Diabetes Mellitus and Society

A Costly Chronic Disease Epidemic

DIABETES MELLITUS describes a class of disorders characterized by hyperglycemia, or a "high blood sugar." Here are some of the reasons why diabetes is a major concern.

A disease described in ancient Pharaonic and Vedic texts, diabetes is growing increasingly prevalent in the United States among young and old, among men and in women, and in all social classes.

  • Diabetes afflicts nearly 1 in 20 persons in Western society.
  • Most persons with diabetes are 40 or older, but some were afflicted before age 5.
  • In the United States about 500,000 cases are diagnosed annually.
  • In 1990, 7 million people knew they had diabetes, but an equal number with the disease remained undiagnosed. It is thought that many more people have diabetes now.

Among certain groups of Americans diabetes is truly epidemic.

  • Diabetes afflicts women and blacks about twice as frequently as white males.
  • The prevalence among Latinos may be 1 in 5
  • Among certain Native American nations it may be as high as 1 in 2.

The cost of caring for diabetes and its complications is very high.

  • In the United States in 1987 that cost was shown to exceed $20 billion.
  • That cost is much greater now.

It is impossible to avoid diabetes in the practice of medicine, whether it be in the emergency room, the ICU, the primary care pavilion, the surgical suite, or the athletic field.

Diabetes is not only a common and costly disorder, but also a chronic one that can be refractory to treatment. Physicians caring for patients with diabetes encounter recurrent frustration. Demanding diseases of this kind enervate caregivers. It can be difficult to generate enthusiasm for treating diabetes despite its domination of the lives and long term health prospects of those affected. But diabetes is treatable, and the rewards of good treatment are great. Good diabetes care is important for many reasons.

  • Diabetes can be rapidly fatal. Diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma, alcoholic ketoacidosis, and hypoglycemia are medical emergencies. More often than not, they are preventable.
  • Chronic hyperglycemia causes debilitating symptoms. The polydipsia, polyuria, and nocturia of diabetes can make life miserable. Wide excursions of glycemia affect vision. Uncontrolled diabetes induces fatigue, weakens surgical scars, and predisposes to infections that range from intertrigo to mucormycosis.
  • Diabetes can devastate pregnancy, increasing the risk of congenital malformations, neonatal complications, and maternal morbidity and mortality.
  • Finally, chronic diabetes leads almost inevitably to secondary complications. More than 2 million Americans are hospitalized each year because of these related disorders. Compared to the general population, persons with diabetes are 25 times more likely to become blind, 17 times more prone to renal failure, 5 times more likely to suffer a gangrenous extremity, and twice as susceptible to heart disease. It is now certain that appropriate treatment of diabetes can retard if not prevent some of these complications.

Perhaps because these sequelae of diabetes are so grave and increasingly common, UMMC can expect to see greatly increased numbers of persons with diabetes in these last years of the 20th century. These persons will require the services of surgeons, dialysis experts, intensivists, cardiologists, ophthalmologists, orthopedists, podiatrists, gastroenterologists, and endocrinologists.

In addition, persons who have not yet had diabetes long enough to develop complications can be expected to clamor for the kind of diabetes control that will prevent secondary complications. The Diabetes Control and Complications Trial (DCCT) has shown that intensive care of diabetes can prevent diabetic complications. Meeting the challenge of the DCCT at UMass Memorial Healthcare is a major goal of the Diabetes Division.