight-18.5-24.9. Overweight-25-29.9. Obese-30 or higher. There are simple tools online to measure your own BMI. In addition, the highest rates of obesity in the US are seen in Hispanics- 47% and in blacks-46.8%; the highest rates of type 2 diabetes continue in these ethnic populations. Obesity related conditions include -hypertension, sleep apnea, cardiovascular disease, strokes, type 2 diabetes, fatty liver disease, osteo- arthritis, dyslipidemia, depression, anxiety and certain cancers. Many of these conditions are considered, “preventable and the cause of multiple premature deaths.” Working to lower obesity rates will reduce the incidence of type 2 diabetes.
What about Prediabetes
Pre-diabetes occurs when blood sugars are higher than normal-100-125 mg/dl but not high enough for type 2 diabetes-126mg/dl. Above all, the body has started having trouble using its own insulin. Ignoring pre-diabetes leads to a high incidence of developing type 2 diabetes. Fortunately, the good news is that pre-diabetes is reversible. Pre-diabetes remains high at 84 million US adults or 34 % of the US adult population; over 90% of people with pre-diabetes do not know they have it. Also, action plans are already in place. There are free programs at YMCA centers lead by the CDC-The National Diabetes Prevention Project as well as dietitian education coverage thru Medicare to teach proper life- style changes. Just a reduction of 5-7% of your present body weight is a step in the right direction. Between education and activity, we can lower the amount of pre-diabetes and pre-diabetes turning to type 2.
What about type 2 diabetes in children and teens?
Young children and teens who are obese are more likely to develop type 2 diabetes; “more than 80% of all children and adolescents with type 2 diabetes are overweight and 40% are clinically obese.” Disease researchers at the CDC made the prediction that, “1 in 3 children born in 2000 will likely develop type 2 diabetes in their lifetime unless a change of diet and exercise is made. Those diagnosed in their early teens with type 2, “had an alarming high rate of diabetes complications by the time they were in their mid-20’s” according to new research. Chronic complications are the common ones -renal failure, heart disease, retinopathy-blindness and amputation- all at a very young age. Furthermore, these lead to a reduced quality of life, a shorter life expectancy and raises health care costs for everyone. Reducing calories, sugar, processed foods along with more exercise will help cut the risk.
What about extended life spans?
Over 25 million adults over 65 or 12 million seniors have type 2 diabetes. Diabetes is on the rise in this group as people live longer and grow heavier. More than 80% of US adults are on Medicare when they die. Characteristics of people in their 60s,70s and 80s are less understood by physicians than people in their youth and middle age. For instance, drug studies are performed on middle aged men, not elderly women; diabetes medication doses are given in the same amount to each group. “Elderhood” now has 3 distinct phases following middle age. The young old-65-75, the old-75-85 and the old, old-above 85. It is feasible that elderhood could result in 20-40 additional years of life. The quality is important. Elders age differently -there is no one path; factors involve: life experiences, genetics, affordability and previous medical conditions.
What can “aging” look like with diabetes?
- Joint mobility diminishes
- Balance suffers
- Compromises hearing and vision
- Reaction time is slower-physically and mentally
- Skin loses elasticity
- Sleeping becomes more problematic
- Chewing may be difficult
- Urinary incontinence
- Reduces sense of taste and smell
- Cognitive problems-reduced memory
- Diabetes treatment should be different – what works for a younger person may cause trouble for an older person
Therefore, diabetes treatment in the elderly should be individualized with no unnecessary risks, one 70-year-old may be active and vibrant, and another may be tired and frail. There is more hypoglycemia- dizziness, weakness and confusion, falls and traumatic fractures in the elderly with tight blood sugar control. Hypoglycemia in the elderly can also trigger cardiac events. Elderly are able to have additional problems with medications is that they metabolize differently, have reduced kidney and liver function, have slower adrenalin release, can be in a dehydrated state and are exposed to polypharmacy. Also, treating the elderly with type 2 diabetes should focus on – smoking cessation, nutrition management and a balance/walking program. A person have to evaluate and treat their blood pressure and lipids. If this management does not work, medication can be introduced by the physician, “start slow and go low”.
Progress is being made and new cases of type 2 diabetes may remain in a stable phase. Each part of the life cycle reacts differently, but all ages do benefit from weight loss, calorie reduction, smoking cessation, a balanced eating plan and exercise, when pre-diabetes or type 2 diabetes is diagnosed.