Why an Epidemic of Diabetes?
Epidemiologists feel that changes linked to the rate of obesity are the main cause of the epidemic. Possible minor contributors to the increase in diabetes include the increasing proportion of certain ethnic groups in the population, increased survival times of diabetics, improved diagnosis of diabetes, greater disparity between rich and poor, more environmental pollution, depletion of nutrients in food, and decreased breast feeding.
These may play a minor role, but changes in diet and exercise patterns are thought to be the heart of the matter.
Which is more important, diet or exercise? Clearly both are significant, but most epidemiologists think that exercise patterns have changed more than eating patterns. Although more Americans than ever have joined gyms, this may not compensate for our increasing reliance on our cars to do daily tasks. Think of all the short trips you make to pick up something or run an errand. In the past people were much more likely to walk on these short trips. In 1975, 10% of trips outside the home were on foot. By 1995, only 5% were. Still, 25% of trips are less than one mile. Formerly, all children walked to school. Now most arrive by car (not bus), and less than 10% walk.
These changes in our daily lifestyle patterns are thought to be at the root of increasing rates of diabetes we see in the US. There is a further danger that as the global economy expands to more countries, so will the devastating epidemic of obesity which comes with it.
Individual Costs of Diabetes
If you think staying healthy is expensive, you should try getting sick. Diabetes, like many chronic diseases, is very expensive to treat. The average yearly cost to treat a diabetic patient in an American HMO ranges from $4,400 (diet and exercise only) to $8856 (sulphonylurea and insulin) per patient, depending on treatment. Controlling the diabetes is not the expensive part. 62-89% of the costs are due to cardiovascular, cerebrovascular, peripheral vascular complications arising from the diabetes which must be treated. Many times cost is a barrier to effective diabetes treatment.
US National Costs
Economists have come up with very rough estimates of the costs associated with obesity, diabetes and related disorders at a national level. Diabetes care costs about $50 billion annually, or 7% of all healthcare costs. Heart disease treatment cost another $50 billion, stroke and hypertension $33 billion. Obesity and other related diseases cost between $70 and $100 billion. This is not including $30 billion spent on diet and fitness products and services. This comes to $230 billion in costs related to insulin resistance syndrome. This may be around 20% of all healthcare costs. To put this in perspective, healthcare accounts for around 15% of the total US gross domestic product.
Crisis in developing countries!
If changes in the epidemiology of diabetes in the US and other developed countries are due to lifestyle changes, what will happen to other countries which adopt aspects of the American economic system and way of life? So called “diseases of prosperity” are increasing around the world as more countries achieve a “higher standard of living”. The problem is particularly severe in countries dominated by ethnic groups with a strong hereditary disposition towards diabetes.
In India the prevalence of diabetes is 11.6%, compared to 8.3% in the US. India predicts 80 million diabetics by 2030. The Indian healthcare system is overwhelmed by the number of diabetics and is unable to meet the cost of providing glucose controlling medications and monitoring. Planners worry that costs will only increase as those with uncontrolled diabetes go on to develop heart disease.
As India becomes more prosperous, what was once a disease of the wealthy few is becoming a national crisis! The irony is that over 50% of Indian children still suffer from underweight and malnutrition. Other countries across Asia face similar problems.
Incidence of Type 1 Diabetes is Increasing!
Turning now to type 1 diabetes, it too is increasing. The number of type 1 diabetics in the US increased from 302,613 in 1990 to 675,000 in 1993. The increase in total type 1 diabetics is partially due to improved treatment and young diabetics living longer. However, the rate of new diagnoses is increasing alarmingly. This increase is perhaps more worrying because there is no agreement regarding why this change is happening.
Getting Diabetes Sooner (Type 1)
Not only are more children acquiring type 1 diabetes, they are getting sick younger. The average age at onset is decreasing in British children diagnosed with type 1 diabetes. The average age at diagnosis is now 8.8 years. This means more effects from diabetes during the vulnerable years of development and earlier onset of complications.