Diabetes rate increases come despite major pharmacologic advances in treatment
Diabetes is costly, and not just because of its financial burden on health-care systems.
According to the 10th edition of the International Diabetes Federation (IDF) Diabetes Atlas, the condition affected 10.5 per cent of adults aged 20 to 79 in 2021 globally, and that’s expected to rise to 12.5 per cent by 2025.
Based on the UN’s 2023 world population estimate of just over 8 billion people, literally hundreds of millions of people are living with diabetes – a chronic condition that affects how your body turns food into energy. In 2021 alone, diabetes-related health expenses were about $966 billion!
More locally, the Centers for Disease Control (CDC) estimates 38 million Americans have diabetes and over 100 million people may have prediabetes – meaning their blood sugar levels are higher than normal but aren’t serious enough to be Type 2 diabetes. As recently as 2019, the American Diabetic Association estimated 28 million people in the U.S. had diabetes and 97 million were thought to have prediabetes.
The effects on the economy, health expenses, and the toll of human suffering and death are almost beyond comprehension.
Increases in diabetes rates are despite major pharmacologic advances in treatment. But the data do not represent a dichotomy — treatment of a disease once it occurs does not affect the development of the disease. We need to prevent the epidemic, not simply try to fix it once it’s here, to make a real impact on health. For instance, I remember being taught in medical school that once diabetes is diagnosed, much of the damage to organs including the kidneys, heart, eyes, nerves, and blood vessels has already occurred.
Pharmacologic intervention ranges from generally starting with oral hypoglycemic agents (OHA) to the newer GLP (glucagon-like pepetide-1) agonists and SGLT2 (sodium glucose transporter-2) inhibitors. Both long- and short-acting forms of insulin are also used.
Any medication that affects insulin production or release in the body can lead to profound hypoglycemia. Many patients with diabetes can tolerate, in the short term, quite high blood sugar levels, but LOW blood sugar levels can be acutely dangerous. Hypoglycemia can lead to 4 to 10 per cent of diabetes-related deaths. In the U.S., 10.7 per cent of emergency hospitalizations in patients 65 and older were due to side-effects of the OHA group of medications. The current estimates of this part of the population number about 55 million, according to the U.S. Census — so once again, a very large number of people are admitted on an emergency basis to the hospital due to the side-effects of one group of medications used to treat diabetes.
This all points to the obvious conclusion that we, as a country and the entire human population, need a better way to manage diabetes. Fortunately, there’s an answer to this problem, and the next article in this diabetes series will focus on it.