Type 2 diabetes strikes younger, overweight Americans

By Lori Tighe

dm01.gif (15293 bytes)An alarming number of American children have been diagnosed with diabetes Type 2, once called “adult-onset.” Just a decade ago, this most common form of diabetes was considered a disease of old age. Since then, Type 2 cases have skyrocketed 70 percent among 30-somethings and younger. It is now considered a disease of the fattening American lifestyle.

As Eric Schlosser wrote in his recent best-selling book, Fast Food Nation, “This is an industry that both feeds and feeds off the young. During the two years spent researching this book, I ate an enormous amount of fast food. Most of it tasted pretty good. That is one of the main reasons people buy fast food; it has been carefully designed to taste good. It’s also inexpensive and convenient. But the value meals, two-for-one deals, and free refills of soda give a distorted sense of how much fast food actually costs. The real price never appears on the menu.”

The real price is, of course, is obesity and its all-too-frequent companion, diabetes. Since people cannot be forced to eat right, exercise and lose weight, medicine is left with helping diabetics manage their lifestyle and glucose levels to help avoid its long-term complications, such as heart disease, blindness, kidney failure and limb amputations.

Obesity Epidemic
“It’s overwhelming,” said Francine Kaufman, M.D., president elect of the American Diabetes Association (ADA). “The country is seeing 8 to 40 percent of new diabetic children with Type 2. We used to see 2 to 4 percent. It’s mirroring the epidemic of obesity in the country.” Although Type 2 has a genetic component, obesity makes a person more vulnerable. Obese people can become resistant to their own insulin, which helps absorb glucose. More than 80 percent of diabetics are obese. Controlling glucose levels is the only way patients can stave off permanent organ damage.

At least 16 million Americans have diabetes, and the number is expected to rise to 22 million in 25 years. The gene pool hasn’t changed much in 30,000 years, but the environment we raise our children in has, said Kaufman, who works at Children’s Hospital of Los Angeles at the University of Southern California. She testified before Congress for a bill to change the food in schools. Kids drink sodas like water, eat Burger King for lunch and no longer take physical education. “We don’t have control over our children’s lifestyle while they attend school,” Kaufman said. “We’re at odds with what should be done and what is being done at school.”

Although the bill failed, awareness of the diabetes epidemic as a public health issue grew. In August, the American Association of Clinical Endocrinologists (AACE) lowered the recommended diabetes screening age for high-risk people to 30. Risk factors include: a diabetic relative; being overweight; being African-American, Hispanic, Asian, American Indian or a Pacific Islander. Other risk factors include heart disease, high blood pressure, high triglycerides or low HDL cholesterol. Women who had gestational diabetes while pregnant or delivered a baby weighing more than nine pounds, and women with polycystic ovarian syndrome (a hormonal disorder) also are considered high risk. Having a previous blood sugar test that found impaired glucose tolerance, a condition that leads to diabetes, is the final high risk. Prompting the need for earlier testing are the silent symptoms of diabetes. At least 33 percent of diabetics don’t know they have the disease until it’s too late and organ damage already has occurred.

New guidelines
“The new guidelines are being received quite well,” said AACE president Rhoda H. Cobin, M.D., associate professor of medicine at Mt. Sinai School of Medicine in New York. “Our standards for diabetes control finally put us in line with European guidelines.”

An early diagnosis allows patients to control their glucose levels sooner and, thereby, prevent complications, which are costly to treat, Cobin said. “When you look at 30-somethings in high risk groups, their likelihood is quite high for diabetes. You have to make a cost analysis of how much it is to diagnose these people versus how much it costs to treat the disease’s complications. Diagnosis is cheap.”

Diabetes: a silent disease
Unfortunately, most diabetics have the disease for seven to 10 years before being diagnosed. A significant barrier to early diagnosis is the asymptomatic nature of diabetes, said Bill Marquardt, product manager at Indianapolis-based Roche Diagnostics, which makes an array of products for diabetes care. The company’s Accu-Check glucose meter currently holds the No. 1 market share position among glucose meters. “Roche is currently working on a non-invasive technology,” Marquardt said, “to more easily screen for diabetes in high risk populations.”

Medical technologies and therapies continue to fine-tune the management of diabetics’ blood-glucose levels. “Tight control of glucose and frequent testing is where the action is,” said Kim Kelly, director of the diabetes program at LifeScan in Milpitas, Calif. Lifescan, a Johnson & Johnson Co., is a close second, behind Roche, in the personal glucose monitoring market.

The pocket watch-sized LifeScan glucose monitors give results in five seconds, are easy to operate and allow for alternate-site (not fingers) needle sticks. “Once you do have diabetes, it’s imperative to get the best control over it that you can. It’s our position that the more often you test, the more information you have,” Kelly said. “Diabetics want to get a result quickly and without hurting.” Type 1 diabetes, an insulin dependent, much more rare form that is usually diagnosed in childhood, requires blood-glucose tests three or more times daily. Type 2 diabetes, or insulin resistant, requires testing more than once a day.

Emerging HbA1c
Hemoglobin A1c, a crucial measurement of a diabetic’s average glucose level, is emerging as an important predictor of healthcare resource consumption over a 12-month period, according to Marquardt. He noted that Roche recently added a stat HbA1c assay to its Integra line menu. In a 1977 study, overall patient costs for diabetes directly correlated to glycosylated hemoglobin levels. Knowing which patients have the highest HbA1c levels helps gauge individual risk for hospitalizations and complications.

Another new direction in diabetes management is continuous glucose monitoring, said Christopher Saudek, M.D., president of the ADA, and a professor of medicine at Johns Hopkins University in Baltimore. “It senses glucose levels day and night. It’s not ready for everyone to use now, but it will be in the next few years.”

One such device, the Medtronic MiniMed, is available for hospital monitoring of diabetic patients. It works like a tiny plastic catheter, allowing for a constant read on blood glucose levels.

In September, Redwood City, Calif.-based Cygnus, maker of the non-invasive GlucoWatch Biographer monitor, asked the Food and Drug Administration to approve the device for use by children (aged 7-17) with diabetes. The monitor uses an extremely low current to non-invasively measure glucose every 20 minutes over a 12-hour period.

“The risk of developing diabetes is higher than virtually all other severe chronic childhood diseases,” said John C. Hodgman, chairman, CEO and president of Cygnus. “Diabetes affects nearly one out of every 600 children in this country, a total of more than 100,000 children. Interest in the GlucoWatch Biographer by parents trying to help with their children’s diabetes has been very strong.”

Cygnus has been studying potential GlucoWatch Biographer benefits for children for a while. Promising data were first presented at the ADA meeting in June. A subsequent study, by H. Peter Chase, M.D., clinical director emeritus at the Barbara Davis Center for Childhood Diabetes at the University of Colorado, was also hopeful. “We were very pleased with the ability of the GlucoWatch Biographer to detect low glucose levels during the night,” Chase said, “And we have encouraging information regarding the effect of Biographer usage on HbA1c levels.” Chase, recently named the 2001 Outstanding Physician Clinician in Diabetes by the ADA, noted, “This is very exciting and encouraging for the future of children living with diabetes.”

Lori Tighe is a freelance writer in Timonium, MD.