Diabetes taking a toll across the country

Every week, Dr. Steve Wolf informs three to six of his mostly Santa Rosa patients that they are diabetic. Ten years ago it was one to two.

Wolf, a family doctor with Sutter Medical Group of the Redwoods, said some of his patients are not surprised, but the most common reaction is denial.

"They ask, &‘are you sure, could it be wrong,'" he said.

It's a scenario that is playing out more and more across the country and health professionals point to a key cause:

We're too fat.

This week, the federal Centers for Disease Control and Prevention reported that an estimated 26 million people were diabetic and another 79 million adults were pre-diabetic. The CDC's new estimates are alarming, say local health care providers and public health officials.

Diabetes, the seventh leading cause of death in the United States, is a major cause of heart disease and stroke, the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness.

"The cost of diabetic care in this country is astronomical," said Dr. Mark Netherda, deputy public health officer for Sonoma County.

"And if you couple that with the cost of secondary complications caused by diabetes, including stroke, heart disease, vascular disease resulting in amputations, severe vision problems including blindness, you're looking at a very, very significant proportion of how our health care dollars are spent in this country."

Netherda said the estimates released this week are an extrapolation of older data, and it's unclear what the corresponding local estimates would be. But according to the latest figures, from UCLA's California Health Interview Survey, conducted between 2005 and 2007, 6 percent of adults in Sonoma County said they had a diabetes diagnosis, compared to 7.4 percent of the population statewide.

Among Sonoma County residents living below 200 percent of the federal poverty level, the rate was 10.7 percent. For those living above that threshold, the rate was only 4.7 percent. A lack of education was also tied to higher rates of diabetes, Netherda said.

There are a number of risk factors for the most common form of diabetes, Type 2, such as age, family history, hypertension, a sedentary lifestyle. But Wolf said the "No. 1" risk factor is obesity.

Dr. Jerry Minkoff, chief of endocrinology at Kaiser Permanente in Santa Rosa, said the average super-sized, fast-food meal could have fed a family of Paleolithic homo sapiens 100,000 years ago.

But humans today - saddled with a cave dweller's genes and a body well adapted to starvation - simply eat too much, he said.

A diabetes diagnosis is given when a patient's fasting blood sugar reaches over 125 milligrams of blood sugar per 100 milliliters of blood. Type 1 diabetes occurs when a person's body is not producing insulin, the hormone needed to convert sugar, starches and other food into energy.

In Type 2 diabetes, the body either does not produce enough insulin or the body develops a resistance to it. When there is too much glucose in the blood, diabetes complications occur, damaging blood vessels, nerves, eyes and kidneys.

Minkoff said there are more than 6,600 Santa Rosa Kaiser members diagnosed with diabetes. Another 40 to 50 percent of patients over 50 are pre-diabetic, he said.

He said Santa Rosa Kaiser, with 140,000 members, recently topped other Kaiser health care systems in Northern California with the best rates for controlling blood sugar, blood pressure and cholesterol.

With diabetes rates across the country growing, a greater focus is being placed on identifying the pre-diabetic.

Wolf said that 10 years ago, the focus was on screening and diagnosing diabetics. But Wolf said that the diagnosis was coming too late in the game, and patients had for a decade or more developed severe diabetic complications.

The warning sign, or criteria for abnormal fasting blood sugar, was brought down from a diabetic reading of 126 to 100, the onset of pre-diabetes. That triggers more tests and a call to change one's eating habits and lifestyle.

Another big concern among medical professionals and public health officials are the higher rates of diabetes among certain racial and ethnic groups.

According to the CDC report, American Indians in southern Arizona had diabetes rates of 33.5 percent, blacks, 18.7 percent, and Mexican Americans, 13.3 percent; compared to 7.1 percent for whites and 8.4 percent for Asians.

Netherda said that in Sonoma County, the diabetes death rate for Latinos is 22.4 deaths per 100,000 people, compared to 18 deaths per 100,000 white residents.

Netherda said a number of county-wide health campaigns are underway to curb the spread of diabetes.

"At some point we have to turn that ship around and teach kids that just because a half-pound burger is available, that doesn't mean that's what you have to eat," Netherda said.