"Diabetes: The Newest Tragedy" by Allen Weiss, MD, MBA , President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

July 1, 2008 - Slightly less than one third of all medical and surgical patients hospitalized at NCH at any given time have diabetes or pre-diabetes. In 2005 the American Diabetes Association stated there were 20.8 million people in the United States with diabetes, plus an estimated additional 6.2 million undiagnosed. There are also over 40 million pre-diabetics.

These numbers surprise most people, particularly when combined with the projection by the World Health Organization that the incidence will double by the year 2030. Why the increase? Two major reasons are usually considered and both make us uncomfortable.

The first reason is the “western-style” diet and life style which is high fat, high carbohydrate and almost no exercise. We are the fattest country in the history of civilization, We consume more calories and have the most sedentary life style. As a nation, our body mass index (BMI) is the highest ever. BMI is the ratio of weight vs. height and unless we start growing taller as a nation we are going to have to slim down. This “western-style” diet has also added to the risk of heart disease when combined with diabetes.

The other reason for the major increase in diabetes is that diabetics are now living longer and able to have families. Prior to 1921 with the discovery of insulin by medical researchers Frederick Banting and Charles Best, young diabetics never lived long enough to pass along the genes which predispose one to getting diabetes. Now that children are treated effectively and can lead essentially normal lives, their children will have a predilection to get diabetes. Thus, we note the doubling in incidence by 2030 and the almost one third of NCH's admissions with diabetes. One other contributing factor is that everyone is living longer and diabetes increases with age. In “olden days” people died young and many of the dread diseases we deal with daily, such as cancer and diabetes, were not common because infections and accidents killed people when they were still young {by today's standards).

Just so everyone understands, about 10% of people with diabetes have Type 1, also known as Juvenile Diabetes which, typically, comes on in the young and is caused by a failure of the cells in the pancreas to produce insulin. This can be well controlled with various forms of insulin, some of which are continuously administered by a pump and based on the amount of sugar in the blood.

The most common form of Diabetes is Type 11 or adult onset. People with a family history of diabetes, who are overweight and inactive are at the highest risk. Treatment includes weight loss, exercise, and some medicines which can be taken orally or, if necessary, by injection.

Both types of diabetes can be treated well and the common complications of kidney disease, eye disease, heart disease and generalized vascular illness can be delayed or avoided entirely.

The understanding, education, treatment and most importantly, prevention of diabetes is now available. It is up to us to share, embrace and treat. We are fortunate that today most diseases can be prevented or at least ameliorated. Diabetes is a perfect example of this advance in medical science. Do your part!

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.