SACRAMENTO, Calif. Just as America's diabetes epidemic began almost two decades ago, Georgia Richardson was diagnosed with Type 2 diabetes, the potentially life-threatening illness that affects the body's ability to process blood sugar.
"To be honest, I was in denial about my diabetes for awhile," she said. "It's as if I thought, 'Maybe it will go away,' even though I knew it wouldn't."
Now 77, Richardson, a retired Sacramento, Calif., teacher, eventually reduced her weight and began an exercise regimen. But she admits she lost valuable time embracing the necessary lifestyle changes that can help combat the disease.
"We need to look at things people don't want to face," she said, "and diabetes is one of them."
If extending longevity was the signature public health achievement of the 20th century, many experts believe that conquering obesity and Type 2 diabetes — conditions that often go hand in hand — will be the key public health challenge of the 21st.
"It's a largely self-inflicted problem," said Dr. John Bissell, chief of neurology at Kaiser Permanente South Sacramento Medical Center. "And there are huge public health problems as a result."
While doctors also worry about the rise of Type 2 diabetes in younger people, an aging country — driven in large part by the enormous population wave of the baby boom generation — is by definition a country coping with a diabetes problem. Older age is one of the main risk factors for the disease, along with obesity, poor exercise habits, certain ethnic backgrounds and genetic predisposition.
Left unchecked, the diabetes epidemic will result in higher medical costs as well as the threat of shortened life spans for younger generations. It also raises the possibility that for people already 65 and older, their elderly years could become a time of chronic, painful consequences.
Type 2 diabetes is the leading cause of kidney failure, new cases of blindness and amputation for reasons other than trauma. It's a top contributor to high blood pressure, stroke and heart attacks, and it's been linked with the development of dementia.
In short, the disease makes older age exponentially more difficult than it needs to be.
"The dementia link is significant," said Bissell, "but I don't think that's well understood by people with diabetes. They have so many other health problems, and they have so many people beating on them about their weight because of those health problems."
Almost 27 million Americans age 65 and older - more than one-fourth of that age group - have Type 2 diabetes, according to the Centers for Disease Control. An additional half of all people in that demographic are pre-diabetic, with blood sugar levels high enough to cause concern. While new diabetes cases have soared especially high in the South, the overall national rate has doubled since 1995.
Without a major public health awakening, the CDC projects that one-third of all Americans will have the disease by mid-century.
"We see the effects of the diabetes epidemic every day," said Dr. Kimberly Buss, Sutter Medical Foundation's medical director of diabetes education. "We used to get 100 new cases referred to us every month. Now it's 400 or 500 a month.
"And as the proportion of people 65 and older goes up, the total prevalence of diabetes will increase."
Type 2 diabetes results when the body can't produce the hormone insulin or when it has become resistant to the insulin it produces. (Weight and inactivity help create insulin problems, though researchers don't know why.) Without insulin to whisk glucose into the cells for use as energy, damaging levels of sugar build up in the bloodstream.
Many people develop excessive thirst, fatigue, blurred vision, darkened neck folds and other symptoms that lead them to seek help. But many, like Richardson, have few symptoms before routine blood work provides diagnosis.
The good news is that unlike Type 1 diabetes — an autoimmune disorder with onset in childhood — Type 2 diabetes often can be prevented by healthy lifestyle habits: walking 30 minutes five times each week and eating a balanced diet.
It's a simple solution to the epidemic. But by the millions, people don't do it.
The consequences are steep. Type 2 diabetes cannot be cured, though evidence indicates weight loss surgery might help reverse it. Generally, with diligence, the illness can be managed, so complications never occur.
Buss finds that newly diagnosed older patients tend to take diabetes education seriously, even when they're already dealing with other chronic ailments.
"They take their diagnosis as the motivation they need to truly make dramatic changes," said Buss. "It's a catalyst for them. They're just at the point of retiring from work. They have the time to focus."
And since the most devastating complications often take a decade or two to develop, people diagnosed at 65 still have time to prevent the damage.
"We often see folks in this age range really embrace the changes," she said.
The risk of Type 2 diabetes increases as we age and prevention is key, said Dr. Sol Jacobs, division of endocrinology at Emory Clinic. While some risk factors such as age and family history are not modifiable, changing certain behaviors can make a difference. But starting early, even in young children, is important, he said. Here are a few tips to help stave off the condition.
- A good diet that excludes refined carbohydrates such as candy or cake. Stick with veggies and whole grain carbohydrates, said Dr. Jacobs. Also avoid any saturated and trans fats.
- Exercise as tolerated under a physician's supervision. Even moderate weight loss — 5 to 10 percent over six months— has been shown to make a difference, said Dr. Jacobs. The exercise should include moderate aerobic activity, which for someone who is inactive can be in the range of 15 to 30 minutes every day or every other day.
- Though diet and weight loss are better at preventing diabetes, committing to lifestyle changes can be tough. There is evidence that in patients at high-risk for diabetes or suffering with pre-diabetes, the medication Metformin can prevent the progression of the disease. But medication is not a cure-all. Anyone who takes Metformin should still make changes to his or her diet and begin exercising.
