Understanding The Changing Face Of Diabetes

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By Jeff Hall, Editor-In-Chief

New figures from the Centers For Disease Control (CDC) continue to cast a sobering view on treating diabetes in the years to come. Now there are 17 million Americans who have the disease and nearly six million of them are unaware they have the condition, according to CDC estimates. The prevalence of the disease, the sixth-leading cause of death in the United States, has increased 33 percent in the last decade. Even more troubling is the fact that the demographics of the diabetes population are growing wider.
The CDC notes that over a million new cases will be diagnosed each year among patients 20 years old and over. According to a recent St. Louis Post-Dispatch article, diabetes researchers are also starting to see rising incidences in children, people in their 30s and those of normal weight, people who were previously considered at low risk of developing the disease.
In light of these disturbing trends, are there things podiatrists can do to help make an impact against the disease?
1. Have a higher index of suspicion with a wider variety of patients. Traditionally, minority and overweight patients have a greater risk of developing type II diabetes. Nothing has changed in that regard. However, if you see similar signs and symptoms in other patient populations, especially among those who have a family history of diabetes, be just as diligent in applying your diagnostic criteria as well. Of course, obtaining a thorough history and physical exam will help you prevail in the diagnosis, regardless of the patient demographics.
2. Pay particularly close attention to obese children. While you may not see a lot of kids in your practice, clearly a proactive approach is essential if you do see any obese pediatric patients, especially those who are less energetic and have a high intake of sweets.
A study that appeared in The New England Journal Of Medicine earlier this year revealed that one in four obese children under the age of 10 and one out of five adolescents under the age of 18 have impaired glucose tolerance, which leads to type II diabetes. (See “News And Trends,” pg. 10, May issue.)
3. Encourage a regular exercise routine and appropriate diet changes. Findings from the Diabetes Prevention Program revealed that such lifestyle changes reduced the risk of type II diabetes by 58 percent. As Frank Vinicor, Director of the Diabetes Division of the CDC, noted to the St. Louis Post-Dispatch, “ … those findings hold true for everyone, regardless of weight, age or ethnicity.”
4. If you encounter resistance, mention some of the potential complications from the disease. Whether it’s a lack of compliance or a reluctance to visit another physician whom you’d like to refer the patient to, it may be worthwhile to mention some of the statistics from the CDC.
• Adults with diabetes have two to four times the risk of dying from heart disease—the leading cause of diabetes-related fatalities—than those without diabetes.
• In 1999, nearly 115,000 people with diabetes underwent dialysis or kidney transplants and over 38,000 diabetics began treatment for end-stage renal disease.
• More than 60 percent of nontraumatic lower-limb amputations in the U.S. occur among diabetics.
Given the increasing prevalence of type II diabetes, it is clear that a proactive approach to prevention is essential and that podiatrists can play a key role in preserving the health and well-being of this patient population.

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