Guest guest Posted January 9, 2006 Report Posted January 9, 2006 Subject: The Growing Menace of Diabetest, Part 2 > Diabetes bears an inverse relationship to income, for poverty usually > means less access to fresh food, exercise and health care. New York's > poverty rate, 20.3 percent, is much higher than the nation's, 12.7 > percent. > > African-Americans and Latinos, particularly Mexican-Americans and > Puerto Ricans, incur diabetes at close to twice the rate of whites. > More than half of all New Yorkers are black or Hispanic, and the > Hispanic population is growing rapidly, as it is around the nation. > > Some Asian-Americans and Pacific Islanders also appear more prone, and > they can develop the disease at much lower weights. Asians constitute > one-tenth of New York's population, more than twice their proportion > nationwide. > > The nature of these groups' susceptibility remains under study, but > researchers generally blame an interplay of genetic and socioeconomic > forces. Many researchers believe that higher proportions of these > groups have a " thrifty gene " that enabled ancestors who farmed and > hunted to stockpile fat during times of plenty so they would not > starve during periods of want. In modern America, with food beckoning > on every corner, the gene works perversely, causing them to accumulate > unhealthy quantities of fat. > > But the velocity of new cases among all races has accelerated > significantly from just a few decades ago. Genetics cannot explain > this surge, because the human gene pool does not change that fast. > Instead, the culprit is thought to be behavior: faulty diet and > inactivity. Dr. Vinicor, of the Centers for Disease Control, likes to > use this expression: " Genetics may load the cannon, but human behavior > pulls the trigger. " > > Of the country's spike in diabetes cases over the last two decades, > C.D.C. studies suggest that about 60 percent stem from demographic > changes: a population increasingly comprising older people and ethnic > groups with a higher risk. > > The studies ascribe the other 40 percent to lifestyle changes: the > fundamental shift that has people eating jumbo meals and shunning > exercise as if it were illegal. At every turn, technology has made > physical activity unnecessary or unappealing. Gym class has largely > been deleted from schools. Fewer than a third of junior high schools > require physical education at all, the C.D.C. says. > > On the whole, New York's corpulence is below the national average, > with 20 percent of adults qualifying as obese, compared with 30 > percent for the country, the C.D.C. says. But the figure is much > higher in poor areas like the South Bronx and East Harlem. > > When the health department studied diabetes in the city's 34 major > neighborhoods, the distribution echoed demographic patterns: Diabetes > left only a light imprint on more affluent, white areas like the Upper > West Side and Brooklyn Heights. The prevalence was about average in > working-class Ridgewood, Queens, and almost nil on the Upper East > Side. > > But that apparent immunity is weakening. Of those 34 neighborhoods, 22 > already have diabetes rates above the national average, and the > numbers are rising all over as the city continually remakes itself. > > " New York is switching from a mom-and-pop type of environment to a > chain-store type of environment, a proliferation of fast food, even in > high-rent neighborhoods they haven't had access to before, like the > East Village and Lower Manhattan, " said Muennig, an assistant > professor of health policy and management at Columbia. > > If changes in daily living can bring on diabetes, they can also delay > it, though it is uncertain for how long. > > A federal program studied people around the country at high risk of > getting diabetes, and concluded that 58 percent of new cases could be > postponed by shifts in behavior - most notably, shedding pounds. > > But Dr. Frieden, New York's health commissioner, says meaningful > prevention cannot be achieved at the city level. " I can urge people > until I'm blue in the face to walk and take the stairs and eat less, > and it won't make much difference, " he said. > > His emphasis is on trying to better treat those who already have > diabetes, an ambitious goal in its own right. Most primary care > doctors treat too many patients to provide the attention that > diabetics need, or to check for the disease, he said. Specialists are > scarce. And compliance among patients is notoriously poor. > > Even the most basic step in controlling the disease - watching one's > blood sugar - is too much for many diabetics. Doctors recommend that > two to four times a year, patients take a so-called A1c test, which > gauges the average sugar level over the prior 90 days and is more > revealing than daily at-home measurements. > > But in 2002 , the health department found that 89 percent of diabetics > did not know their A1c levels. Of those who did, presumably the most > conscientious, four out of five had readings over the level the > American Diabetes Association says separates well-controlled from > poorly controlled diabetes. > > The patients in the survey were not much better at knowing their blood > pressure and cholesterol, which are also crucial for diabetics to > control. > > " Diabetes is an interesting beast, " said Dr. K. Berger, who > heads the diabetes division at the health department. " It's probably > one of the easier conditions to diagnose but one of the hardest to > manage. " > > Shortages and Shipwrecks > > There is an underappreciated truth about disease: it will harm you > even if you never get it. Disease reverberates outward, and if the > illness gets big enough, it brushes everyone. Diabetes is big enough. > > Predicting the path of a disease is always speculative, but without > bold intervention diabetes threatens to hamper some of society's most > basic functions. > > For instance, no one with diabetes can join the military, though > service members whose disease is diagnosed after enlisting can > sometimes stay. No insulin-dependent diabetic can become a commercial > pilot. > > Shereen Arent, director of legal advocacy for the American Diabetes > Association, says she already fields 150 calls a month from diabetics > who complain that they are being discriminated against in the > workplace, double the number just a couple of years ago. She mentioned > a typical case, a man rejected for a job at a baked-bean factory in > Texas as a safety risk. " If this continues, " she said, " we're in big > trouble. " > > Dr. Lorber is an endocrinologist in Queens who thinks a lot > about the disease's present and future. " The work force 50 years from > now is going to look fat, one-legged, blind, a diminution of > able-bodied workers at every level, " he said, presuming that current > trends persist. > > As more women contract diabetes in their reproductive years, Dr. > Lorber said, more babies will be born with birth defects. Those needy > babies will be raised by parents increasingly crippled by their > diabetes. > > " At a time when we are trying to shift health care out of hospitals, > with diabetics you don't have a choice, " he said. " Nursing homes are > going to be crammed to the gills with amputees in rehab. Kidney > dialysis centers will multiply like rabbits. We will have a tremendous > amount of people not blind but with low vision. And we have lousy > facilities in this country for low-vision problems. These people will > not be able to function in society without significant aid. " > > Cost pressures have been slashing the number of hospital beds, and > some exasperated doctors are known to denigrate advanced diabetics as > " shipwrecks, " because they have so many health problems and virtually > live in the hospital. > > Not only will the future mean too few beds and unsupportable drains on > Medicaid and Medicare, Mr. Muennig said, but if an emergency strikes - > a terrorist attack, an earthquake - the city health system's ability > to respond may be compromised because all the beds will be full of > diabetics. > > Most schools do not have full-time nurses. Some public schools, Ms. > Arent said, try to turn away children with diabetes, even though that > is illegal. Others ban them from field trips and sports teams. And > this is now, when diabetes is still relatively rare among children. > > If trends continue, people will live through years blighted by > disability, then die too young. Diabetes is thought to shave 5 to 10 > years off a life. > > " Life expectancy usually decreases because there's a plague or there's > a massive economic trauma, " Mr. Muennig said. " In this case, we will > see a decline in life expectancy due to a chronic condition. " > > In 2003, diabetes vaulted past stroke and AIDS from the sixth-leading > cause of death in New York to the fourth. It was fifth, slightly > behind stroke, in 2004. But the health department says it believes the > actual toll is much worse because doctors who fill out death > certificates may ascribe the death to a complication rather than to > the diabetes at its root. Lorna Thorpe, deputy health commissioner, > combed through medical charts and concluded that diabetes should be > third, trailing cardiovascular disease and cancer. > > Laurie Raps is a claims representative for Social Security on Staten > Island, 31 years on the job. From her perspective, interviewing people > embarking on full-time disability, she has seen the disease's long > tentacles. When she started, she saw people in their 50's and 60's, > hobbled by the usual problems of age: [19]arthritis, herniated discs, > heart conditions. Now, every week, she gets diabetic after diabetic, > people as young as 30. > > In fact, a 2004 study by UnumProvident, a major provider of disability > insurance, found that the number of workers filing claims for Type 2 > diabetes doubled between 2001 and 2003. > > " It's a double whammy, " Ms. Raps said. " You don't have these people > working and paying into the system, and then you have these people > collecting from the system. " > > Ten years ago, Ms. Raps developed diabetes. Her husband has it. Both > her parents have it, their lives being washed away. > > " When I look at the people who sit before me with disability claims, I > have to check the birth date in their records, " she said. " They look > 10 or 20 years older. Diabetes does that. It wears you down and wears > you down. We're looking at a future of people 10 or 20 years older in > sickness than they are. What kind of future is that? " > > 'A 15-Year-Old Is Immortal' > > " I'm and I've had diabetes for 13 years. " > > " I'm Dominique and I've had diabetes for seven years. " > > " I'm ph and I've had diabetes for two months. " > > The brisk introductions went on, the ritual start to the monthly > meeting of a support group called Sugar Babes Place. All the members > had diabetes. All were children. > > Sugar Babes is the idea of Dr. Yolaine St. Louis, chief of pediatric > endocrinology at Bronx-Lebanon Hospital Center. When she started > practicing medicine 16 years ago, the only children she saw with > diabetes had Type 1. > > Now, of Sugar Babes' 90 official members, roughly 40 percent have Type > 2. One is 8. Another is 7. > > It scares Dr. St. Louis. It scares many doctors who see the same > thing, because they know it does not have to be. Type 2 was supposed > to be an old person's disease. Diabetes still increases with age in an > almost linear fashion - today, one in five New Yorkers age 65 and > older have it - but the starting point used to be mostly in their > 50's. > > Dr. Alan Shapiro, a pediatrician with the Children's Health Fund and > Montefiore Medical Center who has spent 13 years ministering to > children in the South Bronx, said there was an easy way to illustrate > the change. When he began, there was a " failure-to-thrive " clinic, > meant to address the undernourished, because so many children were > dangerously thin and small. > > " Now I don't think we hardly ever see a failure-to-thrive case, " he > said. > > In the clinic's place is an obesity program. Dr. Shapiro never saw > children with Type 2 diabetes in his early years in medicine. Now, the > program has about 10 cases. > > One concern he and fellow doctors have is the surge in children who > take antipsychotic drugs for anxiety and conditions like [20]autism. > Some newer drugs can promote weight gain and thus elevate the risk of > diabetes. Dr. Shapiro has an autistic patient who he feels needs the > new medication. But since taking it, the young man has markedly put on > weight and, at 18, developed diabetes. > > This extension of the disease to the young is where health care > professionals feel society and public policy have most glaringly > failed. Diabetes, they say, should never have gotten there. > > There has been little research into the long-term impact of Type 2 > diabetes on children. But doctors have a rough idea. The harsh > consequences that can accompany diabetes tend to arrive 10 to 15 years > after onset. > > If people contract diabetes when they are 15, 10 or even 5, they may > well start developing complications, not on the cusp of retirement but > in the prime of their lives. > > There is a big difference between losing a limb at 21 and at 70. There > is a big difference between going on dialysis at 30 and at 65. > > " I heard a horror story a few weeks ago, " Dr. Lorber said, " of a girl > who was born [21]deaf, got diabetes at 11 or 12 and went blind from > diabetes at 30. " > > The C.D.C. has projected that a child found to have Type 2 diabetes at > age 10 will see his life shortened by 19 years. > > " Imagine if kids were showing up at emergency rooms in cardiac > arrest, " said Dr. L. Katz, director of the Prevention Research > Center at the Yale University School of Medicine. " ly, I think > that's the next big thing. It's that dramatic. If diabetes doesn't > respect age, why should coronary disease? Lord knows, I hope this > never happens. But this is what keeps me up at night. " > > Yet children can be the most reluctant to accept the truths of their > condition. > > " A lot of them are in denial, " Dr. St. Louis said. " They have blood > sugars of 300, 400, and they tell me right to my face they don't have > diabetes. 'You're wrong,' they say. 'I don't feel anything.' I tell > them what can happen down the road, and they shrug. A 15-year-old > doesn't care what's going to happen at 35 or 45. A 15-year-old is > immortal. " > > The doctor was telling the Sugar Babes that everyone should have two > compact blood-sugar meters, one for home and one for school. Then she > warned them, " If your sugar is bad and you don't do anything, you're > going to be dropping down all over the Bronx. " > > Interest was tepid. Some children couldn't keep their eyes off the > waiting dinner arranged at a buffet table by the wall. No rapt > attention from ph, 12, who had begged not to come, until his > mother put her foot down. He moaned that he had schoolwork. > > " Look at that, " said Dorothy -Swaby, a diabetes nurse educator > who worked with Dr. St. Louis, nodding at a girl who was talking on > her phone. " We're educating about diabetes, and she's on her > cellphone. Typical teenager. " > > As time ran out, hula hoops were brought out. Dr. St. Louis was trying > to identify activities other than video games and TV that the children > might try. Last meeting, they held a jump-rope contest. > > " They have 10,000 excuses why they can't do something, " the doctor > said. " So you have to give them ideas and then hope. " > > The meeting wound up. The hoops were stashed away. Some of the > children stepped toward the buffet table and began to eat. > > > -- > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.1.371 / Virus Database: 267.14.15/223 - Release Date: 1/6/2006 > > Quote
Guest guest Posted January 9, 2006 Report Posted January 9, 2006 Yes, Mike that pothered me too, but when you look at the person who wrote it, he/she probably has not had any association with persons of disability. Re: long, interesting article Amen. I was a bit disturbed by the attitude of some of the medicos that amputees and the blind couldn't lead a normal life. But the overall focus and message of the article is clear and dead on. Mike > Very good article! > > > > > > Quote
Guest guest Posted January 9, 2006 Report Posted January 9, 2006 Yes, Mike that pothered me too, but when you look at the person who wrote it, he/she probably has not had any association with persons of disability. Re: long, interesting article Amen. I was a bit disturbed by the attitude of some of the medicos that amputees and the blind couldn't lead a normal life. But the overall focus and message of the article is clear and dead on. Mike > Very good article! > > > > > > Quote
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