Physician Focus: Diabetes is the silent epidemic

Dr. David M. Harlan

An epidemic is a widespread occurrence of a disease at a specific time, typically involving infectious disease. Examples include polio in the 1930s to 1950s -- until curtailed by vaccine -- and AIDS and malaria, which still infect millions, mostly in less developed nations.

In the U.S., excellent resources -- public health policies, research and medical facilities, and dedicated health care professionals -- have limited the severity of potential epidemics. Witness the recent H1N1 swine flu; our quick response probably minimized illness and death.

Yet despite our medical knowledge and prowess, we're in the midst of a silent epidemic that shows no signs of easing. Indeed, it shows every indication of increasing.

Diabetes affects an estimated 24 million adults and children in America. Each year, more than 1.5 million new cases are diagnosed in people 20 and older. By one estimate, diabetes will nearly double in the next 25 years, reaching more than 44 million people. And it's one of the nation's costliest diseases: including direct and indirect medical costs and lost productivity, the annual cost of diabetes approaches a staggering $220 billion, more than twice the cost of all cancers combined.

Those numbers testify to the epidemic nature of this chronic disease, making it a major public health crisis as much as a personal medical condition.

Diabetes is a condition of too much glucose, or sugar, in the blood. Glucose is the body's main ingredient for cell metabolism and is regulated by insulin, a hormone produced by the pancreas. Diabetes results when the body doesn't produce enough insulin, or the body is resistant to insulin's activity.

Different types of diabetes exist. Type 1 diabetes (formerly known as juvenile diabetes) results when the immune system kills the cells in the pancreas that make insulin. Type 1 can occur at any age, but is often found in children. Type 2 diabetes -- accounting for more than 90 percent of cases -- occurs when the pancreas makes insulin but not enough for the body to function properly. A third type, gestational, develops during pregnancy when the mother's insulin needs are high. Pre-diabetes is a condition where blood sugars are elevated but not high enough to reach the threshold of diabetes. Clinical studies have shown that those with pre-diabetes often progress to develop the disease.

The most prevalent, Type 2, is insidious in onset. The few symptoms (excessive thirst and urination, change in vision) can develop so gradually that individuals don't recall noticing anything. That's why there's so much undiagnosed diabetes. The Centers for Disease Control and Prevention estimates that nearly 6 million people in the U.S. have diabetes and don't know it.

Untreated and uncontrolled, diabetes has devastating consequences. It's the country's seventh leading cause of death and a leading cause of blindness, kidney failure, amputations and premature mortality. Complications also include heart disease, stroke, nervous system disease, and eye and foot problems.

What causes diabetes? A strong genetic component exists for Type 1 and Type 2, but other factors, such as lifestyle (for example, a sedentary lifestyle), behavior and diet also play important roles in Type 2. Scientists believe it's no accident that the rise in Type 2 diabetes has gone hand in hand with soaring rates of obesity.

Early diagnosis is important, so all patients should get screened. Simple, painless tests can determine if a patient has diabetes or pre-diabetes. If either is confirmed, basic steps and behaviors can help control the condition, especially Type 2. Clinical tests have shown that walking briskly for 30 minutes a day five days a week, watching your diet, and losing body fat if you're overweight, can prevent or delay the onset of Type 2. While there's no cure for diabetes, the good news is that with proper diet, exercise and medication, it can be controlled. Diabetes need not rule your existence.

Diabetes is often treated using a team approach: primary care provider, specialists as needed -- like eye specialists -- and a diabetes educator. The most critical member of that team, however, is the patient. Only the patient can control diet, exercise and lifestyle and be vigilant with medications and medical follow-up.

Patients and providers together must recognize and attack this all-too-silent epidemic. Only then can we reduce its incidence and limit its devastating complications. To learn more, visit the National Diabetes Information Clearinghouse at For a special video by the Massachusetts Medical Society, visit

David M. Harlan, M.D., is chief of diabetes and director of the Diabetes Center of Excellence at the University of Massachusetts Memorial Medical Center and a professor of medicine at the University of Massachusetts Medical School in Worcester, Mass. Readers should use their personal judgment when seeking medical care and should consult with their personal physician for treatment. Physician Focus is a public service of the Massachusetts Medical Society. You are welcome to e-mail comments to