Expert Commentary: Robert Kritzler MD 11/06/09

Posted by Admin on November 6, 2009

Diabetes mellitus affects close to 21 million Americans, both children and adults, representing over 7 percent of the US population (source: American Diabetes Association 2009). Unfortunately, close to one-third of these individuals are unaware that they have the disease. They may be in a pre-diabetic phase or, if actually diabetic, do not have symptoms. Awareness among that one-third is as important as compliance, since lifestyle modification can largely prevent the onset of the disease. Within the other two- thirds, many are not getting the treatment they need.

Overall, diabetes can lead to major consequences that are catastrophic for the individual and costly for our health care system.

There are two broad types of diabetes:
Type One -- the body stops producing insulin secondary to an autoimmune disease. People with this type of diabetes require treatment with insulin injections.
Type Two -- the body resists insulin.  This type is associated with obesity.

As our world is experiencing an epidemic of obesity, Type Two diabetes is on the rise. What once was a disease of adults is now becoming all too common among teenagers and even younger children.

Medical science has made important gains in diabetes research. To date, we have not solved the problem of preventing or even delaying the onset of Type One diabetes. Type Two diabetes, in contrast, is largely preventable through changes in lifestyle. That said, these changes remain simple but elusive in our society.

In both types of diabetes the long term complications are similar, affecting the heart, kidneys, eyes and circulation in the extremities.

Clinicians, physicians, nurses, nutritionists, health educators and others speak of the importance of compliance and adherence in the prevention and treatment of both types of diabetes. Adherence usually is related to medication and compliance to other things such as diet and lifestyle. If one follows what science has proven as the correct path, diabetes can be treated, sometimes held at bay, and even prevented (Type Two).

Lifestyle modification can prevent Type Two diabetes and is equally important in the treatment of Type One. Exercise and a diet aimed at returning to or maintaining a healthy body weight are critical. If diabetes becomes symptomatic, this lifestyle may be, in Type Two, all that is needed to prevent and control the disease. In Type One, and in more serious Type Two, medication is required. In Type Two, oral medication is the starting point. In Type One, insulin injections are necessary. Within both types measuring one’s blood glucose (by a finger stick) informs rational treatment.

Many people do not perform this blood glucose measure and thus have sub-optimal treatment.  Without insulin, those with Type One become very sick in a short timeframe. Because of this, most with Type One do take their insulin.  However, many are not optimally treated without complying with careful monitoring of blood glucose and sound lifestyle management.

Those with Type Two are frequently without symptoms. A number of studies have found that as many as 75 percent of those with Type Two do not adhere to the prescribed medication, let alone lifestyle.  Without the important diabetes, cholesterol, blood pressure, and heart medications, the progress of the disease can be unchecked. The end results are the catastrophic complications of diabetes.

The reasons behind non-compliance are complex, and can be social, personal, and economic. The “fix” is not simple, but is essential for both the individuals with diabetes and for the control of costs in our health care system. Diabetes is epidemic…sometimes preventable…frequently containable…and increasingly treatable. All it takes is doing the “right thing” both as individuals and as a society.

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