Millions in the U.S. live unknowingly with a disease that could take their life

By Dennis Thompson

(HealthDay News) -- Diabetes has reached epidemic proportions in the United States, with about 23.6 million people -- nearly 8 percent of the population -- suffering from the condition, according to the U.S. National Institutes of Health.

Diabetes is the leading cause of blindness and kidney failure in America, according to the American Diabetes Association. It's the leading reason people have limbs amputated, outside of trauma. It doubles your risk for having a heart attack or stroke. It leads to a complicated lifetime of blood tests and strict diets and systemic illness. It is not curable.

So why isn't diabetes spoken of with the same dread that accompanies cancer or congestive heart disease?

Medical experts continue to grapple with that question. November has been designated as American Diabetes Month.

"All Americans -- and all the people on this planet, for that matter -- need to realize that having diabetes, or being at risk for diabetes, is serious," said Sue McLaughlin, president of health care and education for the American Diabetes Association. "If the current trend continues, one in three children born in the year 2000 will have type 2 diabetes in their lifetime. This figure increases to one in two children if the child's ethnic background is non-white," she added.

"Choosing to ignore the risk factors for diabetes, or choosing to do nothing to reduce them, is placing a large bet on your health," McLaughlin said.

Part of the problem might be that diabetes has proven to be a "silent killer."

• Nearly one in four of the 23.6 million people who have diabetes don't even know it, according to government health experts. That's about 5.7 million people walking around with untreated diabetes.
• Even worse, more than one-fourth of the entire United States population is believed to have pre-diabetes, a condition in which blood sugar levels are elevated but type 2 diabetes has not yet set in, according to the U.S. Centers for Disease Control and Prevention.
• Diabetes is the seventh-leading cause of death in the United States, but CDC experts believe that the ranking is low because diabetes-related deaths are under-reported. Studies have found that only 10 percent to 15 percent of those with diabetes had it listed as their cause of death, and just 35 percent to 40 percent had diabetes listed anywhere on their death certificate.
• "People don't really realize all these heart attacks that happen, it's due to diabetes as much as anything a lot of the time, but it's the heart attack that gets the attention," said Dr. Richard Bergenstal, executive director of the International Diabetes Center in Minneapolis and president-elect for medicine and science of the American Diabetes Association.

Just what diabetes is, and its consequences on people's health, also aren't fully understood, McLaughlin said.

"High blood glucose affects the integrity of every tissue in the body: nerves, connective tissue, organs, bones, muscle, etc.," she said. "Unfortunately, diabetes leads the nation as a disease that causes hardship and devastating consequences to people affected by this disease. A person's quality and length of life may be seriously impacted by uncontrolled diabetes."

The impact of diabetes can include:

• A much greater risk of losing your sight to cataracts, glaucoma or other eye diseases.
• Kidney failure. "People with diabetes are the fastest growing group of individuals needing dialysis or transplantation," McLaughlin said.
• A rate of amputation 10 times higher than for people without diabetes.
• Nerve damage that results in pain in the feet or hands, slowed digestion and sexual dysfunction, among other problems.
• Death by heart attack or stroke for two of every three people with diabetes.
• And that's not even mentioning the decreased quality of life that people with diabetes have, McLaughlin added.

"Activities of daily living such as driving a car, walking, climbing stairs, doing housework or yardwork, cooking and toileting may be impacted and become much more difficult for a person because of the negative effects and damage caused by uncontrolled diabetes," she said.

Diabetes isn't cheap, either. The American Diabetes Association figures that people with diagnosed diabetes incur average medical expenditures of $11,744 a year, of which $6,649 is attributable to care and management of diabetes.

"These medical expenditures are two to three times higher than what expenditures would be if the person didn't have diabetes," McLaughlin said.

"Indirect costs include increased absenteeism and reduced productivity while at work for those who are employed but whose diabetes is difficult to manage, reduced productivity for those who are unemployed, unemployment from disease-related disabilities and lost productive capacity, due to early mortality," she said.

However, there's hope. Recent large-scale studies have shown that people diagnosed with pre-diabetes can keep the disease from progressing to full-blown type 2 diabetes, McLaughlin said. They had to reduce the amount of food they ate, cut back on fatty foods, exercise at least 150 minutes a week and lose 5 to 10 percent of their body weight, she said.

But first, Bergenstal said, people need to know they have pre-diabetes -- and then they have to be convinced to care.

"We can stop their progression to diabetes with some pretty simple steps, but many doctors are not screening forward to identify people with pre-diabetes," he said. "We have some good interventions to stop you from going from pre-diabetes to diabetes, but we have to find you first."

Bergenstal recommends that people fitting the following criteria talk with their doctor about taking a blood glucose test that could show whether they are pre-diabetic:

• Older than 45
• Overweight or obese
• Family history of diabetes
• Member of an ethnic or minority group

On the Web

The U.S. National Diabetes Information Clearinghouse has more on diabetes.

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