“Today, one out of ten adults in this country has diabetes, with over 90 percent of them having Type 2,” says Eisenhower Endocrinologist and Diabetes Specialist Helen Baron, MD, who’s internationally recognized for her expertise in this field. “But the Centers for Disease Control and Prevention predicts that by 2050, one in three people will have this disease.”
And that’s just in the United States. Globally, there are an estimated 500 million cases of Type 2 diabetes — a number that’s expected to increase dramatically over the next decade, particularly in lower-income countries.
“We’re looking at a segue from an epidemic to a pandemic,” says Dr. Baron.
Why is Type 2 diabetes so widespread?
“It comes down to the basic tenets across medicine in general: nature and nurture,” Dr. Baron explains. “It’s how we’re born and what we choose.
“Type 2 diabetes is a disease process that comes into play because we didn’t pick our parents, so we didn’t get a perfect blueprint for pancreatic beta cell function,” she continues, referring to cells in the pancreas that make and secrete the hormone insulin, which regulates our blood sugar levels. “There’s a strong genetic predisposition to beta cell dysfunction which leads to developing Type 2 diabetes. In other words, this disease runs in families.”
Type 2 diabetes: all in the family
In fact, Dr. Baron notes, someone who has one parent with Type 2 diabetes has a 25 percent lifetime risk of developing the disease, while someone with both parents having Type 2 diabetes has a 50 percent chance of developing it themselves.
“Genetic predisposition gives us an idea of what our best-case beta cell function could be if we eat right, maintain an ideal weight and exercise regularly,” Dr. Baron says. “But if we don’t pay attention and nurture our bodies, we shorten the lifespan of our beta cells and bring Type 2 diabetes on board.
While Type 2 diabetes can develop at any age, older adults are the most at risk. That’s due to the combined effects of increasing insulin resistance and impaired pancreatic beta cell function that come with aging.
Age a huge risk factor
“As we get into our sixties, seventies and older, the potential to develop diabetes increases because our beta cells are petering out,” Dr. Baron says. “This makes diabetes a particularly big issue here in the desert given our age demographic.
What’s more, she notes, while about a third of the U.S. population has prediabetes — a precursor to developing Type 2 diabetes if you don’t make lifestyle changes — 48 percent of adults 65 or older have prediabetes, and most of them don’t even know it. “That’s a huge potential health problem for the older adult population here in the desert,” she says. What’s the solution?
“Education, education, education,” Dr. Baron says. “Know your body, know your family history, and know your own individual risk factors for diabetes, which include high blood pressure, high cholesterol, obesity — especially carrying weight around the middle — and inactivity.”
Ethnicity is another risk factor. Although the reasons are unclear, people of African American, Hispanic, Native American and Asian-American descent are at higher risk of prediabetes and Type 2 diabetes.
In addition, women who have had gestational diabetes (a type of diabetes that occurs during pregnancy), who gave birth to a baby weighing more than nine pounds, or who have polycystic ovary syndrome (a condition characterized by irregular periods, excess hair growth and obesity) are also at increased risk of developing Type 2 diabetes.
An “explosion” of new medicines
“The good news is that we’ve had an explosion of medications come into the field of diabetology since the 1990s,” Dr. Baron says. “Not just individual medications but entirely new classes of drugs, specifically for treating Type 2 diabetes.
“These are medicines with pleiotropic effects,” she continues. “This means they do more than simply control blood sugar. Some increase satiety (feeling full after eating) or delay gastric emptying, which can help patients lose weight. Another class of medications protects against heart attack, stroke and heart failure — the risk for which increases in people with diabetes.
“So diabetes treatment is no longer one-size-fitsall,” Dr. Baron says. “We can create a bespoke [personalized] medical regimen for each unique patient. Of course we want to achieve glycemic control, but we can also tailor treatment to achieve other priorities such as minimizing weight gain, promoting actual weight loss, reducing the risk of heart attack, or optimizing costeffectiveness.” She acknowledges that the biggest challenge people newly diagnosed with diabetes must often overcome is the sheer enormity of all aspects of the disease.
“Being told you have a disease for which there’s no cure, no holiday, no day off can be pretty overwhelming,” Dr. Baron says. “To make matters worse, it’s a progressive disease as beta cells inevitably lose their function. We may find a treatment regimen that works for a while, but as someone contributes less of their own insulin to maintain their blood sugar over time, we have to contribute more medicine.
“It’s like running only to stand still, and it can be frustrating,” she continues. “But if you stand still, the disease process can overwhelm the body, so managing diabetes is about always being proactive, and doing the right thing in terms of diet, exercise and weight loss.”
Why glycemic control is critical
When diabetes overwhelms the body — as a result of not keeping blood sugar levels under control — that’s when serious health complications can occur. These complications include vision loss, kidney failure, circulation problems that result in limb amputation, heart disease and stroke.
“Complications aren’t tied to the duration of diabetes but to the duration of uncontrolled diabetes,” Dr. Baron stresses. “You can have diabetes for 50 years and if it’s controlled, you’re unlikely to have complications. But if it’s completely uncontrolled for ten years, then multiple complications are virtually certain.”
It all underscores the vital importance of preventing the onset of Type 2 diabetes or detecting it at its earliest stage. And that starts with knowing your numbers.
“It’s as simple as A-B-C,” Dr. Baron says. “‘A’ stands for hemoglobin A1C, which is a three-month average of your blood sugar levels. It’s a diagnostic tool to know if your levels are normal, if you’re prediabetic or have overt diabetes. ‘B’ stands for blood pressure, and ‘C’ stands for cholesterol.
“These are all simple, straightforward tests that can be done in any primary care physician’s office, and they should be done at least yearly, if not more frequently,” she notes. “And as soon as we see any deviation from what we consider to be normal parameters, we start treatment.
“But all too often, people fear a diabetes diagnosis and don’t present to us until the disease is far along,” she says. “Yet, the earlier we find there’s a problem, the better — we can utilize fewer medications, use lower dosages, and we have more options and combinations we can apply. That means we can keep diabetes controlled for longer.
“We are here to help, and it starts with knowledge and education,” Dr. Baron adds. “Our aim is to get more people to know their numbers and seek support, encouragement and appropriate clinical care to manage or prevent this disease — so doctors don’t find ourselves saying, ‘I wish they had presented earlier.’”
To contact the Eisenhower Diabetes Endocrinology Clinic, call 760.321.5257. To learn more about Eisenhower’s Diabetes Program and its classes and education, visit EisenhowerHealth.org/Diabetes or call 760.773.1403.