Diabetes is a chronic condition associated with abnormally high levels of blood glucose. Glucose, a type of sugar, is the primary energy source for the human body. Many different types of food are converted into glucose after passing through the digestive system to constitute a readily usable form of energy that can be transported in the bloodstream to the brain and other organs. Insulin is the hormone produced by specialized beta cells of the pancreas that is responsible for maintaining the required glucose levels in the blood by stimulating glucose uptake into tissues. Type 1 diabetes accounts for only about 5 percent of all cases; it is due to an immune attack on pancreatic beta cells and the loss of ability to produce insulin. It most often affects children and young people. In contrast, type 2 diabetes accounts for more than 90 percent of cases. In this case, the pancreas initially still produces insulin, but the glucose-starved tissues can no longer respond to it. Over time, the ability to produce insulin declines, and insulin may have to be administered. Significantly, type 2 diabetes is considered to be largely preventable by maintaining a healthy diet and exercise.
Diabetic patients do not die of “high blood sugar” per se, but of long-term complications associated with the condition. The details of how high blood sugar causes its harmful long-term effects are not yet fully understood. However, since diabetics are prone to develop cardiovascular disease, including atherosclerosis and stroke, diabetic nephropathy (kidney dysfunction), and peripheral neuropathy, which can lead to amputation of the legs or feet, they frequently need to be put on medication to control blood pressure and cholesterol levels, in addition to insulin.
In a 2008 publication, the International Obesity Taskforce estimated that globally, nearly 1.7 billion people may be at risk for weight-related disease [1]. Putting this staggering number into context, the total worldwide population count stands at 6.7 billion. Today’s worldwide mortality rates associated with high-body-mass-index obesity are around 2.5 million, but this number is expected to double by the year 2030. The Centers for Disease Control estimated almost 24 million Americans are diabetics. This comprises almost 8 percent of our total population. Of those, about 5 million remain undiagnosed. Interestingly, although the United States is home to only about 8 percent of the world’s population living with diabetes, it spends more than 50 percent of all global expenditure for diabetes care.
A study commission by the American Diabetes Association in 2008 revealed that diabetes has reached the status of “public health crisis,” costing the United States at least $174 billion a year. This figure includes $116 billion in health care cost and $58 billion in indirect costs, such as lost productivity. The International Diabetes Federation predicts that by 2025, the cost will exceed $302.5 billion [2]. The human cost boggles the mind: 284,000 people in the U.S. died from diabetes in 2007.
Despite the scary statistics, responsible people are now focusing on the preventable aspect of type 2 diabetes. Diabetes is inextricably tied to the obesity epidemic. Obesity, in turn, has complex causes including cheap, readily available, calorie-dense foods full of fat, sugar, salt, and artificial flavors specifically designed to appeal to our tastes and to make us crave more. The deeper causes of overeating and obesity, like so many other common disorders, are linked to psychological factors rooted in feelings of alienation from family, society, nature, and the universe at large. These feelings of alienation must be addressed and society’s spiritual hunger must be nourished before true change can happen. I believe that the growing interest of young couples in the art of cooking at home, in preference over take-out, the growing popularity of organic produce over highly processed foods, and the changing menus in school cafeterias are all heralding an overall change in fundamental attitudes.
References:
[1] Stephen R. Bloom, Francis P. Kuhajda, Ismail Laher, Xavier Pi-Sunyer, Gabriele V. Ronnett, Tricia M.M. Tan, and David S. Weigle. The Obesity Epidemic. 2008. Molecular Interventions 8:82
[2] Diabetes Atlas, third edition, International Diabetes Federation 2006
Dr. Kupershmidt is a research associate professor of anesthesiology in Vanderbilt University.