Ky. must break free of diabetes epidemic

A June 13 front-page story tells us the average American woman now weighs as much as the average American man did in 1960 at 166 pounds.

Over the same period, American men have gained almost 30 pounds, with the average American man now weighing about 195 pounds.

That's the clearly visible front story.

The invisible back story is that the weight gain has been accompanied by lessened physical activity. We don't walk anymore. Together, the increased weight and decreased exercise have been in large part responsible for the great increase in Type 2 diabetes which comprises 90 to 95 percent of diabetes cases.

Since 1980, the incidence of diabetes in Kentucky — and in the country — has tripled. An estimated 600,000 adults in Kentucky will have diabetes this year, 25 percent of whom are unaware of it, and an estimated 1,100,000 Kentuckians will have pre-diabetes, 90 percent of whom do not know they have it.

Some 4,450 deaths from diabetes are predicted for Kentucky this year. With that increase has come an increase in its complications, heart disease and strokes, but the frightening BAD ones as well — blindness, amputations and dialysis for those with kidney failure.

This year an estimated 72,000 Kentuckians will develop significant visual impairment, including blindness. There will be some 1,000 amputations, about three a day in the state, and an estimated 800 people will develop kidney failure, many of whom will start dialysis.

The cost of dealing with the complications is enormous. Dialysis alone costs about $80,000 per person per year. Diabetes patients on Medicare cost three times as much per year as those without diabetes, $15,000 versus $5,000.

The annual price tag for those with diabetes on Medicaid in Kentucky is about $1 billion. The total annual cost of diabetes in Kentucky for 2015 is estimated to be $5.6 billion.

That's the bad news.

The good news is that we can find those with pre-diabetes and diabetes by a simple finger-stick screening test and then do something about it. We can prevent or delay the onset of diabetes for those with pre-diabetes, and prevent or delay the onset of complications for those with diabetes.

An editorial published this month in the Annals of Internal Medicine endorses the idea of screening and states "there is moderate certainty that measuring blood glucose to detect pre-diabetes or diabetes has net benefits and no significant harms in adults at high risk for diabetes." It recommends "a national policy to screen all persons at high risk for diabetes".

Other leading diabetes authorities, writing in the October 2014 issue of Diabetes Care, have also agreed that screening would be beneficial. They point out that, "As diabetes develops, we currently waste about the first 10 years of the natural history" of the disease by not finding cases early and starting treatment for pre-diabetes or diabetes.

But we don't have to wait for a national policy on screening to take action to benefit the health and pocketbooks of Kentuckians. We have a health and financial crisis.

The time is long overdue to follow the 1994 recommendation of the Centers for Disease Control and Prevention — recognize that we are dealing with an epidemic, and adopt a public-health approach to it.

It will not be easy, inexpensive or quick, but this approach will control the epidemic and reduce both the incidence of new cases and the complications of existing cases. It will also reduce the staggering and increasing cost of diabetes. There is no other option.

Gilbert H. Friedell, M.D. and J. Isaac Joyner, MPH of Lexington are authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention (Butler Books, 2014).

This story was originally published June 29, 2015 at 12:00 AM with the headline "Ky. must break free of diabetes epidemic."