Are we slurping and couch-potatoing our way into diabetes?
In a first-ever study, an alarmingly high number of California adults – and even those under age 40 – are considered prediabetic, meaning they are at higher risk of developing life-threatening Type 2 diabetes.
About 33 percent of younger adults are estimated to be prediabetic, according to the county-by-county study released Thursday by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy.
Rates for prediabetes ranged from 43 percent of all adults in Butte County to a high of 54 percent in Nevada County. In Sacramento County, 46 percent of all adults are estimated to be prediabetic. Tallied together, more than half of all Californians – 15.5 million or 55 percent – are estimated to be either diabetic or prediabetic.
Calling the results “astounding,” Dr. Harold Goldstein, the report’s co-author and executive director of the California Center for Public Health Advocacy, based in Davis, said he didn’t expect such high numbers. “The numbers are so large that they stop you in your tracks. ... It’s hard to digest that the situation is as bad as it is.”
The study, which used a predictive model based on national blood-testing results and survey data of 40,000 California residents, showed that California’s 18- to 39-year-olds are gaining on their elders in their risk for developing Type 2 diabetes.
“These are the young adults who grew up during the childhood obesity epidemic,” Goldstein said.
Diabetes has been a pernicious problem in American health care for decades. Left untreated, it can lead to leg amputations, blindness, liver disease, kidney failure, heart attacks, stroke and a host of other life-threatening ailments.
The numbers of prediabetic Californians go “hand in hand” with increasing rates of obesity and diabetes seen here and nationwide, said Dr. Susan Babey, the study’s co-author and co-director of the chronic disease program at UCLA’s Center for Health Policy Research. “It goes back to sedentary kids. We’re less active than we should be or used to be. Our diets are not as good as they should be. We don’t eat enough fruits and vegetables. We eat too much sugar.”
Unlike Type 1 diabetes, which is typically genetic and not considered preventable, Type 2 diabetes can be avoided with an improved diet and increased physical activity. There also are medications, such as metformin, that can help manage diabetes. If untreated, up to 30 percent of those identified with prediabetes will develop Type 2 within five years, according to the Centers for Disease Control and Prevention; as many as 70 percent will develop the disease in their lifetime.
Type 2 is associated with obesity, older age, family diabetes history, and race and ethnicity. African Americans, Latinos, Pacific Islanders and Native Americans are at greater risk of developing Type 2 diabetes.
Blood testing for prediabetes typically starts at age 45, or for younger adults who are overweight, have high blood pressure, a family history of diabetes or other risk factors. There are two main tests: the fasting plasma glucose test, which requires eight hours of fasting, and the Hemoglobin A1c test, which measures average blood sugar over the past three months. People are considered prediabetic if their fasting blood glucose level is between 100-125 milligrams per deciliter or if their A1c level is between 5.7 and 6.4 percent.
Doctors who treat patients with diabetes say they’re not surprised by the UCLA study results.
“I deal with this every day,” said Dr. Francisco Prieto, a family practitioner with the Sutter Health Group in Sacramento. “Some of it is cultural. Some is policy. The way we changed the rates of smoking in California, (making it) socially unacceptable, was a great thing. Changing the way people eat is going to be tougher.”
Dr. Deborah Plante, an endocrinologist who sees patients as young as 14 with Type 2 diabetes, said it’s worrisome that so many people are unaware they’re at risk. “Many people with Type 2 walk around undiagnosed,” she said, some only discovering the disease when they wind up in the hospital with a heart attack or a stroke. “Most patients usually don’t have symptoms. It’s up to physicians to do screenings.”
A former Dignity Health physician, Plante is starting her own practice so that she can offer lifestyle coaching and diabetes education to help patients keep the condition at bay. “It’s hard to get organizations to pay attention to this, in terms of having obesity and prediabetes programs,” Plante said. “A lot of times, insurance won’t cover it. ... I think many health systems fall short.”
Health systems such as Kaiser Permanente offer classes in preventing diabetes, while the state Department of Public Health also offers classes and awareness campaigns on pregnancy-related diabetes.
Nationally, YMCAs run yearlong classes in diabetes prevention, focused on changing diet and physical activity, including 92 classes in the Bay Area and Los Angeles. The Sacramento Central YMCA expects to start offering its first diabetes-prevention classes by December, said Jay Lowden, president and CEO of YMCA of Superior California. He hopes the $429 cost will be covered by sponsors, insurance companies or individual employers.
To check if you’re at risk for Type 2 diabetes, the American Diabetes Association urges consumers to take its online test. (It’s at www.diabetes.org/risktest.) This summer, the association’s Sacramento Sierra office is hosting its first “diabetes prevention” day camps in West Sacramento and South Sacramento for kids and teens ages 5-17 who are referred by their physician.
Diabetes takes a huge toll not only physically, but financially. In California, the total cost of treating diabetes is estimated at $24.5 billion, according to a 2012 report by the state’s Department of Public Health and the University of San Francisco.
The UCLA study urged more individual screenings and insurance reimbursement of “lifestyle modification” programs, such as those endorsed by the National Diabetes Prevention Program. In a multistate clinical trial a decade ago, the CDC found that people who lost 7 percent of their body weight and exercised for 30 minutes a day could lower their risk of developing diabetes by 58 percent, and by even more for those over age 60.
The study co-authors also advocated for reducing consumption of sugary sodas. This week, three state lawmakers proposed Assembly Bill 2782, which would add 2 cents per ounce to the cost of a regular, sugar-sweetened soda. The tax would raise an estimated $2.3 billion a year to fund state and local obesity and diabetes prevention efforts. According to the office of Assemblyman Jim Wood, D-Healdsburg, California spends 3 cents per capita on diabetes prevention, the lowest rate in the country.
“If we’re serious about turning around diabetes, we have to focus on the biggest culprits. Sugary beverages are the No. 1 source of sugar in American diet,” said Goldstein, who was active in Berkeley’s successful 2014 effort to tax sodas.
While a diagnosis of prediabetes is not a guarantee of developing full-blown diabetes, “It is a wake-up call not only to individual Californians,” said Babey, “but also to the state to increase efforts on diabetes prevention.”
What it is: Based on blood tests, prediabetes means blood glucose (sugar) levels are higher than normal but not high enough to be diagnosed as diabetes.
Why it’s dangerous: About 30 percent of those with prediabetes will develop Type 2 diabetes within five years; 70 percent will develop the disease in their lifetimes. Diabetes is the leading cause of kidney failure and adult blindness, as well as nontrauma lower-limb amputations. It’s also a contributor to heart attack and stroke.
Types of diabetes: Type 1, which typically strikes children and young adults, accounts for 5 percent of all diabetes diagnoses. It’s controlled by taking insulin. Type 2 diabetes is considered preventable by losing weight, increasing exercise and/or medication.