The rate of new cases of diabetes has nearly doubled over the last 10 years in most states, and the cost of drugs to treat the disease rose from $6.7 billion annually in 2001 to an eye-popping $12.5 billion in 2007. That brings the emerging epidemic of high blood sugar levels among Americans into sharper focus.
Public health officials are correctly worried that the spiking rate of new cases of Type 2 diabetes --- the kind that forms later in life and is linked to excess weight --- will have a huge impact on the nation's overall health over the next decade. Uncontrolled blood sugar levels significantly increase the risk of heart attacks, strokes, blindness, poor circulation and other debilitating conditions. Among racial minority groups, the diabetes rate is 2.5 times higher than for whites.
Still, there is cause for optimism, despite the fact that last year 1.6 million adults were diagnosed with the disease. Evidence continues to mount that lifestyle changes and long-prescribed generic drugs can control Type 2 diabetes --- keeping it from getting worse in those who have it and keeping blood sugar levels under control for people at risk for developing it.
The latest studies paint a picture of diabetes as a major problem in the South. The Centers for Disease Control and Prevention surveyed residents of 40 states and found an alarming increase in new cases over the last two years in Georgia, South Carolina and Tennessee, compared to 10 years ago. The findings mirror other geographic studies on obesity and physical inactivity among residents of other southern states.
The new data could help public health officials in Georgia create more effective prevention messages. Perhaps it will inform the decisions of health insurers about the wisdom of prevention and blood-sugar control programs for the patients they cover --- programs that many patients now bypass because they have to pay for them out of their own pockets. (Here, employers can also step up to the plate by building on-site exercise facilities or agreeing to cover a portion of gym memberships for employees through their group health plans.)
Insurers and public health officials should take a cue from Kaiser Permanente's Healthy Eating, Active Living program now operating in a handful of states. The program focuses on developing community initiatives that emphasize physical activity and eating well. Community organizers work with local grocery stores to stock more fresh-grown vegetables, with city and county planners on bond issues for more bicycle and walking paths, and with schools to substitute more healthful alternatives for sugary drinks in vending machines.
Physicians also play an important role in controlling the epidemic. In a landmark, 2002 study of patients classified as "prediabetic" --- higher than normal blood glucose level with other high risks of developing the disease --- the Diabetes Prevention Research Group randomly assigned 3,000 patients to three groups. One group received a placebo, while another took a daily oral dose of metformin (the generic, glucose-reduction drug).
A third group took part in an intensive behavior-modification program aimed at helping them lose 7 percent of their body weight. That group went on a low-fat, low-calorie diet, exercised 150 minutes a week and met regularly with a case manager to discuss what they were doing. Over the three years of the study, the behavior-modification group was 58 percent less likely to develop diabetes, while those on metformin cut their risk by 31 percent.
Other experience suggests the simplest approaches to diabetes prevention and management often are the best. Some of the newer, more expensive diabetes drugs --- thought to be driving much of the cost increase in recent years --- may not be any more effective for many patients than the older, generic versions. One recent study showed that metformin, which costs $4 to $5 per month, does a better job of preventing heart attacks in diabetics than Avandia, a costly, newer brand name drug that is widely advertised directly to patients.
That finding, and others, prompted a panel of experts in diabetes treatment last week to restate practice guidelines that the older drugs should be prescribed first for newly-diagnosed Type 2 patients.
Getting control of diabetes in the United States will be a challenge for public health advocates, community leaders, physicians and insurers. But the key players are the patients themselves --- too many of whom think the silent epidemic is not as big a threat to them as it truly is.
The evidence is clear. If patients manage their own blood sugar levels --- through diet and exercise, and with the right drugs --- the diabetes epidemic can be controlled.
--- Mike King, for the editorial board (mking@ajc.com).
ALARMING RISE OF DIABETES IN THE SOUTH
With the exception of West Virginia, Southern states led the nation in the increase in residents who have been diagnosed with diabetes. Here's how Southern states stacked up in 2007 compared to 1997.
State..........2007 rate ..1997 rate
West Virginia..12.7........5.8
S. Carolina....11.5........5.4
Alabama........11.3........5.4
Georgia........11.2........6.2
Texas..........11.1........3.6
Tennessee......11.0........5.2
Kentucky ......10.5........4.0
All states......9.1........4.6
Source: Centers for Disease Control and Prevention survey of 40 states. Figures are age-adjusted death rates per 1,000 residents for 1995-97 and 2005-07.
Copyright 2008 The Atlanta Journal-Constitution