Diabetes 'Revolution' is Cutting Both Ways

Diabetes expert John Buse recalls looking into his office's waiting room in the early 1990s and seeing it filled with people suffering the long-term complications of the disease. They would be blind, have legs missing from emergency amputations or be on kidney dialysis.

Not anymore.

Diabetes rates continue to skyrocket, but "most days in the clinic, I see no one disabled with diabetes," Buse says. "No one."

The Centers for Disease Control and Prevention reported this month that the prevalence of heart disease dropped 14 percent in diabetics ages 35-64 from 1997-2005. Since the mid-1990s, rates of other complications such as diabetic kidney failure, blindness and deaths caused by a lack of insulin have declined, the CDC reports. It reflects what Buse calls a "revolution" in diabetes treatments during the past decade.

That's the good news. The bad: Not everyone is reaping the benefits. Heart deaths have declined in men with diabetes, but not in women; kidney failure rates among diabetics are much higher in blacks and Hispanics than in whites. Meanwhile, the disease is increasing worldwide at such an alarming rate that the number of new cases is outpacing the number of those benefiting from gains made in treatment. That's largely because obesity, the chief risk factor for the most common form of diabetes, is a growing problem.

Diabetes, caused by the body's inability to produce or use insulin effectively to prevent a buildup of sugar in the blood, now afflicts nearly 21 million in the USA and roughly 250 million worldwide. Health analysts project that by 2025, 50 million Americans and up to 380 million people globally will have diabetes. So even as treatments for diabetes complications improve, the disease's rising prevalence means there will be more people disabled by it and more who eventually will die from it.

During the past decade, medical studies have shown that by reducing high blood pressure and cholesterol and keeping blood sugar levels as close to normal as possible, diabetics can forestall many of the disabling complications that once seemed inevitable. This knowledge, along with simpler, more accurate blood tests and better drugs, has improved treatment, says Buse, an endocrinologist at the University of North Carolina at Chapel Hill.

But the soaring rate of people with diabetes threatens to overwhelm health systems and undermine economies, health specialists say. The problem has mobilized world health leaders, who are marking World Diabetes Day on Wednesday to draw attention to the issue. For the first time, the United Nations is taking part in such activities and has passed a resolution encouraging member states to develop national policies to prevent and treat diabetes.

The International Diabetes Federation, which tracks global diabetes, says the disease will cause 3.8 million deaths worldwide this year, nearly equal to HIV/AIDS and malaria combined. In the USA, the CDC says, it is the sixth leading cause of death, contributing to nearly 225,000 deaths in 2002, up from 213,064 in 2000.

"The prevalence of diabetes is going up because obesity is going up," says Judith Fradkin, director of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. "But if we hadn't made the prog-ress we have, things would be much worse."

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