This post was written by Gerald Bernstein, MD, Director of the Friedman Diabetes Institute at Beth Israel Medical Center.
The wonderful actor Tom Hanks said a mouthful when he told late-night talk show host David Letterman that he was recently diagnosed with type 2 diabetes, a condition in which the body does not produce or properly use insulin. Tom Hanks to me is everyman, best characterized in his movie “Saving Private Ryan.” He looks like a regular guy and, from what I can tell from the general media, he is—not too heavy, not too thin (except for during movie roles he played as an AIDS patient and a castaway), and apparently realistic about life and work in general.
What Hanks said that is so important is that his blood sugar was somewhat elevated when he was in his 30s, meaning he had prediabetes. He was also wise enough to know that the eventual progression to clinical diabetes was inevitable. As with everything else about Hanks, this news was a piece of life and he is dealing with it.
Houston, We Have a Problem
Data from the Centers for Disease Control indicate that, like Hanks, 42.3% of the American population over the age of 20 has either prediabetes or clinical diabetes. Add in the numbers under age 20 and you approach 140 million people, almost half the country. And, our rates of obesity—a contributing factor to diabetes—are staggering. Obviously, our nation has a big problem.
The Path to Clinical Diabetes
The propensity for type 2 diabetes probably starts in utero and then is a linear progression over the life of the individual, meaning that the blood sugar will progressively rise as a person ages. This path to clinical diabetes may be hastened by lifestyle, including obesity and inactivity, or slowed by normal weight and regular activity.
The big point is that the period of prediabetes may go on for 20 years before the numbers qualify as clinical diabetes. Prediabetes is associated with increased risk for cardiovascular disease, heart attack, strokes and more. We know there are changes in the blood vessels of obese children as young as 5 years old. The best we can offer now to mute the impact of prediabetes is a government-mandated nutrition and activity program for preschool through the 12 years before college or work. This can delay the onset of clinical diabetes to a much older age, when its impact will be somewhat lessened.
Managing Risks
Finally, when clinical diabetes is diagnosed, the individual now faces a second set of risks that involve the eyes, kidneys and other organs. The data show that these additional risks can be reduced by blood glucose control, along with proper nutrition and physical activity.
In addition, diabetes programs like the Friedman Diabetes Institute can help large numbers of people reduce their risks through continuing education and community partnerships. As the delivery of medical care changes, the approach to screening for prediabetes and instituting preventative measures, with or without pharmacology, can be regimented and not treated casually.
If the United States fails to manage its growing diabetes epidemic, we may face a massive problem 20 to 30 years from now. That’s when much of today’s under-30 population may be stricken with the aforementioned cardiovascular events due to prediabetes, weakening our country’s ability to produce and defend.
To learn more about diabetes and the Friedman Diabetes Institute, please visit our website.