Experts foretell diabetes epidemic will have major impact in Chicago

While childhood obesity rates remain sky-high in the U.S., society has yet to feel the full weight of our expanding waistlines, experts say. For young adults, this could mean a type 2 diabetes epidemic lurks in the not-so-distant future.

"It can take up to 10 years for a person to develop type 2 diabetes, so it means we have yet to see the most damaging effects of childhood obesity," says Dr. Joyce Lee, a University of Michigan pediatric endocrinologist whose work on this topic was recently published in Archives of Pediatric Adolescent Medicine.

Lee compared the obesity epidemic to a tsunami with lag time before it strikes. When this built-up wave finally hits young adults, serious type 2 diabetes implications will surface, she said.

"It used to be that individuals developed type 2 diabetes in their 50s and 60s, but now it's reaching them in their 20s and 30s," Lee says, adding that if the disease is occurring in prime adulthood years, it could lower life expectancy. "The longer you have diabetes, the more likely you are to develop devastating side effects, such as blindness, heart disease and kidney failure."

Diabetes authorities also raised concerns about type 2 diabetes affecting a greater percentage of women during their childbearing years.

"If the mom has diabetes of any kind and she gets pregnant, the child has a high risk of becoming obese and insulin resistant at an early age," says Dr. Rebecca Lipton, a University of Chicago specialist in endocrinology and pediatric science. "It's like a ticking time bomb for young adults. These are people in their reproductive years, so it's a vicious cycle."

Obesity is a major risk factor for type 2 diabetes, a chronic disease that begins as insulin resistance, according to the U.S Centers for Disease Control and Prevention. Insulin resistance is a disorder in which the body's cells do not use insulin properly.

Type 2 diabetes is different from type 1 diabetes, a currently non-preventable disease caused by autoimmune destruction of the pancreatic cells that produce insulin, leading to lack of insulin production.

As obesity and diabetes cause people's quality of life to go down, disease-related costs go up, greatly taxing the healthcare system, experts say.

"This whole diabetes thing is very scary from a health economic view," said Dr. John Buse, president of the medicine and science divisionof the American Diabetes Association. "People with diabetes account for about 20 percent of healthcare spending. Because diabetes is so expensive, and the numbers are increasing so rapidly, it really threatens the health of our economic system."

Another notable cost, according to Lipton, will be disability payments, "because [people with diabetes] are not going to be productive employees."

For 2007, the estimated direct and indirect cost of diabetes in the United States was $174 billion, according to CDC data. Direct medical costs accounted for $116 billion, and indirect costs, such as disability, work loss and premature mortality, were listed at $58 billion.

Diabetes authorities say this predicted epidemic will hit certain Chicago neighborhoods extra hard, reflecting a disparity in the rates of type 2 diabetes throughout Chicago.

"I think we're going to be seeing increasing rates [of type 2 diabetes] on the South and West Sides," says Dr. Steve Rothschild, a preventive medicine expert from Rush University Medical Center and chairman of the Humboldt Park Diabetes Taskforce.

Rothschild's taskforce was created in reaction to a study called "Disproportionate Impact of Diabetes in a Puerto Rican Community in Chicago," published in the December 2006 issue of the Journal of Community Health.

The study showed that Puerto Ricans in Chicago's Humboldt Park neighborhood suffer diabetes at two to three times the overall rate of diabetes in Chicago. In 2006, 21 percent of Puerto Ricans in this community had diabetes, Rothschild said.

The lifetime risk for Latinos and African Americans to develop type 2 diabetes approaches 40 percent, according to Dr. Edward Gregg from the CDC's Division of Diabetes Translation.

Among Americans born in 2000, the lifetime risk for diabetes in Hispanic men is 45 percent, compared to 30 percent for non-Hispanic white men. For women, the lifetime risk is more than 50 percent for Hispanics, and less than 32 percent for non-Hispanic whites, according to "Lifetime Risk for Diabetes Mellitus in the United States," a study published in a 2003 issue of The Journal of the American Medical Association.

Dr. Buse, of the ADA, said it is important to keep in mind that this is a prediction, and that the increased rate of type 2 diabetes is influenced by other major factors, including an aging population.

Buse said we simply do not have enough information to know whether an outbreak of diabetes in young adults is on the horizon. He joined others in calling for more diabetes research, especially community-based studies.

Overall, experts say more U.S. dollars should to be allocated towards preventing type 2 diabetes, versus dealing with the aftermath and costly implications of the chronic disease

"The crisis" Rothschild said, "is that in the next 25 years, rather than continuing to see life expectancy grow, it might plateau or decrease just because of the rate of diabetes."