A Healthier Tomorrow

Imagine a Healthier Tomorrow – The Diabetes Dilemma 

By Alison H. Page

In prior columns we have discussed the factors that contribute to a person’s likelihood of living a long and healthy life and the percentage each factor contributes.  Again, as a reminder, those factors as determined by research done at the University of Wisconsin, fall into the categories of individual behavioral choices (30%), access to good health care (20%), socio-economic factors (40%) and environmental factors (10%). 

We have also discussed the concept of Blue Zone thinking – creating an environment that supports people living as healthy a lifestyle as possible. 

This month we will imagine how we might approach a health issue like diabetes applying what we know from these two bodies of research. So, let’s imagine a healthier tomorrow, a tomorrow free of diabetes. 

First, a little background information:

What is diabetes?

According to the National Centers for Disease Control and Prevention (CDC), diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in your blood.  Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.

The three main types of diabetes are: type 1 diabetes (usual onset is in childhood), type 2 diabetes (usual onset is in adulthood), and gestational diabetes (diabetes that occurs with pregnancy).  Another condition called prediabetes is almost always a precursor to type 2 diabetes. Modest behavior changes can prevent or delay the onset of type 2 diabetes in people who have prediabetes.

How big a problem is it?  According to the Wisconsin Department of Health website:

• 40% of Wisconsin adults are expected to develop type 2 diabetes in their lifetime.
• 8% of Wisconsin adults have diabetes.
• 28% of Wisconsin adults have diabetes and don’t know it.
• 37% of Wisconsin adults have prediabetes.
• Approximately 356,000 adults and 6,500 children and adolescents in Wisconsin have been diagnosed with diabetes. It is estimated that an additional 138,000 have diabetes but are undiagnosed.
• The direct (medical care) and indirect (lost productivity) costs of diabetes in Wisconsin total an estimated $3.9 billion
• Diabetes is the seventh leading cause of death in the United States.
• Each year, more than 1,300 Wisconsin residents die from diabetes and many more suffer disabling complications such as heart disease, kidney disease, blindness, and amputations.

Much of the health and economic burden of diabetes can be averted through known prevention measures. So what can we do? We can’t eliminate all diabetes, but we can take action in all health factor categories and work to create a Blue Zone that minimizes the risk of people in our community acquiring type 2 diabetes.  Let’s imagine….

A community where people make behavioral choices that decrease the likelihood of acquiring diabetes.  People in our community choose not to smoke, do not drink excessively, and work to maintain a healthy weight by eating healthy foods and getting adequate exercise. 

A community where people have access to excellent health care services that can assist them

through the difficult process of changing their own health behaviors so they can prevent diabetes, but also assist them when they are diagnosed with diabetes. These services should be readily available in the community, in schools, churches and other places where people gather.  Since many people have few symptoms of diabetes, they often go undiagnosed.  People with prediabetes are generally only identified through screenings where their blood glucose levels are checked. In our imagined community people would be screened for diabetes regularly and be aware that they should seek help if they have any symptoms of diabetes, such as excessive thirst, frequent urination, wounds or sores that are slow to heal, or numbness or tingling in their feet. 

A community where a person’s socio-economic status does not determine whether or not that person will have access to nutritious food or health care services.  How can we ensure access to health care services for everyone?  I am not just talking about getting people health insurance coverage.  Many people who have health insurance do not have good access to health care.  They may have a very high deductible plan and cannot afford the cash out of pocket for care unless it is essential.  They may have a job that does not allow them time away to get health services.  They may have transportation difficulties.  They may have communication challenges. We can and should do more to connect everyone to the care and services they need. 

A community where the environment makes living a healthy lifestyle the easiest thing to do.  We can change the environment we live in to prevent some types of diabetes mainly by doing things that contribute to weight control.  There is a strong correlation between being overweight and getting type 2 diabetes.  The best way to reverse prediabetes is through weight management.  As a community, the best way to alter our environment to help people maintain a healthy weight is to provide access to nutritious food and eliminate unhealthy foods.  When it comes to unhealthy foods, one of the worst is sugar.  So, let’s start there.   Americans ingest way too much sugar, through our consumption of processed food and our addiction to soda.  The jury is in on soda.  It is poison and should be eliminated from our diets.  One study found that people who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks.

If 138,000 people in the State of Wisconsin have undiagnosed diabetes and 37% of all Wisconsinites have prediabetes (and most of them don’t know it), what can we do about it?  We can do a lot.  Let’s get started and create that healthier tomorrow…together.