This post was written by Gerald Bernstein, MD, Director of the Friedman Diabetes Institute at Mount Sinai Beth Israel.
One of today’s greatest public health issues is the growing number of people with diabetes mellitus, most commonly type 2 and most often (but not always) associated with excess weight. To appreciate the scope of the problem, it is important to understand the true nature of the disease.
The Journey to Diabetes
Diabetes is a condition in which the body produces little or no insulin or uses it improperly, resulting in high levels of blood glucose (sugar), the body’s primary energy source. If left untreated or mismanaged, it can cause serious, sometimes life-threatening health problems.
It is highly likely that one’s journey to diabetes begins in the womb, and that risk for it begins at birth and rises progressively as we age. At the beginning of this journey, blood glucose and its related complications are not yet an issue. Factors affecting diabetes risk and onset include:
1. How well the body produces insulin
2. How readily insulin secretion responds to glucose
3. How effective the produced insulin is
4. How old the insulin-producing cells are
The Early Years
Through the early years, most people do not have problems unless the metabolic system (the way our body uses digested food for energy and growth) is stressed. The most common stressor is obesity, which impairs the effectiveness of insulin. The degree of impairment will determine whether or not a person will be diagnosed with clinical diabetes at a younger age than normal. Childhood obesity, for instance, has provoked much earlier onset of clinical diabetes.
Prediabetes
As one moves along the path towards a diagnosis of diabetes (a clinical condition with symptoms), there is an earlier period called “prediabetes.” With no clear symptoms, prediabetes may last from 5 to 20 years. During that time, risk for cardiovascular impairment progresses to the point where the large vessels of the body (in the heart, brain, etc.) are already damaged by the time diabetes actually begins. This may lead to early stroke and heart attacks, even in children. Once diabetes is diagnosed, the risk for small blood vessel disease begins, which can lead to blindness, kidney failure, limb loss and other complications.
Preventing and Treating Diabetes in Our Communities
The number of people on this journey is staggering. According to the Centers for Disease Control, more than 40% of the U.S. population over the age of 20 has either type 2 diabetes or prediabetes. All told, that’s about 140 million people. Preventing and treating diabetes calls for a large public health measure. New York City has already taken a few steps, such as recording every A1c blood test (which measures blood glucose levels) done on its citizens, and mandating that certain restaurants include calorie labels on menus.
Clearly, it is critical to detect and prevent prediabetes where possible, and to treat and educate those patients who do receive a diabetes diagnosis. The Mount Sinai Health System, formed through the merger of the Mount Sinai and former Continuum hospitals, now cares for a population equivalent to the size of a small city. The challenge is how a large organization like ours can provide meaningful intervention, including screening, to hundreds of thousands of people, especially when the interventions are multifaceted and time consuming. Complicating this effort is that it takes place in a complex urban environment with an unbelievably diverse population.
Our aim is to attack the twin peaks of risk — cardiovascular and microvascular (small vessels) — and help patients achieve the desired metabolic and behavioral goals to significantly lower their risks for complications. In “The Growing Problem of Diabetes — What Can We Do? (Part 2),” we will discuss what I think is a possible pathway to this solution.
To learn more about diabetes and the Friedman Diabetes Institute, please visit our website.