How diabetes reached epidemic proportions, and what we can do about it
September 4, 2023
Type 2 diabetes has become America’s quiet epidemic.
About 37 million people in the U.S. have this progressive condition, which can lead to heart attacks, stroke, kidney disease, blindness, amputations, and even erectile dysfunction. An additional 96 million have pre-diabetes, which is the gray zone where the disease could be reversed or controlled but many people are unaware they have it.
Diabetes also disproportionately impacts Black and Hispanic populations. Black patients are 60% more likely to be diagnosed with diabetes than White patients. Hispanic patients are 70% more likely. And both groups face a higher risk of being hospitalized or dying from diabetes complications.
The Centers for Disease Control and Prevention (CDC) declared diabetes an epidemic in 1994 – almost 30 years ago – and yet today it is still an unfortunate fixture of our country’s public health. But it doesn’t have to be that way.
UT Southwestern is taking a proactive approach by sponsoring community events such as Fade Out Diabetes, which provided free diabetes screenings at a Grand Prairie barbershop in September 2023, and our innovative Culinary Medicine program at UTSW RedBird, which helps educate patients about healthier cooking and eating.
Combined with a modern approach to prevention, nutrition, medication, and weight management – and better access to care – we can help reverse the rising tide of diabetes. But it all starts with raising awareness about what causes the disease and how to reduce your risks.
What causes diabetes?
Diabetes mellitus is a metabolic disease characterized by high blood glucose (blood sugar) levels that are tracked over time as your A1C number. People with diabetes have high blood sugar because their bodies don’t produce enough insulin – the hormone that turns nutrients into energy – or because their cells don’t respond to the insulin that is produced.
Researchers at UT Southwestern's Touchstone Diabetes Center are devoted to studying what causes diabetes. The investigators have identified a gene variant that may help identify people at risk for Type 2 diabetes before they develop the disease, improve diabetes screening, and encourage people to make important lifestyle changes to prevent diabetes onset.
What does A1C measure?
You’ve probably heard your aunt or grandpa announce they’ve got to check “their sugar,” and then they prick their finger with a testing meter. If they test after chugging a Dr. Pepper, their levels might be higher, because soda contains a significant dose of sugar.
But that simple blood sugar test differs from an A1C test, also called a hemoglobin A1C test, which measures a patient’s average blood sugar levels over the last three months. Hemoglobin is a protein in our red blood cells, which carry oxygen throughout the body and regenerate every 90 days. When you consume sugar, carbs, or starchy foods, glucose attaches to the hemoglobin.
So, by checking your A1C, we can determine the percentage of your red blood cells covered in sugar over time – not just one moment in time. We use the much more accurate hemoglobin A1C number to screen for pre-diabetes and guide our patients’ nutrition and medications to keep the condition from progressing.
What are the risks of unmanaged diabetes?
Diabetes isn’t a “set it and forget it” condition. It requires lifestyle changes to keep the disease from causing serious complications, such as:
- Stroke
- Heart attack
- Blindness, or diabetic retinopathy
And some potentially surprising complications can affect your health and quality of life:
- Dental problems
- Erectile dysfunction
- Increased risk of vaginal and skin infections
- Neuropathy – pain and nerve damage in the legs and feet
- Foot ulcers that can result in amputation
- Weakened immune system
- Kidney disease that requires dialysis
- Pancreatitis and other inflammation-associated conditions, including cancer
- Vascular dementia – cognitive problems caused by blocked blood vessels to the brain
Type 2 diabetes is a progressive condition, which means it didn't start yesterday, or even five years ago – it likely started at an early age with how we grew up eating. So, our first few conversations with a new patient start with learning about their health history and daily eating habits.
We don't need a crystal ball to know that following the habits established by parents or grandparents with diabetes will increase your health risks. And it’s likely your health problems will start at an earlier age, because packaged food is only becoming more sugary and more processed over time.
Which foods fuel diabetes?
UTSW offers culinary medicine eConsults
Expert advice on nutrition delivered to patients electronically can help fight diabetes, save time for primary care doctors, and be covered by insurance, UT Southwestern researchers found in a recently published study.
A lot of patients will say, "You're telling me my blood sugar is high, but I’m not sitting around eating bonbons!” That’s a common misconception. Eating candy is not the only way you develop Type 2 diabetes. The body breaks down starches and carbohydrates such as bread and pasta into sugar for energy, and what you don’t burn through exercise gets stored as fat.
So, while you may not be inhaling candy, some of your favorite foods may be adding sugars into your diet and increasing your diabetes risk over time.
Related reading: Farm to table: Rediscovering a simple, practical approach to food
How does high fructose corn syrup affect the body?
In the 1980s, U.S. food manufacturers discovered a cost-effective way to flavor our food by adding a sweetener called high fructose corn syrup into everyday items. Today it’s found in virtually every aisle and item in the grocery store – from soups and sandwich bread to cookies and ketchup.
The problem is that the body sees added sugar as a foreign invader, not a natural source of food energy. So, when you eat or drink added sugars, the body walls them off as fat and puts your immune system on a constant offensive, battling inflammation.
Inflammation and obesity have been linked to many serious, chronic illnesses, including stroke, heart disease, autoimmune disorders, and several types of cancer. Limiting added sugar in your diet, exercising regularly, and working toward a healthier body mass index (BMI) can reduce your risk of diabetes and can even roll back fasting glucose numbers that are considered pre-diabetic (100-125 mg/dL when fasting) to the normal range (less than 100 mg/dL). Estimate your BMI with this calculator.
Which medications can help manage diabetes?
There has been a steady uptick in effective diabetes therapies, creating pathways for treatment, prevention, and in some cases full reversal of Type 2 diabetes for patients.
Blood pressure and cholesterol medications
Based on your numbers, such as A1C, blood pressure, and BMI, your health care provider might recommend one of several medications to help control your risk of heart problems or stroke as part of your diabetes management. Some of these medications might include:
- Statins, which significantly lower LDL or “bad” cholesterol and can cut stroke and heart attack risk in half.
- PCSK9-inhibitors, which can reduce very high bad cholesterol by half or more.
- Insulin, which helps control your blood sugar and is becoming more affordable and readily available in longer-lasting injections.
- ACE inhibitors and calcium channel blockers, which are among a long list of effective medications to counter hypertension.
Weight-loss medications
A wave of medications that were originally designed to treat diabetes have recently made national headlines because they’ve proved effective at promoting significant weight loss in some patients. Medications such semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro) have created another option for patients interested in losing weight and potentially putting their Type 2 diabetes into remission.
But it’s important to keep things in perspective. There are only a few years’ worth of data collected on the capabilities and side effects of weight-loss medications. And cost is a real issue, because most insurance companies do not currently cover them.
Related reading: Why it’s so hard to keep excess weight off and how long-term treatment can help
Why see a provider who knows about diabetes?
Diabetes is an epidemic that is already affecting young adults at an alarming rate. Among Mexican Americans in particular, diabetes prevalence rose more than 3% between 2009 and 2020 for adults ages 20-44. Rates of young adults who are not properly managing their diabetes also jumped significantly, from 45% to 56% in the same time frame.
Diabetes is a progressive condition. The time to stop it is now.
Primary care providers are a good place to start. The team at RedBird is continually deepening our well of diabetes knowledge and offering modern, practical solutions. Diabetes management takes a community – it's a team approach with the patient at the center and their health care providers working together toward the greater good.
To talk with a provider about diabetes management, call 214-645-8300 or request an appointment online.
