Health: Why So Many Of Us Are Getting Diabetes

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Advances in diabetes research over the past few years have been swift and wide ranging. Scientists are beginning to identify the genetic and environmental factors that predispose some people to insulin resistance and increase their risk of diabetes. They are looking beyond glucose levels to gauge patients' health and progress. They have identified other pathways that may play a role in triggering diabetes. Every new insight into Type 2 diabetes, from its biochemistry to its metabolic roots, makes clear that it can be avoided--and that the earlier you intervene the better.

The real question is whether we as a society are up to the challenge. "Our health-care system is currently set up to deliver care for acute disease," says Ann Albright, chief of the California Diabetes Prevention and Control Program. "It's get in, get your shot, and away you go." Diabetes, however, is a chronic disorder that demands constant attention. You have to change your eating habits and incorporate physical exercise into each day's activities. You need to monitor your glucose levels several times a day to see how well you're doing. These prevention measures pay off in the long run in fewer heart attacks, strokes, amputations and cases of blindness and kidney failure. But very few insurance programs focus on them--or pay for health professionals who can teach folks how best to incorporate them into their lives.

Comprehensive prevention programs aren't cheap, but the cost of doing nothing is far greater. "If we don't take care of this issue now, we will have huge numbers of Type 2 diabetics, and we will be paying for them with our tax dollars," says Dr. Phyllis Preciado, an internist who runs a diabetes clinic in California's farming-rich Central Valley. As the U.S. loses productive members of the work force, she notes, more people will turn to public assistance for treatment. And the increased toll in human suffering will be staggering.

There are ways to keep costs down. It doesn't take a physician to teach a patient the principles of better nutrition or how to use a glucometer. Nurses, nutritionists, diabetes educators and other non-M.D.s can play a key role. Experts say it's important to reach the communities that are hardest hit by diabetes--American Indians, for example--all the while taking cultural differences into account. "You can't give everybody the same diet to solve the problem," says Albright, a registered dietitian. "People obviously eat the foods they've grown up with. So you have to try to help them get as much of those things that they like into their eating plan but also make the changes that will help lower the fat or moderate the carbohydrates."