Issue 107 Item 13 Growing Diabetes Epidemic, it Deserves Respect

U.S. HEALTH SYSTEM FUELS GROWING DIABETES EPIDEMIC. Doctors need to “wake up” if they think serious complications of diabetes are inevitable in minority patients. Chronic diseases such as diabetes are reaching epidemic proportions in the United States, largely due to a health care system that is better suited to treating acute, episodic illness, Dr. Christopher Saudek, president of the American Diabetes Association, said today.

There are 120 million Americans with chronic diseases, Saudek said; 17 million have diabetes. Saudek and others appeared at a news briefing for the publication of a diabetes theme issue of the Journal of the American Medical Association.

“Diabetes deserves respect,” he said. “The personal devastation it causes it truly great.”

During the past 10 years, the proportion of Americans with diabetes has slowly risen from 4 percent to more than 6 percent across the country. It is responsible for 450,000 American deaths a year, or 19 percent of all deaths annually in the United States.

According to estimates, the rate of diabetes will continue to grow in leaps and bounds and the health care system will not be equipped to handle the load, unless new research leads the way to more efficiently and effectively deal with the consequences of diabetes and other chronic diseases, Saudek said.

Blacks, Hispanics and other minorities with diabetes have higher rates of complications from the disease, imposing enormous costs on the health care system.

This does not need to be so, said Dr. Joe V. Selby, of Kaiser Permanente’s Division of Research, at the briefing. Doctors need to “wake up” if they think serious complications of diabetes are inevitable in minority patients.

Selby and colleagues conducted a study of racial disparities within a diverse population of diabetes patients who had similar insurance and access to care. They found that while racial differences existed, they were not lopsided in favor of whites, as indicated in previous studies of patients with various levels of insurance.

Black patients had heart attacks at a lower rate than whites, but had heart failure and stroke at a similar rate. Asian patients had one-third the rate of leg amputations of all the other ethnic groups, and all the minority groups had much higher rates of kidney failure than whites, according to the study, which is published in the JAMA theme issue.

“Having high-quality care may reduce or eliminate ethnic or racial disparities in complication rates for patients with diabetes,” Selby said.

Another study in the issue shows that two serious and potentially fatal complications of juvenile-onset diabetes occur at a higher rate in children who lack full insurance.

The two complications which cost the U.S. 100 million a year in the 1990’s, lie at the extremes of the scale of blood sugar: diabetic ketoacidosis, in which the levels are too high, and severe hypoglycemia, where the levels are too low. Both conditions can cause coma and death and almost always lead to emergency room visits or hospitalization.