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Changing Course

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“With limited availability of healthy food in low-income communities, a preponderance of soda and junk food marketing, and urban neighborhoods lacking safe places to play, we have created a world where diabetes is the natural consequence.”

IT’S NO SECRET that there is an epidemic of diabetes in the United States. Nationally, diabetes rates have tripled over the past 30 years, and in California, diagnoses have increased by 35 percent since 2001. But a recent study by the Fielding School-based UCLA Center for Health Policy Research suggests that the problem is even worse than that in California – particularly given the growing number of older adults, who are at the highest risk of any age group for developing the disease.

The study found that approximately 13 million adults in California, or 46 percent, have prediabetes – a precursor to type 2 diabetes – in addition to the 2.5 million adults (9 percent) who already have been diagnosed with diabetes. Combined, the two groups represent 15.5 million people, 55 percent of the state’s adult population.

Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. Up to 30 percent of people with prediabetes will develop type 2 diabetes within five years, and as many as 70 percent will develop the disease in their lifetime. The complications of diabetes can be severe. It is associated with a dramatically increased risk of amputation, nerve damage, blindness, kidney disease, heart disease, hospitalization and premature death.

As expected, the study found that the prevalence of prediabetes in California is highest among older adults. In the 55-and-older age groups, prediabetes rates are approximately 60 percent. Equally alarming, the study found that 33 percent of young adults (ages 18-39) have prediabetes, suggesting that the number of older adults with the disease will continue to climb in the coming decades. Among adults ages 40-54, nearly half have prediabetes.

“Having these estimates specific to California and broken down by county can help to get the message out that we need to do more to prevent people with prediabetes from developing type 2 diabetes,” says Dr. Susan Babey, co-director of the UCLA Center for Health Policy Research’s Chronic Disease Program and lead author of the study, the first analysis and breakdown of California’s prediabetes rates by county, age and ethnicity.

Babey notes that because people with prediabetes tend not to have symptoms, most aren’t aware they have this precursor to type 2 diabetes unless they have been screened by their health care provider. “There are significant barriers not only to people knowing their status, but to getting effective help,” Babey says. “A simple blood test for diabetes should be covered by all insurers, as should the resources and programs that can make a real difference in stopping the progression of this terrible disease.”

Established diabetes prevention programs focusing on lifestyle changes have been shown to be effective, in some cases cutting in half the risk that people with prediabetes will develop type 2 diabetes, Babey says. In addition to making such programs more accessible and increasing screening, the study’s authors recommend policy and other changes to encourage healthy, active lifestyles.

“With limited availability of healthy food in low-income communities, a preponderance of soda and junk food marketing, and urban neighborhoods lacking safe places to play, we have created a world where diabetes is the natural consequence,” says Dr. Harold Goldstein (MSPH ’89, DrPH ’97), executive director of the California Center for Public Health Advocacy, which commissioned the study. “If there is any hope to keep health insurance costs from skyrocketing, health care providers from being overwhelmed and millions of Californians from suffering needlessly from amputations, blindness and kidney failure, the state of California must launch a major campaign to turn around the epidemic of type 2 diabetes.”