One third of Americans are diabetic or prediabetic

According to the 2011 National Diabetes Fact Sheet released by the United States Centers for Disease Control (CDC) on January 26, last year saw an increase in the numbers of people with diabetes in virtually every age category.

The federal agency reports that some 25.8 million Americans, or 8.3 percent of the total population, have diabetes. Fully a third of these individuals do not know that they have the disease and are unaware of the serious risks it creates for their health. In a staggering indictment of the state of public health in the US, the CDC found that a further 79 million people in the country are prediabetic, meaning that their blood sugar levels are elevated, but not yet to the point where they meet the criteria for a full diabetes diagnosis.

Diabetes is a malfunctioning of blood sugar control in the human body. Blood sugar levels depend, in part, on the quality and timely release of the protein called insulin from the pancreas, an elongated endocrine organ behind the stomach.

In Type I diabetes, which is generally diagnosed in individuals under the age of 20, a person’s pancreas has virtually ceased producing insulin. In Type II diabetes, which generally onsets after the age of 20, the body fails to produce enough insulin and what it does produce is unable to reduce and control blood sugar as efficiently as in non-diabetics.

The CDC report notes that “diabetes is the leading cause of kidney failure, non-traumatic lower limb amputations, and new cases of blindness among adults in the United States.” It is also a major cause of heart disease and strokes, and “the seventh leading cause of death” in the country. According to the government agency, “The risk for death among people with diabetes is about twice that of people of similar age but without diabetes.”

Even these stark statistics likely under-report the real situation, with research showing that 35 percent to 40 percent of deceased diabetics did not have the disease listed anywhere on their death certificates.

The 2011 report shows a 9.3 percent increase in instances of diabetes and a 38.5 percent increase in instances of prediabetes in the US over the previous two years. In the CDC’s 2008 Fact Sheet, the agency found that 23.6 million Americans were diabetic and another 57 million people were prediabetic.

Dr. Robert Henry of the University of California at San Diego told Med Page TODAY, “This just confirms that diabetes is continuing to increase in this country. We predicted it, and it appears to be true—the epidemic is continuing unabated.” Henry, who is president of science and medicine for the American Diabetic Association, indicated that the findings are anything but surprising.

Wednesday’s CDC release revealed that, among US residents aged 65 years and older, 10.9 million, or fully 26.9 percent, had diabetes last year. About 1.9 million people aged 20 and older were newly diagnosed with diabetes in 2010.

Among minorities, the risk of getting the disease is in even higher. Compared to non-Hispanic white adults, the risk for Asian Americans of acquiring diabetes was 18 percent higher, for Hispanics 66 percent higher, and for blacks 77 percent higher. The CDC notes that among American Indian adults in southern Arizona visiting the Indian Health Service facilities, 33.5 percent had diabetes.

Diabetes can have severe consequences for long-term health, particularly if it is improperly managed and treated. The risk of stroke, for example, is two to four times higher in adults with diabetes. Among adults aged 20 to 74 years of age, diabetes is the leading cause of new cases of blindness. Poorly controlled diabetes also ravages the function of the nervous system in the body’s extremities, making injuries to the bottoms of toes and feet more likely. These often go unnoticed until serious infection has set in. The healing of open cuts and sores on extremities in diabetics is inevitably slower, and not infrequently impossible, resulting in the necessity of lower limb amputations.

In addition, poorly controlled diabetes increases instances of dental problems and complications during pregnancy. It also endangers the health of persons with day-to-day communicable illnesses, as compared to non-diabetics. The simple tasks of walking, climbing stairs, and engaging in basic activities of self-care are often dramatically more difficult for people age 60 and older with diabetes, the CDC reports.

Diabetics are also reported to have a significantly higher rate of mental depression.

Ninety percent of diabetics in the US have Type II diabetes, which, as the CDC report points out, is preventable. Once a diagnosis has been made, the severity of the complications can be dramatically reduced with timely and continuing care, including a careful combination of diet, exercise, often oral medication and, not infrequently, insulin administration.

However, what the CDC report fails to note is that such a high level of medical attention is widely unavailable to millions of Americans, who are unable to afford health insurance. With growing poverty, increasing numbers of people cannot buy nutritious food or the glucose test strips needed to monitor sugar levels. For families working multiple jobs and handling the stress of endless financial problems, adequate exercise is also often out of reach.

The rise in the incidence of Type II diabetes has come alongside a decline in the overall quality of nutrition in US society and a sharp growth in obesity. These processes are bound up with subordination of the food industry to the profit motive, a fact that has even garnered attention in the mainstream press. In May 2009, the news magazine Businessweek observed that “evidence is mounting that the obesity crisis is not the result of a lack of personal responsibility,” going on to note that “the processed food industry’s practices may be just as much, if not more, to blame.”

The omnipresence in the food industry of federally subsidized corn carbohydrates and dairy fats, coupled with advertising campaigns aimed at the most vulnerable segments of the population—the young and the working poor—have been cited in studies as chief reasons behind the enormous weight gains of the American people over the last 40 years.

At the 2009 European Congress on Obesity in Amsterdam, Dr. Boyd Swinburn of Deakin University in Melbourne, Australia, pointed out to Heartwire that the food industry has been targeting the most impressionable layers of society. “They’ve worked their marketing out to the nth degree,” he noted.

In 2009, Kelly D. Brownell from the Rudd Center for Food Policy and Obesity at Yale University and Kenneth E. Warner from the University of Michigan published an article entitled, “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar is Big Food?” The authors noted:

“To protect profits, the food industry must avoid perceptions that it is uncaring and insensitive, ignores public health, preys on children, intentionally manipulates addictive substances, and knowingly, even cynically, contributes to death, disability, and billions in health care costs every year. Stated another way, it cannot afford to look like tobacco.”

As Brownell and Warner point out, the food industry buys access to key associations, including the professional organization for US nutritionists, the American Dietetic Association. The Association regularly publishes “fact sheets” on nutritional advice for the public. The food industry pays $20,000 per sheet, which industry lobbyists then write for the association.

According to Brownell and Warner, the food industry’s strategy for deflecting attention from its practices for the poor state of nutrition in the US includes the following:

“Focus on personal responsibility as the cause of the nation’s unhealthy diet; raise fears that government action usurps personal freedom; vilify critics with totalitarian language, characterizing them as the food police, leaders of a nanny state, and even ‘food fascists,’ and accuse them of desiring to strip people of their civil liberties; criticize studies that hurt industry as ‘junk science’; emphasize physical activity over diet; state there are not good or bad foods, hence no food or food type (soft drinks, fast foods, etc.) should be targeted for change; plant doubts when concerns are raised about the industry.”

On the very day of the CDC’s 2011 Fact Sheet release, Robert Langreth of Forbes noted that sections of the pharmaceutical and health care industry were pleased with the latest report.

“What’s bad news for Americans is good news for companies that make diabetes treatments. One company that has ridden the obesity and diabetes epidemic like no other is the Danish company Novo Nordisk…. Other companies helped by the bad news include Merck (of the popular diabetic pill Januvia), Allergan (obesity surgery supplies), Orexigen Therapeutics (new obesity drug pending FDA approval).”