Saturday, June 5, 2010
Diabetes Who Know?
Approximately 18 million Americans have been diagnosed with diabetes, and roughly 6 million more have the disease but don’t know it. The increase in Type 2 diabetes, which occurs mostly in adults, is largely due to the rise in obesity. But researchers are also studying the growing prevalence of Type 1 diabetes, which strikes children and young adults. We spoke with one of the country’s leading diabetes experts, Dr. Judith Fradkin of the National Institutes of Health, about the increasing danger as well as promising breakthroughs.
Q. Why are you urging people without symptoms to be tested?
A. Type 2 diabetes, the most common form, is generally a silent disease. If you wait until you experience symptoms such as increased thirst or pain and tingling in your feet, you won’t benefit from steps that can prevent complications like retinal changes, which an ophthalmologist can pick up on.
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Q. Who is at the highest risk?
A. Type 2 diabetes occurs more often with age, so everyone over 45 should be tested. Younger people should be tested if they have a family history of diabetes or belong to a racial or ethnic group that is at increased risk, including Hispanics, Native Americans, and African-Americans. Women who have a history of gestational diabetes are at very high risk. Finally, obesity is a major risk factor.
Q. Why is Type 2 diabetes showing up in so many young children?
A. Most young people who are getting Type 2 diabetes are extremely overweight. The longer you have diabetes, the greater your risk of complications, so these children are much more likely to develop potentially dangerous side effects.
Q. How can lifestyle changes help?
A. An NIH study found that there was a 58% reduction in the risk of developing diabetes in people who changed their lifestyle to include more exercise and a better diet. You don’t have to get down to an ideal body weight—15 pounds makes a difference.
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Q. Is there a link between diabetes and depression?
A. Depression raises your cortisol levels and makes you more insulin-resistant, so it can increase the risk of diabetes. At the same time, if you have diabetes and are depressed, you’re probably not going to take as good care of yourself. It’s important that people with diabetes be screened for depression and get treatment.
Q. The rate of Type 1 diabetes is also increasing. Do we know why?
A. We think it is due to environmental factors. We are doing a study that is screening newborns who are at genetic risk. We’re collecting samples of their drinking water, their urine, and their stool, and recording what they eat. If we can find an infectious agent, we may be able to develop a vaccine. Or if we discover that something has changed in the diet, we can adjust for that.
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Q. How is treatment improving?
A. We are getting much more information that enables doctors to individualize treatment. We’r e looking at people’s genetic backgrounds and seeing how they might respond to different drugs. Hopefully, we will be able to have more individualized medicine in the near future, and that will help us all.