Diabetes is often called an epidemic, and no wonder. Over the past half-century, the disease has exploded.
In 1958, fewer than 1 in 100 Americans had diabetes; now, it is 1 in 11. Virtually all of the increase has been in Type 2 diabetes, which is related to obesity and can cause complications including blindness, kidney failure and the need for limb amputations.
The problem is especially serious in Kentucky. The Centers for Disease Control and Prevention reported in 2012 that the number of diabetes cases rose 158 percent in Kentucky over 15 years, outpacing every other state except Oklahoma.
A flu epidemic of such magnitude would create public alarm and swift official response. Ebola? If there were even a couple of cases in Kentucky, politicians and health officials would be running around like their hair was on fire.
But diabetes — a slow-moving, chronic disease — is not being treated like an epidemic. That must change, two Lexington health policy experts argue in a new book, The Great Diabetes Epidemic: A Manifesto for Control and Prevention (Butler Books, $24.95).
The authors are Dr. Gilbert Friedell, former director of the Markey Cancer Center at the University of Kentucky and founder of the Friedell Committee, a statewide health care policy organization; and Isaac Joyner, a public health policy analyst who has worked on a variety of issues in Kentucky, Texas and the Carolinas.
They will speak about the book and sign copies at 5 p.m. Friday, which is World Diabetes Day, at The Morris Book Shop, 882 East High Street. They also are scheduled to testify Nov. 18 in Washington in front of the Congressional Caucus on Diabetes.
The authors say a major public health response is needed to stop diabetes' rapid growth, deadly consequences and huge cost. Their book outlines specific steps that people, communities and the government could take.
"If we continue to treat diabetes on a one-patient-at-a-time basis, we can't deal with an epidemic," Friedell said. "Unless you take a public health approach to an epidemic, it doesn't work."
At its current rate, the authors say 40 percent of Americans alive today — and half of people of color — will develop diabetes. The first step in changing that, they say, is widespread, routine screening.
"You have to find cases early, which means you have to screen people who seem well," Friedell said. "The symptoms of diabetes come on maybe 10 years after the disease starts. But nobody knows they have the disease. We're wasting 10 years that we could be doing something good for people."
More than one-fourth of the people who have diabetes have not been tested or diagnosed, according to CDC studies. That means that 370,000 Kentuckians know they have diabetes, but 137,000 more might have it and not know it.
In addition to that, officials estimate that 233,000 Kentuckians have a condition called prediabetes, which means they will develop the disease if they don't take steps to stop it.
Health officials now recommend diabetes screening for people with high blood pressure, or anyone older than 45. Friedell and Joyner say everyone older than 20 should be screened.
One big problem with fighting diabetes is that it is viewed as an individual problem rather than a societal problem, even though the federal government alone spends $90 billion fighting the disease, mostly for treatment.
"There's a tendency to blame the victim," Friedell said. "If you don't eat right and exercise and if you're fat, you're going to get diabetes. That attitude doesn't help. We need individuals to change their behavior, but it's easier to do when the whole community says diabetes is our problem. It's the way that we make change."
Friedell and Joyner want the government and communities to invest more money and effort in proven programs to prevent or minimize the damage of diabetes. It also would require changing insurance company reimbursement policies. The long-term payoff would be huge.
"Your investment up front has a return that's perhaps eight times," Friedell said. "But you have to accept that it's going to be over a few years."
But the biggest problem is public awareness — and urgency.
"There has to be a sense of urgency, and there is no sense of urgency about diabetes," Friedell said. "We need to do something to get the public involved, and the public has to feel that it's important."