Commentary: Complications of diabetes in the United States

By Mona AlvaradoFrazierGuest contributor

Last week’s article discussed the ‘Diabetes Epidemic’ in the Latino community. I hope you remembered the challenge: eat more green vegetables and begin to exercise fifteen to thirty minutes a day.

The other day I mentioned the intake of more green vegetables to my mother. While we were in Costco, I steered her to the back of the warehouse where large bottles of blue, orange and green Naked fruit smoothies lined the freezer area.I pulled out the Green Machine one, which says ‘looks weird, tastes amazing,” and showed it to her. She made a cara and said, “that looks weird,” and reached for the blue bottle of berry mix.

“No, this one has the vegetables,” I said and promptly named off the eleven vegetables and boosts. “And no sugar added.”

She made some more caras and then made that sound of asco, which embarrassed me in front of the handsome Costco employee working near us. Then I read off the fruit list. She reluctantly agreed to try it and I’m happy to report that she loves the stuff, but I have to limit her to one cup a day.

Change can be difficult but when we look at the consequences of diabetes, it is a better option than losing a limb, one’s sight, or life. The medical consequences of diabetes are quoted from the U.S Dept. of Health and Human Services.

Heart Disease and Stroke

In 2004, heart disease was noted on 68 percent of diabetes-related death certificates among people ages 65 years or older. Stroke was noted on 16 percent of diabetes-related death certificates among people ages 65 years or older. Adults with diabetes have heart disease death rates and stroke are about 2 to 4 times higher than adults without diabetes.

Hypertension

In 2005–2008, of adults ages 20 years or older with self-reported diabetes, 67 percent had blood pressure greater than or equal to 140/90 millimeters of mercury (mmHg) or used prescription medications for hypertension.

Blindness and Eye Problems

Diabetes is the leading cause of new cases of blindness among adult’s ages 20–74 years. In 2005–2008, 4.2 million—28.5 percent—people with diabetes ages 40 years or older had diabetic retinopathy, and of these, 655,000—4.4 percent of those with diabetes—had advanced diabetic retinopathy that could lead to severe vision loss.

Kidney Disease

Diabetes is the leading cause of kidney failure, accounting for 44 percent of all new cases of kidney failure in 2008. In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease and 202,290 people with end-stage kidney disease were living on chronic dialysis or with a kidney transplant.

Nervous System Disease

About 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion, carpal tunnel syndrome, erectile dysfunction, or other nerve problems. Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

Amputations

More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes.

Dental Disease

Periodontal, or gum, disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes. The likelihood was even greater—4.6 times — among smokers with poorly controlled diabetes. About one-third of people with diabetes have severe periodontal disease consisting of loss of attachment — 5 millimeters or more — of the gums to the teeth.

Complications of Pregnancy

Poorly controlled diabetes before conception and during the first trimester of pregnancy among women with type 1 diabetes can cause major birth defects in 5 to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies.

Other complications

People with diabetes, ages 60 years or older, are 2 to 3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework compared with people without diabetes in the same age group.

People with diabetes are twice as likely to have depression, which can complicate diabetes management, than people without diabetes. In addition, depression is associated with a 60 percent increased risk of developing type 2 diabetes.

Prevention or Delay of Type 2 Diabetes

The Diabetes Prevention Program (DPP), a large prevention study of people at high risk for diabetes, showed that lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by 58 percent during a 3-year period. The reduction was even greater, 71 percent, among adults’ ages 60 years or older.

Prevention or delay of type 2 diabetes with either lifestyle or metformin intervention was effective in all racial and ethnic groups studied and has been shown to persist for at least 10 years.

Interventions to prevent or delay type 2 diabetes in individuals with pre-diabetes can be feasible and cost-effective. Research has found that lifestyle interventions are more cost-effective than medications.

To prevent diabetes, the people who participated in the DPP study:

> Lost 5 to 7 percent of their body weight (that is 10 to 14 pounds for a person who weighs 200 pounds).

> Were physically active for 30 minutes a day, 5 days a week. Most participants chose brisk walking.

> Made healthier food choices and limited the amount of calories and fat in their diet.

“It is better to take many small steps in the right direction than to make a great leap forward only to stumble backward” – Old Chinese Proverb. Make the small changes over the next few months and help yourself complete the journey to wellness and health.

— Mona AlvaradoFrazier is the writer of two manuscripts: working titles “A Mariposa Heart” and “Strong Women Grow Here.” To see more of her work, visit www.latinapen.blogspot.com