Diabetes And Obesity: An Alarmingly Prevalent Combination

   Despite the increased awareness of diabetes in recent years and its potentially devastating complications, the recent report from the Centers for Disease Control and Prevention (CDC) offers a grim portrait of the effort to curtail and prevent the condition. In the last two years alone, there has been a 14 percent increase in the prevalence of diabetes in the United States (see page 8, “News And Trends”).    The estimated number of Americans with diabetes now stands at 20.8 million people in the United States, a 2.6 million increase from 2003. The CDC estimates that 6.2 million of these people are undiagnosed.    According to the CDC, heart disease and stroke account for nearly 65 percent of deaths in people with diabetes. These folks also have two to four times the risk for stroke in comparison to those without diabetes. The CDC also reports that more than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes.    When asked about the alarming increase in diabetes cases, a number of podiatrists agree that poor diet and sedentary activity are the key causal factors. One DPM notes that when she obtains a full nutritional workup for obese patients, she often finds out the patient is malnourished. How can a patient be well fed and malnourished at the same time? She says a diet heavy on carbohydrates will do the trick.    The DPM points out that the combination of obesity and malnourishment is particularly devastating for patients with wounds as they need “those micronutrients to heal.”    In regard to the dual epidemics of diabetes and obesity, it is clear that lifestyle modification must be a central component of risk reduction and outright prevention. This is reflected in a study, “Randomized Trial Of Lifestyle Modification and Pharmacotherapy for Obesity,” that was recently published in The New England Journal Of Medicine.    The study evaluated over 200 patients in four treatment groups. According to the study, these groups included one group treated with sibutramine (an FDA approved drug for the induction and maintenance of weight loss), one group treated with lifestyle modification alone, one group treated with sibutramine and lifestyle modification, and one group treated with sibutramine and brief lifestyle modification counseling from primary care providers.    The lifestyle modification group involved weekly group meetings led by trained psychologists for the first 18 weeks, biweekly meetings from weeks 20 to 40 and a follow-up visit at week 52. Researchers of the study noted that for the first 18 weeks, the meetings followed the LEARN (Lifestyle, Exercise, Attitudes, Relationships and Nutrition) Program for Weight Control. According to the study, these patients had to keep daily records of food and calorie intake, and physical activity.    What were the results? Those who received a combination of sibutramine and lifestyle modification “lost significantly more weight” at 18 weeks, 40 weeks and one year than the other three treatment groups. Specifically, 52 percent of patients in the combined therapy group lost “10 percent or more of their initial weight” while this percentage in the other groups ranged from 26 to 29 percent.    Empowering patients to take control of their healthcare is clearly essential. Working in concert with diabetologists, nutritionists and physical therapists can also go a long way toward reducing common risks associated with these conditions. Further encouraging multidisciplinary collaboration, the CDC will be holding a joint conference on diabetes and obesity in Denver May 16-19, 2006.    Hopefully, these developments will help turn the tide against these rising epidemics and save many lives along the way.