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Texas Matters: Diagnosis Diabetes

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After the blood sugar check, it may be time for a diabetes medicine whose price has jumped.
After the blood sugar check, it may be time for a diabetes medicine whose price has jumped.

Editor’s Note: Diagnosis Diabetes was produced as a project with a grant from the USC Annenberg Center for Health Journalism’s 2022 Impact Fund for Reporting on Health Equity and Health Systems.

It's almost a sure bet that you or someone you are close to has diabetes.

Diabetes is widespread. The CDC estimates almost 40 million Americans have it. That’s about one in 10 people. Diabetes and its complications are more common and more severe in low-income Americans and people of color.

Another problem is this trend: younger and younger people are being diagnosed with diabetes, even children as young as 5. That was unheard of 20 years ago. And by 2060, diagnosed diabetes in the U.S. is projected to nearly triple, and the prevalence will double to one in five.

People with diagnosed diabetes have more than twice the average medical costs than people without diabetes. According to the National Diabetes Statistics Report, last year in the U.S. diabetes cost an estimated $400 billion in medical costs and lost work and wages.

But there is also an astonishing human cost. In the U.S. diabetes is a leading cause of kidney failure, lower-limb amputations, and blindness in adults and is a major contributor to death, including death from COVID-19.

With such grim and horrifying statistics and also keeping in mind that type-2 diabetes can be prevented, there is a serious disconnect between the magnitude of the crisis and the response to address it.

In fact there are established factors which are making childhood type-2 diabetes worse, like the lack of availability of affordable healthy food in low-income neighborhoods, the marketing of junk food to kids and misleading food labels, said Dr William Herman, a professor at the University of Michigan medical school.

“Candies that are a 100% sugar are advertised as a fat free food. Sugar drinks are advertised as a good source of vitamin C because they toss a little vitamin C into it. So you're getting a message that this is a healthy drink, but it's basically sugar water,” Herman said.

Herman also served as the chair of the National Clinical Care Commission which between 2018 and 2021 evaluated and provided recommendations to improve federal programs related to complex metabolic or autoimmune diseases that represent a significant disease burden in the United States.

“Your risk of diabetes is greater if you live in a community with fast food restaurants and convenience stores, And your risk of type two diabetes is lower if there are full service grocery stores in the community or the neighborhood where you live,” Herman said.

“It's the same with housing. It's the same with parks and recreation facilities. Substandard housing—people who live in substandard housing have more diabetes, people who live in neighborhoods without parks or recreation facilities have more diabetes,” he said.

The National Clinical Care Commission released a report to Congress in 2021 that called for an “all in” governmental approach to preventing diabetes that recognizes this is a societal problem. The report recommends the creation of a federal office of diabetes policy that would create a national strategy to combat diabetes that would tap into parts of the government not normally associated with disease fighting.

“The department of agriculture, transportation, housing, and urban development, FDA EPA for clean water. So tackling diabetes as a societal problem,” Herman said.

However, so far the recommendations have yet to result in significant changes to public policy to address the rise and projected cost of type-2 diabetes.

Which means without a national strategy that would help people eat healthier, be more active and manage their diabetes, the work is going to have to be done piecemeal. It’s going to take local communities coming together, recognizing the diabetes problems and demanding action.

This takes us back to the focus of raising awareness of the prevalence and health complications of type-2 diabetes. To find out more about what people think about diabetes, their risks for the disease and how it affects them, we did some community outreach at San Antonio’s Woodlawn Lake Park on a spring Saturday morning.

Sandra Smith was out walking for exercise and said, “I just see my family struggle. My father had it. My grandmother. I have two brothers that have diabetes.”

Because diabetes is so present in her immediate family, Sandra is certainly at risk for it. But she said that she wasn’t really aware of that.

“Even though I know it's in my family, I wasn't paying attention because I didn't have it. But now that I'm like pre-diabetic, now I'm trying to, I've been to a nutritionist and we've been talking about things to eat. So that's my struggle and no refined, no chips, no cookies, no, you know, have a cookie but not a whole pack of cookies,” she said.

According to the CDC one in three people in the U.S. is pre-diabetic. That means they are at high risk for developing full blown type-2 diabetes and need to know their risk, so they can endeavor to avoid that. But most people do not know that they are pre-diabetic. A simple blood test would detect high levels of sugar in the blood which is an indicator of pre-diabetes. But in Texas many people do not have health insurance or a primary care doctor, so they don’t get tested and can’t alter their lifestyle in response.

Mary Estrada is a nurse who was at the park. She says she has seen the increase in type-2 diabetes; particularly in children.

“I think education should start at home and I think it could, I think they could use a little education even in elementary school because a lot of kids are obese,” she said.

In Texas, 20% of youth ages 10 to 17 have obesity — according to the Robert Wood Johnson Foundation’s State of Obesity report. There is a close association between obesity and type-2 diabetes; however, this relationship is complex and still requires further research. But we do know that being obese is a diabetes risk factor.

Dr. Lindsay Irvin, a San Antonio pediatrician, has also see the trend in childhood type-2 diabetes and she says the food we give our children is partly to blame.

“I am furious about this. This is destroying our children. It is destroying their lives. There's not a child in my practice that can eat the American diet. There is not one, they will hit a wall at some point. They cannot eat this food. It is not made for human consumption,” she said.

To help the kids understand that all this plentiful, delicious food is a threat to them Dr. Irvin taps into an old fairy tale: Hansel and Gretel.

“And then I ask the kids, 'Well, what did the witch want to do with the kids?' And they go, 'She wanted to eat them.' They loved that, that idea. And I was like, exactly, this is exactly, you know, the sugar company doesn't want you healthy. Your mom wants you healthy. I want you to be healthy. You know, the video game industry doesn't care. What happens to you when you're 80, they just want you playing the games. They just want money and they get it. They totally get it,” she said.

Research conducted in San Antonio confirms that childhood type-2 diabetes is rising at an alarming rate but more than that, it’s extremely aggressive. Even with treatment, before these kids reach middle age they could have complications like blindness, amputations, or be on dialysis, said Dr. Jane Lynch, a pediatric endocrinologist for UT Health San Antonio. She was the principal investigator for a groundbreaking study called “Treatment Options for Type 2 Diabetes in Adolescents and Youth” also known as the TODAY study.

“I would argue the younger ages probably reflect a higher risk for comorbidities and complications. And based on our data from the TODAY study these kids that were 10 to 17 at the age of onset progressed onto risks for complications and not being able to be managed with oral medication alone or having what we call beta cell failure at a mean of 12 months in that first phase of our today study,” Lynch said.

This means the diabetes complications that would usually take 18 to 20 years in an adult, like loss of eyesight, kidney disease or vascular problems, developed much more rapidly and aggressively in children with type-2 diabetes.

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David Martin Davies can be reached at dmdavies@tpr.org and on Twitter at @DavidMartinDavi
Yvette Benavides can be reached at bookpublic@tpr.org.