Thursday, October 04, 2007

A Sweet Epidemic

I looked at the test results and knew immediately what it illustrated---my patient is diabetic. Not only is this patient newly diagnosed, I have been directly involved in diagnosing four new diabetics this year alone. Diabetes, along with morbid obesity, is truly an American epidemic, and the Latino community is most likely the hardest hit.

According to the New York Times, public health officials are expecting "a huge wave of new cases (that) could overwhelm the public health system and engulf growing numbers of the young, creating a city where hospitals are swamped by the disease's handiwork, (and) schools scramble for resources as they accommodate diabetic children." And just imagine the effect on the workforce, productivity, and the cost of healthcare.

With a food supply imbued with fats and sugars, a growing population of obese, poorly educated and poverty-stricken citizens, and a society which thrives on convenience, speed, and a sedentary life on remote control, the stage is set for an epidemic of proportions never before imagined. As Americans become sicker and more disabled, and a larger portion of the society reaches old age, healthcare premiums and the cost of healthcare in general could very well outstrip the ability to properly care for those aging with chronic illness.

Disparities in how healthcare dollars are spent play a large role in the tactics used to improve public health and educate the populace. According to the same New York Times article mentioned above, 1,000 New Yorkers were infected with TB last year in the face of a $27 million expenditure on TB prevention and treatment. Meanwhile, with diabetes expected to engulf more than 1 million New Yorkers in short order, New York allots less than $1 million for diabetes education and outreach each year. There is a calculus of scale when dealing with disease, and we seem to be failing the class miserably.

The American Diabetes Association estimates that the cost to the nation for the care of individuals with diabetes in 2002 amounted to approximately $132 billion. For the treatment of all cancers combined, the country spent approximately $171 billion that same yeat. Simple math will tell anyone paying close enough attention that the epidemic of obesity and diabetes in America must be brought under control, or we will have a public health nightmare beyond our wildest dreams within a generation.

So, when I educate my patient about his new diagnosis of diabetes, I am not just doing it for him. Of course, I share with my patient the goal of a long and healthy life free from the ravages of an insidious and potentially fatal chronic disease. More broadly, I strive to also keep him healthy for the good of the society, the healthcare system, the economy, and the future care of others who will some day need to benefit from high quality healthcare just as he does now. The sugar coursing through his blood does its damage quite silently, and it is my job to partner with my patient so that he does not become just one more statistic related to the development of avoidable kidney damage and preventable blindness.

When it comes to this new 21st-century epidemic of diabetes and obesity, the current news---and the predictions for the future of American health and healthcare---is anything but sweet.


Tim said...

Have you read "The Omnivore's Dilemma" (Michael Pollan)? It would be a very informative read for someone in your position. The source of the epidemic of diabetes is better understood and comes with sad revelation that much of the root-cause comes from food preparation practices created and sanctioned by the US Government.


vesta44 said...

Have you ever stopped to think that maybe it's not obesity that is causing more diabetics? Diabetes is NOT caused by weight, it's genetic. And the increase in diagnosed diabetics can be attributed to better, more available screening. It can also be attributed to the fact that the fasting blood glucose levels that say one is diabetic have been lowered, and lowered again, turning people who previously would not have been considered diabetic into diabetics.
This obesity epidemic hysteria is just that, hysteria. There is no direct relationship between obesity and illness. There is correlation, but: CORRELATION IS NOT CAUSATION.

Keith, RN said...

I appreciate both your comments.

While I agree that genetics plays a huge factor in a person becoming or being obese, I still feel that increased adipose tissue---especially in the midriff section of the body---greatly increases the risk of developing diabetes, something borne out by a great deal of reliable research.

I also disagree with the statement that "there is no direct relationship between obesity and illness." There is just too much literature out there that draws direct links between the development of many illnesses and a state of obesity.

The reason they have lowered the diabetes threshold, I believe, is because it was realized that many people who were being "missed" by the tests were actually developing the trademark symptoms of diabetes later on, even though they did not test as diabetic at the time. The thought was to catch these patients very early on and nip the disease in the bud before any damage was done, instituting lifestyle changes at a critical time.

I will take your comments to heart, however, do some more reading, and write some more about it as I gather my findings.