The Diabetes Challenge

Dramatic increases in the number of people with diabetes around the world are causing experts to sound alarm bells. Dr. Robert Henry, President of Medicine and Science at the American Diabetes
Association, sees a fast-approaching calamity. According to the WHO, 346 million people around the globe have the disease, and diabetes-related deaths will double between 2005 and 2030. Experts ascribe the global increase to mass urbanization, increased obesity rates, and aging populations. Dr. Henry points to alarming statistics: "In Canada, the United States, and Mexico, the total number of patients was 33 million in 2000. By 2030, there will be 67 million. Diabetes growth will especially occur in places like Asia and Australasia, where the number will more than double between
2000 and 2030, from 82 million to 190 million plus."

What is diabetes? The U.S. NIH defines it simply as "a chronic disease marked by high levels of sugar in the blood." Insulin, a hormone secreted by the pancreas, controls blood sugar (glucose). In type 1 diabetes, the body secretes little or no insulin, whereas in type 2 diabetes, "the far more common type," the body secretes insulin, though progressively less over time, and does not respond to insulin properly. The exact cause of diabetes remains unknown. "There is a genetic component to both type 1 and type 2 diabetes," says Dr. Henry.

"In type 1 diabetes, much is known about susceptibility to diabetes through altered immunity or the factors that define why the body produces antibodies that destroy the insulin-producing cells. In addition, there are environmental triggers that appear to initiate the onset of type 1 diabetes, and
various suspects have been put forward, such as a viral infection or certain foods, such as milk or perhaps insulin itself. These questions remain unanswered." In type 2 diabetes, genetic susceptibility is less well defined, although multiple genetic abnormalities have been found. However, no major single genetic culprit has been identified.

Rising obesity rates have magnified the problem dramatically, as obesity is present in more than half of type 2 diabetes cases, and an additional 20% to 30% of patients are overweight. However, Dr. Henry stresses that millions of overweight people never get diabetes. "It's an overstatement to say that if people weren't overweight, they wouldn't get diabetes. Many of them would but probably later in their lives. So obesity is an important factor, although not a sufficient one, or even a necessary one. Instead, improper dietary habits and living a sedentary lifestyle are as important as obesity per se in this issue." A lack of physical activity can lead to insulin resistance in skeletal muscles. When this occurs, the body disposes of less glucose for a given amount of insulin. Dr. Henry maintains that right now there is not enough emphasis on promoting healthy lifestyles.

Lifestyle modification has been proven to be the best way to prevent the onset of type 2 diabetes. Programs in the United States, Scandinavia, and China have demonstrated that increased exercise, a low-calorie diet, and weight loss can prevent or postpone the onset of diabetes.

Both experts agree that a complete cure for diabetes is probably not imminent. "Even if we have a breakthrough 5 years from now, it would take at least another 10 years to get it ready for widespread use," says Dr. Henry. "But right now, I'm worried that in the current financial climate we're being
scrunched for money, and the science will suffer. Without research, there will be no new discoveries." Nevertheless, Dr. Henry says management of the disease has come a long way. "We've made marvelous recent advances. There are many new medications, glucose sensors and monitors, and insulin pumps to help control blood glucose and reduce complications. For individuals with type 1 diabetes, a truly functional artificial pancreas is within view. The future, though, isNUESTRAS MARCAS