Is Diabetes really an epidemic, or is it something more?

The Washington Post on November 21 enclosed a full section highlighting the diabetic epidemic, citing that in 1958 1.6 million people in the US had diabetes, while today 29.1 million people are infested with the deadly disease. How has diabetes taken such a strong hold on our country, and how can we possibly be surviving so lethal a scourge? In fact, while adult diabetes is a condition that has important health repercussions and needs to be addressed and treated, these numbers are both deceptive and counterproductive. Diabetes is not always the killer that it is described as. In fact, in many cases its treatment can be as or more dangerous than the disease itself. And by labeling so many Americans with diabetes, we have not necessarily helped people to live longer and better, but we have certainly helped a lot of people profit.

First, some problems with the numbers, since the medical world lives in a Universe of fuzzy numbers, and the diabetic data is yet another example of this. In 1958 diabetes was defined differently than it is today; the sugar level that made someone diabetic back then was much higher than it is today, so of course more people will be labeled as having diabetes now. The difference is dramatic; we keep lowering the sugar that defines someone as a diabetic, and have even created a category of sick people called pre-diabetics. Also, people are living longer now, and since more older people have high sugars, and since we check many more lab tests today than we did in 1958, we are going to identify more diabetics today. Thus, many more than 1.6 million people would have had diabetes in 1958 if the definition of diabetes was the same then as it is today, if we subjected patients to as many blood tests back then as we do today, and if there were more older people back then. In fact, it is dubious as to whether we really have more clinically significant diabetes now than in 1958, or if more adults are actually dying from the disease today as they did back then.

Now that we have “increased” the number of diabetics by lowering the sugar threshold that defines them as having diabetes, and by incessantly checking people’s sugars as quality indicators implore us to do, how do we help these poor, sick people? Is there evidence that using medicines and insulin, checking sugars three times a day, seeing endocrinology specialists regularly, and keeping that sugar tightly controlled will help avoid the ravages of diabetes in adults? The answer is a resounding no. Tight control of sugars in adults has been consistently shown to be dangerous, often more dangerous than allowing sugars to run high. This is especially true in the elderly, where high sugars often lead to better outcomes, including better memory and lower death rates. Medicines used to treat diabetes are themselves dangerous, having multiple side effects, and leading to higher rates of heart attacks and death. And frequent sugar checks in older adults has been shown to be potentially lethal, leading to dramatic and dangerous drops in sugars, increased hospitalizations, and decrease in function. Not to mention all the stress that sugar fixation drops on the elderly! Many of my older patients, some of whom are frail and demented, have had their lives taken over by a counterproductive quest to incessantly check and normalize their sugars, often with deleterious consequences.

Simply saying that we have a diabetic epidemic means nothing. In fact, all we are doing is labeling more and more people with disease and sickness that they do not actually have, exposing more people to the sting of an aggressive medical establishment that often causes more harm than good, filling more people with dangerous medicines, enriching many people and companies who profit from those who are ill, and doing nothing to help people to live longer and better. Calling someone a diabetic when the treatment will not help them, and could actually harm them, is irresponsible. Let’s stop labeling people with fabricated diseases. Let’s stop frightening the population with articles such as that that printed in the Washington Post. Let us be reasonable, help people to improve their lives through diet and exercise, treat illness when it actually impacts their health, and stop being so obsessed with numerical abnormalities that enrich the profiteers at the expense of the people.