Type 2 Diabetes: An Epidemic Growing with Our Waistlines

By: Jean Johnson for Wounds1

“When they give you a visa to the United States in Shanghai, Fujian, or Beijing, they should stamp a clear warning: Danger to your health,” Marcelo M. Suarez-Orozoco, Ph.D., co-director of immigration studies at New York University told The New York Times in January 2006.

Asian Susceptibility

Among other things, Suarez-Orozoco was referring to the extraordinarily high susceptibility Asians from China, Korea, and Japan have for Type 2 diabetes when they immerse themselves in a culture with popular American cuisine.

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University of Sydney in Australia offers the following ways to move toward the low end of the glycemic index: Eat breakfast cereals made of on oats, barley, and bran Choose whole grain breads made with whole seeds Reduce the amount of potatoes you eat Eat plenty of salad vegetables with vinaigrette dressing

More, in the front page article, The New York Times pointed the finger detailing how, even as all kids’ physical education classes in the city’s public schools are cut back to one 50-minute period per week, Asian immigrant children brand new to the country fall prey to a double onslaught. Seduced by television ads for processed foods in crinkly wrappers combined with a gamut of strategically situated fast food establishments from McDonald’s to Blimpie, alarming numbers of Asian children are on the fast track to obesity and Type 2 diabetes.

New York City epidemiologists don’t have extensive data at this point, but according to The New York Times, “They do know that 14 percent of Asian children in New York are obese, more than twice the rate among their parents. And they say there is mounting evidence – including soaring diabetes rates in major cities in China, and in other countries with Chinese immigrants – that New York will soon experience a similar explosion as more Asians arrive and have their first encounters with Western ways.”

First encounters? Blimpie? If it’s all starting to sound like a sci-fi movie there is good reason. Indeed, The New York Times noted that while her peers ignored the steamed dumplings young Annie Wu brought from home for her school lunch, classmates eagerly clustered around nine-year-old May Chen who shared a “bag of all-American snacks” with her little friends.

The paper captured the moment in Technicolor: “A shiny blue can of Lay’s Stax potato chips and a package of neon orange Cheetos Puffs.” Apparently a good time was had by all – at least in the short term. If pundits are correct, however, Annie Wu with her healthier lunch may have the last laugh.

The Epidemic

“Americans and Europeans eat too much fat and consume too little carbohydrates and fiber, and they get too little exercise,” states the American Diabetes Association (ADA). “Type 2 diabetes is common in people with these habits.” The ADA goes on to note that in addition to Asian populations, “ethnic groups in the United States with the highest risk are African Americans, Mexican Americans and Pima Indians.”

Diabetes not only strikes certain ethnic groups more severely than others, it is also age specific. Type 2 diabetes is also called “adult onset,” but that term has been less applicable since the disease has started striking increasing numbers of teenagers. According to leading endocrinologist and dean of the University of Pennsylvania School of Medicine, Arthur Rubenstein, M.D., “If people become diabetic at age 10 or 15 or 20, you can predict that when they are 30 or 40, they could have terrible complications.”

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Grave Facts about Type 2 Diabetes Complications of diabetes include: Heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system disease, amputations, dental disease and complications with pregnancy. Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2000 and is thought to be under-reported by the CDC. Type 2 diabetes is strongly connected to eating and exercise habits – and thus considered one of the latest major life-style epidemics to assault Western society and developed countries.

Complications of diabetes, of course, include being at risk for diabetic comas and insulin shock, having circulation systems so fragile that peripheral wound healing is jeopardized, losing limbs to amputation, and even going blind.

“It was so sad. We watched Bill Leonard decline over a number of years when he was in his forties. First he lost a toe and then another one. His health grew so fragile he couldn’t even work, so he moved back to the family home in Ohio so his mother could look after him,” said Bobbye Smith of Williams, Arizona.

“That’s when we started getting the news. First one leg to the knee. Then his second leg to above the knee. And of course, he was in and out of the hospital all the time. His diabetes was so severe he never was able to keep it under control very well with his insulin shots – and it was in the summer when he was in his late forties that we finally got word that he passed on. That was in the early 1990s I think. And yes, I suppose he did have trouble with his lifestyle. I never heard about him exercising, and he did drink some. I do think he tried to eat well, but he was a meat and potatoes man pretty much as I recall.”

The 1990s was the decade that has marked the onset of the diabetes epidemic, when it rose 33 percent according to the Centers for Disease Control and Prevention (CDC). More recently per 2002 CDC data, more than eighteen million people or 6.3 percent of the population have diabetes with around five million people in this group undiagnosed. Additionally, more than 200,000 diabetics are under 20 years of age, a trend that the CDC states is becoming increasingly common.

New Research

The World Health Organization has determined that 90 percent of the 150 million people globally that have diabetes have Type 2. Consequently, Scandinavian researchers from Sweden and Finland focused on Type 2 diabetes in a recent study. They concluded “that at least two ‘diabetes genes’ predict the risk of Type 2 diabetes (T2D) when combined with lifestyle factors, in the largest study of its kind to date.”

“Scientists believe that such genetic risk factors might be used to design tests that, when assessed with lifestyle factors such as obesity, will allow clinicians to predict an individual’s risk of the disease,” according to the open-access journal, PLoS Medicine at www.plosmedicine.org.

More than 2,000 people were tested in the study, although the team from Lund University in Malmo, Sweden said a limitation of their work was this relatively modest number of participants. “These findings will need to be replicated in larger, prospective studies, such as the Malmo Diabetes Prevention cohort study in which 22,000 individuals are being followed for more than 20 years.”

Whether the Scandinavians and other researchers are able to identify genetic markers, however, is only half the battle. As they underscore in their report, lifestyle factors continue to be critical when it comes to Type 2 diabetes.

Thus, the smart choice during the rising epidemic is to keep the metabolism going strong with a good 30 minutes of daily activity, eating off the low end of the glycemic index, and choosing whole grains, beans, fruits and vegetables that stick to the ribs like no doughnut or French fry ever could.

Last updated: 03-Feb-06