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February 27 , 2006
There’s nothing sweet about diabetes

Michael Johns is executive vice president for health affairs.

Few health developments of the last 10 years have been more widely followed than the growing national problem of overweight and obesity. We’re losing the battle of the bulge, and the associated ills are driving as much as a quarter of increases in health expenditures.

The link of obesity to complications such as high blood pressure, high cholesterol, asthma, arthritis and sleep apnea is featured almost daily on newscasts and in national publications. But of all the health costs of obesity, none is more dramatic than the heightened risk of developing type 2 diabetes—a growing resistance to insulin, leading to an eventual loss of the body’s ability to use and regulate levels of sugar (glucose) in the blood.

Unfortunately, obesity is becoming a problem earlier in life, and so are the heightened risks it carries. Nearly one in three adults is considered to be obese, but nearly one in six children age 6–19 now weighs too much as well. The biochemical changes leading to insulin resistance and outright diabetes are set into silent motion years before the disease becomes obvious.

The ultimate effects of high blood sugar can include diminished vision and blindness, loss of circulation in the hands and feet, poor wound healing, incurable foot ulcers, leg amputation and breakdown in kidney function, leading to the need for regular dialysis treatment to stay alive.

In a recent front-page series dubbed “The Stealth Epidemic,” The New York Times reported that one in eight adult New Yorkers—800,000 people—now have diabetes, and the disease is also cropping up in younger patients each year.

What is true of New York City is no less true of Georgia, a state where obesity, physical inactivity, poverty, uneven access to health care and poor nutrition all merge to form a vicious cycle.

For more than a year, one of Emory’s leading endocrinologists, Lawrence Phillips, has been engaged in a groundbreaking study to find a way to quickly and economically detect a condition called pre-diabetes. If doctors could screen for pre-diabetes in routine office visits, the medical system could pick up more of the estimated 41 million pre-diabetic Americans before the disease fully develops, intervening with personalized prescriptions of exercise, diet and drugs that would save precious years of good health—or, in some cases, forestall disease altogether. That is the hope fueling a three-year, $2.9 million study funded by the National Institutes of Health.

Phillips said diabetes afflicts some 21 million Americans but that number is projected to become 30 million by 2030, with a third of all Americans born in 2006 projected to get diabetes, if current trends continue. Currently diagnosed at an average age of 50, diabetes typically shortens life spans by 9–12 years.

The Screening for Impaired Glucose Tolerance study led by Phillips aims to recruit 2,100 research volunteers by the end of 2007. “Studies in close to 600 people enrolled to date indicate that the project will succeed, and could revolutionize diabetes care,” Phillips said. “But we need more volunteer subjects—
especially men, specifically African American men over the age of 40.”

Of those screened to date, about 20 percent have learned they were pre-diabetic, and 26 people learned for the first time they had type 2 diabetes, Phillips said.

Only two clinic visits are necessary; participants give blood samples and take other tests before and after drinking a 10-ounce sugar drink.

“Volunteer subjects get important health information, and help society by helping to establish the new screening test,” he said. “The information from this study should help improve care for all people, since the goal is to develop a screening test that will be used in routine medical practice.”

For information about this and other ongoing studies, call the Emory Health Connection at 404-778-7777.

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