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Storm Warning

Conditions are brewing for a major epidemic of Type 2 Diabetes

You have probably read the headlines and seen the public-health commercials on television warning of a looming epidemic. But doctors and health officials aren’t talking about AIDS, cancer or the Ebola virus: the current concern is over Type 2 diabetes, a condition in which the body’s ability to use and store glucose (a form of sugar) is impaired, increasing the risk for serious health problems.

While it may not be as immediately deadly as certain cancers or AIDS, experts say diabetes deserves to be taken seriously. Without early diagnosis and proper management, people with diabetes are at increased risk for grave health complications, including cardiovascular disease, kidney failure, blindness, nerve damage and lower-limb amputation. Experts estimate that diabetes now accounts for 25,000 deaths each year, making it the seventh leading cause of death in Canada. Besides the human cost, diabetes and its complications account for one out of every seven health-care dollars spent – about $9 billion a year.

But Canadians seem largely unaware of the disturbing facts surrounding diabetes and unconcerned about their own risk for the disease. According to a recent national survey sponsored by the pharmaceutical company Aventis Pharma, only 39 per cent of the 1,500 people questioned said they were “very” or “somewhat” concerned about developing diabetes (compared with 60 per cent who expressed concern about cancer and 57 per cent who worried about heart disease).

Leigh Caplan, now 37, knew more about diabetes than the average person when her Type 2 diabetes was diagnosed after a routine blood test eight years ago. “I’m a nurse, so I already had some basic knowledge,” she says. She had also witnessed the grim reality of uncontrolled diabetes first-hand: her late mother, who had suffered from the disease since adolescence, lost her eyesight as a result of diabetes when Caplan was still a child. Even so, Caplan was unprepared for her own diagnosis. “I was stunned at first,” she recalls. “And scared – especially about the possibility of complications, which I knew all too well because of my mother.”

Caplan assuredly is not alone. It is estimated that 2.25 million cases of diabetes in Canada have already been diagnosed – mainly Type 2. In fact, the World Health Organization forecasts that more than 300 million people worldwide will have the disease by 2025, compared with 135 million in 1995. Until recently, Type 2 diabetes was largely considered an ailment of late middle age or older, but now it’s being routinely diagnosed in 30- and 40-year-olds, and even in children. It’s an all-too-common diagnosis among Canada’s aboriginal population, and also among immigrants from South Asia, China and Japan.

One leading diabetes expert at the University of Toronto likens the rising rate of diabetes to the “perfect storm,” a reference to the raging fronts that converged in the North Atlantic in 1991 to create the greatest storm in recorded history. (The tempest was depicted in the recent movie The Perfect Storm.)

“When it comes to the perfect storm of diabetes, all the conditions are right,” says Dr. Bernard Zinman, a professor of medicine who heads the division of endocrinology and metabolism at Mount Sinai Hospital in Toronto. One contributing factor is that the massive baby boom generation is moving into its 50s, when the risk of diabetes normally increases. Another contributor to the storm is the current climate of what he calls “overnutrition” – the consumption of unhealthy fast foods and super-sized portions, which is driving up the rate of obesity, “a known risk factor for Type 2 diabetes,” he says.

A third factor, says Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes at Mount Sinai and the holder of the Sam and Judy Pencer Family Chair in Diabetes at the University of Toronto, is that, in general, “people are exercising less, physical education programs in schools have been downsized or cancelled, and kids spend hours in front of the television or computer screen.”

There could be another explanation for the increased number of recorded diabetes cases: In 1998, the Canadian Diabetes Association (CDA) guidelines that doctors use to diagnose and treat Type 2 diabetes were revised. A major change involved lowering the threshold for “fasting blood glucose” – a person’s glucose level before eating – from 7.8 mmol/L (millimoles per litre) to 7.0 mmol/L. The goal is to catch Type 2 diabetes at an earlier stage so that lifestyle changes and other treatments can begin, and long-term diabetic complications can be prevented, explains Dr. Zinman.

One outcome of the lower threshold is that many more cases of Type 2 diabetes are now being diagnosed. This is important, Dr. Zinman believes, because people with Type 2 diabetes typically have no symptoms, unless their glucose levels are extremely high. In fact, it’s estimated that one-third of adults with diabetes aren’t aware they have it; many live with unhealthy blood-glucose levels for years until the condition is picked up during a routine health check. (The Aventis Pharma survey found that while some people knew some of the signs of uncontrolled diabetes – including unusual thirst, fatigue and frequent urination – 24 per cent couldn’t name a single symptom.)

After the initial shock of her diagnosis wore off, Caplan realized that in some ways, she was fortunate: “My mom had to boil her insulin needles to sterilize them, and test her urine. When it comes to managing my disease, I have so much more at my disposal than she did.”

Today, Caplan takes daily injections of insulin – “to help compensate for my lazy pancreas” – and works to control her glucose levels by monitoring her blood twice daily, eating carefully and walking at least an hour every day. She is especially determined that her two young sons develop healthy eating and exercise habits, which she hopes will reduce their risk for developing diabetes.

Caplan’s own health situation motivated her to become a diabetes nurse educator. As part of a team, she currently works at the Tri-Hospital Diabetes Education Centre (TRIDEC), established in 1971 at Women’s College Hospital and now operated by Sunnybrook and Women’s College Health Sciences Centre. Each year, TRIDEC professionals counsel more than 1,600 people with diabetes, educating them about their disease, teaching self-management skills and supporting them as they deal with their diagnosis.

At some point in these sessions, Caplan usually reveals to her patients that she, too, is “one of them.” They generally seem surprised but pleased to know that their teacher is “walking the walk” and not just “talking the talk.” “I understand how overwhelming it is to learn you have diabetes and to face managing it for the rest of your life,” she says.

Evelyne Michaels is the editor of Health News, published by the Faculty of Medicine.

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