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One out of three Americans over 20 is pre-diabetic and another 29 million already have diabetes. According to a recent report, the risk for some cancers is 15 percent higher for someone with higher-than-normal blood sugar. Gwen Ifill speaks with Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital, about how to prevent high blood sugar levels.
We have talked frequently about the growing burden of diabetes. But new data show the picture is more sobering than ever. A recent study found the risk for some cancers, such as those in the breast, liver, pancreas or stomach, is 15 percent higher if a person has higher-than-normal blood sugar, a condition often referred to as pre-diabetes.
And the Centers for Disease Control is reporting that one out of three Americans over the age of 20, or 85 million people, have pre-diabetes. Another 29 million already have diabetes, which would put half of the U.S. adult population at risk of developing serious health problems.
Dr. David Nathan is director of the Diabetes Center at Massachusetts General Hospital, as well as professor of medicine at Harvard Medical School. He joins me now.
Dr. Nathan, what explains this kind of increase over just a decade, an increase of 27 percent?
DR. DAVID NATHAN, Director, Diabetes Center at Massachusetts General hospital: Well, we have been seeing this increase not just in the past decade, but over even the past several decades.
And it seems to be attributable almost entirely to the co-epidemic, if you will, of obesity and overweight. So, now in the U.S., for example, 35 percent of the population is overweight, and another 35 percent is actually obese. And obesity and overweight, as well as sedentary lifestyle, are the major risk factors for the development of diabetes.
Let's make the distinction between type 2 diabetes and pre-diabetes. How often does one lead to the other?
DR. DAVID NATHAN:
Well, so pre-diabetes is a term that we invented a number of years ago, and it's meant to capture those persons who are at average-than-average or at very high risk for developing diabetes.
The term is a bit unfortunate, because not everyone with pre-diabetes actually develops diabetes, but approximately 50 percent we think go on to develop diabetes over time.
And remind us again of the medical issues we're talking about that result once a diabetic diagnosis is made, which is we're talking heart disease. What other diseases?
Well, so diabetes, whether it's type one, which is the juvenile form, or type two, which is the adult-onset form, which is the epidemic form now, both of them lead to long-term complications.
And those complications affect either the small vessels in the eyes, the kidneys, the nervous system, or the medium to larger size vessels that supply the heart and the brain. So the kinds of complications that people with diabetes develop over the course of their lifetime including blindness, kidney disease, amputations, heart disease and stroke.
And currently diabetes is the most common cause of blindness, kidney disease, amputations, and contributes largely to the heart attacks and stroke in the U.S.
Is age, race, or ethnicity, are any of those a contributing factor or risk factor?
As I said, type 2 diabetes is sometimes called adult-onset because it does usually affect people beyond age the age of 40. It can develop at earlier ages. But, in fact, if you look at the population greater than age 65, about 25 percent of them have type 2 diabetes. Ethnicity and race are also important risk factors, so that, for example, Hispanic Americans, African-Americans, Asian Americans and American Indians all have higher risks than Caucasians.
What about this report linking it to higher risk of cancer?
We have known some time — for some time, unfortunately, that in addition to all those vascular complications that there appears to be an increased risk for cancer in the diabetic population.
What hasn't been very clear up until now is whether that is attributable mostly to the increased obesity and overweight, because that's what diabetes is occurring in, overweight and obese people, or whether it was owing to the diabetes itself. It's still not very clear which one contributes, but, in fact, I'm not sure that it makes much difference, because one way or the other, people who are overweight, obese and who have type 2 diabetes appear to be at increased risk for that number of — those cancers that you mentioned earlier.
And so what kind of intervention is really warranted? Obviously, diet and exercise, but also medication?
Well, so there is good news behind the story, actually, in some ways.
And that is, we have known now for more than a decade that there are ways of either preventing or delaying the onset of type 2 diabetes. A study named "The Diabetes Prevention Program" showed back more than a decade ago that if you changed the factors that appear to lead to type 2 diabetes, that is, specifically, you lose weight and you increase your activity levels, you can lower the risk of diabetes by almost 60 percent, 60 percent.
There's a medication called metformin, which is a very commonly used medication to treat diabetes, but you can actually also use it earlier in order to try to prevent diabetes. And it was shown in the same study, "The Diabetes Prevention Program," to reduce diabetes by 31 percent.
So we do have answers to how to decrease the epidemic. In addition, once people — if someone escapes the prevention, if they develop diabetes, we also have a good understanding of how to prevent the complications, how to decrease the development of blindness and kidney disease.
And that involves a careful maintenance or achievement of good levels of blood sugar control, blood pressure control, and cholesterol control as well.
Dr. David Nathan of Massachusetts General Hospital, thank you very much.
Thank you for having me.
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