October 31, 2008

Diabetes Diagnoses Have Doubled

You've probably seen the headlines or the TV news stories about how the incidence Diabetes has Doubled in the past ten years.

Here, from U.S. News and World Report is a typical version of this story:

Rate of Diabetes Cases Doubles in 10 Years: CDC--The obesity epidemic is fueling the type 2 disease epidemic, officials say

As is the case with just about all reporting about Type 2 Diabetes this story neglects to mention some very important facts that explain some of this rise as being in truth a rise in diabetes diagnoses which is NOT the same as a rise in the actual incidence.

The Diagnostic Criteria were Improved in 1998

In 1998, before the ADA revised its document setting out the Diagnostic Criteria for Diabetes Mellitus, most doctors only diagnosed diabetes when people's fasting blood
sugar was over 140 mg/dl.

In 1998, the fasting cutoff was changed to 125 mg/dl.

This change resulted in people getting earlier diagnoses and earlier treatment. This is good, not bad!

Doctors are Screening More Aggressively

There are a lot more drug companies pushing a lot more diabetes drugs now than there were in 1998, and one side effect of this is that doctors are being urged to screen patients more aggressively. In 1998 many doctors were still screening patients for diabetes with a urine dip test which often misses evidence of high blood sugars.

Back in 1998, I did not test positive on a urine dip test until my blood sugar was 240 mg/dl three hours after eating (and that reading was taken with a blood calibrated meter, so the actual plasma reading would have been 12% higher.)

More Doctors are Finally Taking "Pre-Diabetes" Seriously

Fifteen years ago I was told that "pre-diabetes" was a "fad diagnosis" even though I'd been diagnosed years before with "pre-diabetes" on a glucose tolerance test. Even when she learned that my blood sugars were going into the 200s after ever meal, my doctor back in 1998 told me it was "nothing to worry about" because the blood sugars eventually came down to around 100 mg/dl by the next morning.

Since then, many, though not all, doctors have come to realize that pre-diabetes and what they used to consider "Mild" diabetes imply the presence of blood sugars high enough to cause "diabetic complications" and need to be diagnosed and treated.

The Baby Boom is Aging

The incidence of Diabetes rises as people get older. It always has. Women, in particular, become much more insulin resistant after menopause, unmasking blood sugar abnormalities that were hidden until then.

What is changing is that there are a lot more people now in the age group where these diagnoses start to rise since the huge population mass we call the "Baby Boom" is now mostly in its 50s.

So we might just as honestly ascribe the increase in diabetes to an "epidemic of menopause" as to the "obesity epidemic." This isn't a real epidemic, it's a well-understood demographic change.

Given these facts, the increase in diabetes diagnosis may be good news, because it means people are getting diagnosed earlier and with blood sugar levels that were ignored in the past to the point where many a person died of a diabetic heart attack without ever learning they were diabetic.

In addition, earlier diagnosis makes it possible for people with diabetes to avoid the horrible complications that were the fate of people a generation ago who were diagnosed only after they had already developed neuropathy, retinopathy, and early signs of kidney damage.

The growth in the incidence in Type 2 diabetes that is not accounted for by the above factors is probably explained by these:

1. There is a huge, not well-understood explosion in the incidence autoimmune diseases of all kinds. A surprising number of those diagnosed with "Type 2" diabetes have antibodies characteristic of autoimmune diabetes.

2. Toxic chemicals like the Bisphenol-A that lines our tin cans are now known to promote insulin resistance and obesity. Other chemicals known to cause diabetes are PCBs and pesticides, both of which are found in human bodies at alarming rates. The chemical industry would prefer that you keep blaming people for causing their obesity and their diabetes through gluttony because it would be very expensive for them to remove these chemicals from our environment.

3. The Drugs Used to Treat Depression Cause Weight Gain, Insulin Resistance, and Diabetes. The overmarketing of psychiatric drugs to people with normal, if unpleasant, human emotions is a major, unexplored, cause for our current "obesity" epidemic. If the people reporting about health in the media ever did anything more than read press releases you'd learn about this. But because these drugs are so profitable, the drug companies have kept this information out of the news.


ItsTheWooo said...

Those psych drugs are a huge cause of diabetes, and they are MUCH more common now than they were years ago. At work we have a resident who was recently put on risperdal. This woman does not have diabetes. Within 3 weeks of taking risperdal she developed disturbing side effects characteristic of NMS (neuroleptic malignant syndrome, a consequence of dopamine blockade). Her blood sugar was 500+ when we sent her to the ER.

When I did clinicals in the psych ward, all of the patients appeared to have glucose intolerance and fatigue from the drugs. I found it incredibly ironic that pastries our class brought as a treat were more effective sedatives than ativan/benzodiazapenes. Within minutes of eating the doughnuts, every patient was sedated or outright asleep.

I've actually begun to wonder if glucose intolerance is part of the reason psych drugs actually work. If your body cannot make energy, you simply won't have the ability to scream, be crazy and generally bothersome to your family/caretakers. I've observed it first hand. Slumped over in a lethargic heap, on the verge of sleep, you aren't about to be a problem are you?

Anonymous said...

It goes without saying that a major factor has to be the Healthy High Carb Low Fat Diet.

It interests me that a number of diseases with a clearly genetic component are now becoming "epidemic". Obviously there are environmental factors involved such that probably everyone carrying the genes is pushed into expressing them.

What's even more alarming is that some figures demonstrate that Type 1 which has a lesser genetic component than Type 2 appears to be increasing at a faster rate, what the hell is causing THAT to happen?

Jenny said...

Type 1 is more frequent in people with a couple different genetic profiles, but autoimmune disease of ALL types has become much more prevalent during my lifetime.

Why is a subject of much controversy. One argument is that children are being kept too clean during the formative period during which the immune system "educates itself" and develops in a way that is more prone to autoimmunity.

Another might be that the soy in children's diets is pushing the immune system towards more autoimmunity.

This may also be due to environmental toxins causing subtle genetic harm.

Or who knows what?

Anonymous said...

Oh yes good point, Crohn's is another autoimmune condition (probably triggered by an infectious agent whose effect is trivial on others) which is "probably"affecting everyone who is susceptible, then there's asthma and other allergies all on the rise. Too many chemicals and not enough Real Dirt, wouldn't it be ironic if the cause turned out to be pine disinfectant? (grins)

Anonymous said...

I'm wondering if taking statins might be an additional cause of the rise in diabetes. I know that, besides other side effects, statins suppress testosterone and other hormones (why my osteoporosis isn't getting any better, too). Anyone heard about this possibility?