Diabetes 'real scourge' on society

Updated October 28. 2007 11:37AM

Diabetes 'real scourge' on society'

By Kathy Alter
GazetteOnline
kathy.alter@gazettecommunications.com

CEDAR RAPIDS - The Center for Disease Control chronicles a 153 percent increase in diabetes diagnoses from 1994 to 2005.

Dr. Fadi Yacoub, a nephrologist with Internists Associates of Iowa, has been practicing 13 years in Iowa, eight in Cedar Rapids.

The incidence of Type I Diabetes has remained fairly stable, Yacoub says, but there is “no question about it” that Type II Diabetes has “skyrocketed for one single reason – weight. The more weight the more diabetes the more kidney disease.”

Dr. Alan Reed, chief of the division of transplantation at University Hospitals and director of its organ transplant center, says “Type II Diabetes is a real scourge on our society.”

Reed, who has performed “several hundreds” of kidney transplants says “we tend to be a victim of our own success.”

People are living longer in large part because of medical advances and Type II Diabetes and the many complications it spawns, including kidney failure, is mostly seen in aging patients. “All you have to do,” Reed says, “is look at the number of people on dialysis and waiting for transplants.”

Yacoub has experienced those growing numbers in his own practice. In the last “two to five years,” the number of kidney patients Yacoub sees has “increased dramatically” and many of those patients are “a lot older, more frail.”

There are 20.8 million children and adults in the United States, or 7 percent of the population, who have diabetes, according to the American Diabetes Association, including 6.2 million people (or nearly one-third) who are unaware that they have the disease.

Add to that the 54 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.

Is there a need for more nephrologists and support staff to deal with the increasing numbers? There may be, Yacoub says, but beefing up medical professional numbers is not the answer.

“The bigger question,” he says, “is how are we going to make diabetes go away? If you remove diabetes in the future, 50 percent – if not more” of the number of kidney patients alone would disappear.

In the 1970s when statistics on kidney failure patients were first being gathered only a “very few were from diabetes,” Yacoub says, and so when projections of patient numbers were made “we grossly underestimated the impact of diabetes.”

The predictions were off by about 400 percent: the 40 patients then predicted compared to the actual 200 seen today. “Today half to 60 percent” of kidney failure cases are caused by Type II Diabetes, Yacoub says.

Those numbers are “very different from most European countries and Japan.”

Diabetes – especially Type II – is “not glamorous,” Yacoub says, so there are “not enough dollars spent” on researching how to make Type II Diabetes go away or how to control obesity.

The long term answer, Yacoub says, is “to start in childhood. Keep kids healthy, active, thin and trim. Type II is totally controllable if you prevent it” and prevention starts early.

Reed agrees that prevention is the answer and says “we need to do things that reward prevention.” Another problem, Reed says, “one that hit me squarely between the eyes,” is “there is no money to be made in prevention only in treatment.”

Society sees obesity “not as a disease but as a lifestyle,” Yacoub says, and so instead of spending money to find ways to combat obesity and Type II Diabetes “we tend to spend on treating the complications” of diabetes, Yacoub says. Those complications can include hypertension, heart problems, neuropathy, blindness and kidney failure.

None of the above addresses the personal impact of diabetes. The ripples have “tremendous effect on those surrounding, the whole family and friends,” Yacoub says. “They are very dramatic, expensive and often debilitating and affect family, friends and social life.”

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