Eric Goulder, MD, FACC
Heart Talk - November 2021
The Silent — and Preventable — Pandemic That’s Three Times More Deadly Than Covid
November marks Diabetes Month, dedicated to raising awareness of a disease that’s now “a pandemic of unprecedented magnitude,” according to a new report from the International Diabetes Federation (IDF). Globally, 557 million people — more than one in 10 adults — are living with diabetes, a rise of 16 percent (74 million) over the numbers in 2019. Another 541 million adults have prediabetes, an earlier stage of the disease. Another scary statistic: Diabetes and its complications claimed 6.7 million lives worldwide in 2021, reports IDF, triple the toll for Covid this year (2.2 million). The good news, however, is that type 2 diabetes, the most common form, is both preventable and highly treatable, particularly if it’s caught early. Here’s a look at the latest discoveries about diabetes, new screening guidelines and key facts you need to know.
1. TYPE 2 DIABETES REVERSAL MAY BE MORE COMMON THAN PREVIOUSLY BELIEVED.
In a new study published in PLOS Medicine this month, researchers analyzed data from a national Scottish diabetes registry and identified 162,316 adults with a type 2 diagnosis. Of this group, about 5 percent had achieved remission for one year or longer. “That is higher than expected and indicates a need for updated guidelines to support clinicians in recognizing and supporting these individuals,” stated study coauthor Mireille Captieux from the University of Edinburgh in a news report. The team found that disease reversal was most likely to occur in those who had lost weight since their diagnosis and had milder elevations in their blood sugar levels when they were diagnosed. The study adds to earlier research suggesting that type 2 diabetes reversal may be possible for up to 10 years after diagnosis, particularly if the person follows a low-calorie diet. There’s also a lot you can do to avoid getting diabetes in the first place: Check out our top 10 prevention tips.
2. DIABETES IS ON THE RISE, ESPECIALLY AMONG YOUNGER ADULTS.
The IDF predicts that if current trends continue, the number of people living with diabetes will soar to nearly 800 million, with type 2 accounting for 90-95 percent of cases. Unlike people with type 1 diabetes — an autoimmune disease in which insulin production irrevocably halts because of antibodies that attack and destroy the insulin-producing beta cells of the pancreas — those with type 2 do produce insulin. However, their muscles, fat and liver become insensitive to this hormone, which normally helps cells use glucose for energy: a disorder known as insulin resistance (IR). Although people often think of type 2 diabetes as an older person’s disease, rates among 30-somethings have soared by 70 percent in recent years, and it’s become increasingly common in teenagers and even kids. The chief culprit is the obesity epidemic, since studies report that being even a little overweight quintuples diabetes risk and being severely obese multiplies it by 60-fold!
3. NEARLY HALF OF PEOPLE WITH DIABETES ARE UNDIAGNOSED.
The IDF’s latest Diabetes Atlas reports that globally, about 45 percent of people with diabetes are unaware of their disease. That’s dangerous, because the longer it goes untreated, the higher the risk for debilitating or even life-threatening complications. For example, a person with untreated type 2 diabetes is at as high risk for a heart attack as a nondiabetic person the same age who has already suffered one! Diabetes also dramatically raises risk for strokes, dementia, nerve damage, vision loss, hearing impairment, erectile dysfunction, chronic kidney disease, and many other debilitating or life-threatening conditions.
4. SEVENTY PERCENT OF HEART ATTACKS HAVE THE SAME ROOT CASE AS TYPE 2 DIABETES.
It’s very common for people to be diagnosed with prediabetes or diabetes shortly after they’ve suffered a cardiovascular event. In one large study of people treated in the ER for a heart attack, 20 percent were known diabetics. When the other patients were given blood tests, 66 percent had abnormal blood sugar levels that met diagnostic criteria for prediabetes or diabetes. Patients often chalk this double whammy up to bad luck, believing they have been hit with two unrelated diseases at once. Actually, most heart attacks and nearly all cases of type 2 diabetes have the same root cause: insulin resistance (IR), an inflammatory disorder that causes a cascade of dangerous events at the cellular level, damaging all of the body’s arteries. To learn more about how type 2 diabetics can reduce their heart attack risk, click here.
5. MORE THAN ONE IN THREE AMERICANS — 88 MILLION ADULTS — HAVE PREDIABETES, ENDANGERING THEIR HEART, BRAIN AND ARTERIAL HEALTH.
Of this group, 85 percent are unaware of their disorder, according to the CDC. Al- though most people think of prediabetes as the beginning of a long, slow march to type 2 diabetes, it has many other devastating effects. Also known as IR, prediabetes can often progress silently for decades if it goes untreated. For that entire time, the brain is suffering. IR’s inflammatory effects have recently been shown to drive the development of Alzheimer’s disease (AD), which is so closely linked to IR that some scientists think AD should be renamed type 3 diabetes. Indeed, a recent study reported that 80 percent of people with AD also have IR. Once this prediabetic condition is detected and treated, however, it can often be reversed with simple lifestyle changes, such as weight loss, increasing physical activity and eating a healthy diet based on your DNA.
6. IN THE TIME IT TAKES TO WATCH A MOVIE, YOU CAN GET THE BEST SCREENING TEST FOR DIABETES — AND MOST INSURANCE PLANS COVER IT.
New guidelines issued earlier this year by the U.S. Preventive Services Task Force advise that screening start at age 35 if you’re overweight or obese, or at a younger age if advised by your provider due to such factors as obesity or family history. The ADA rates the 2-hour oral glucose tolerance test (OGTT), in which you drink a sugary liquid after an overnight fast, as the “gold standard” in accuracy. Blood is drawn at the one- and two-hour marks to check glucose levels. Studies show that other widely used screening tests, such as the A1c test, which doesn’t require fasting, are much less accurate. For example, a BaleDoneen study found that of 547 patients checked with various blood sugar tests, the A1C test missed 63 percent of those with IR/prediabetes. Moreover, 27 percent of the patients classified as pre- diabetic by the A1C actually had normal blood sugar when checked with the highly accurate OGTT.
7. THERE ARE NEW GUIDELINES ABOUT WHEN DIABETES SCREENING SHOULD START.
Earlier this year, the U.S. Preventive Services Task Force issued new guidelines recommending that people who are overweight should begin screening for diabetes and prediabetes at age 35, 5 years younger than its previous recommendations. The task force advises screening at an earlier age for people from racial or ethnic groups with disproportionately high rates of diabetes (such as Black, Native American, Hispanic/Latinx, Asian-American and Pacific Islander patients), as well as those with a family history of diabetes or a personal history of gestational diabetes or polycystic ovary syndrome (PCOS). Some medical groups call for screening to begin at age 30 — or at a younger age for people at higher risk. Because IR has been shown to start damaging arteries as soon as a person becomes insulin resistant, the BaleDoneen Method recommends that all adults start screening at age 25, using the highly accurate 2-hour oral glucose tolerance test discussed above.
8. SOME PEOPLE WITH “NORMAL” BLOOD SUGAR LEVELS ARE ACTUALLY IN THE EARLY STAGES OF INSULIN RESISTANCE.
Historically, the ADA has defined an OGTT two-hour sugar level of less than 140 mg/dL as normal, a level of 140 to 200 mg/dL as marking prediabetes and a level above 200 mg/dL as diagnostic of diabetes. Recent research by one of the world’s top diabetes experts, Dr. Ralph DeFronzo, however, suggests that danger zone for IR starts when two-hour blood sugar reaches 120 mg/dL or higher, a point at which 60 percent of the beta cells are exhausted. When 90 percent of the cells are fatigued (a situation also known as beta cell function loss), you are diabetic. Dr. DeFronzo has also published excellent data in peer-reviewed journals showing that if one-hour blood sugar results exceed 125 mg/dL, the patient should be considered prediabetic.
9. IF YOU’RE DIABETIC, CONTINUOUS GLUCOSE MONITORING CAN IMPROVE BLOOD SUGAR CONTROL.
A continuous glucose monitor (CGM) automatically tracks your blood sugar 24 hours a day, allowing you to check levels at a glance and observe trends that can help you improve the management of your diabetes. For example, some of our patients have discovered that certain foods they had considered healthy caused their blood sugar to spike, help- ing them make more informed dietary choices. These FDA-approved devices can also help you better understand how your body responds to physical activity and medications and get a more complete picture of your diabetes. They also sound an alarm if your glucose drops to a dangerously low level and alert you if it rises above a preset threshold. There are several types of CGMs, which are available by prescription. Discuss your options with your healthcare provider.