Health matters: What's the trend for diabetes?
Q. In prior columns, you've discussed the increase in cases of diabetes and its relationship to the obesity epidemic. But you've also emphasized that treatment of diabetes works. So what's the bottom line regarding diabetes--are things getting be...
Q. In prior columns, you've discussed the increase in cases of diabetes and its relationship to the obesity epidemic. But you've also emphasized that treatment of diabetes works. So what's the bottom line regarding diabetes-are things getting better or worse?
A. In short, the answer is-both. The incidence of diabetes-that is, the number of new cases-is going up here in North Dakota, across the United States, and in fact throughout the world. This is for both types of diabetes-Type 1, where people don't make enough insulin that allows the sugar in the blood into the cells of the body; and Type 2, where the body is resistant to the effects of insulin. What is especially troubling is that the increased incidence is occurring not just in senior citizens, but in young adults as well. A recent study found a nearly 2 percent per year increase in Type 1 diabetes, and a nearly 5 percent per year increase in Type 2 diabetes in people under 20 years of age over the 10-year period from 2002 until 2012. Especially troubling for North Dakota is that the study found that the greatest rate of increase occurred among Native Americans. So that's the bad news. The good news is that another large study again confirmed the effectiveness of treatment. Hospitalizations for heart complications from diabetes and mortality decreased markedly over the period from 1998 through 2014. We think that the most important factors involved in achieving these substantial reductions in complications from diabetes are better control of diabetes itself as well as the associated problems of high blood pressure and cholesterol levels. The bottom line, unfortunately, is that despite these impressive improvements in outcomes, the effect of diabetes on the population is increasing as more people become afflicted. We simply need to do a better job of prevention, especially through effective weight control.
Q. It seems that as my friends and I age, most of us are coming down with knee problems. Is there anything encouraging you can say?
A. Your observation is quite correct; it has been estimated that almost half of us will develop degenerative arthritis, the most common cause of knee pain, in at least one knee by the time we turn 85. But equally disturbing is that about half of the people with knee arthritis are younger than 65. So knee arthritis is a common problem-and not just for seniors. Unfortunately, there is no cure-although some people have such severe symptoms that they undergo a knee replacement. But for most of us, the question is whether more conservative treatment is of any help. A just-reported study sheds some encouraging light on the role of non-medication treatment of chronic knee pain. Patients who received education about their problem and guidance on how to manage the pain, including the use of exercise equipment like resistance bands and ankle weights, had significantly more reduction in pain and an increase in functional ability than those who did not. Importantly for a rural state like North Dakota, the Internet was used to connect patients with the treatment program, so this type of program could be made available anywhere-whether the patient is near a medical facility or not.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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