Diabetes: Part 2
— Gabriele Amersbach*
1. What causes diabetes?
About 95% of people with diabetes have type 2 diabetes. Only about 5% of people with diabetes get type 1 diabetes, which usually appears in childhood or early adulthood. Often type 1 diabetes has a genetic component, although a virus may trigger the disease.
People with type 2 disease often develop the disease as they reach middle age (over the age of 45), although with increasing obesity rates, even younger people are being diagnosed with the disease. While there may be a family history with type 2 diabetes as well, many people become diabetic as a result of overweight or obesity, lack of exercise, and health problems like high blood pressure.
In both types of diabetes, your blood sugar or blood glucose is too high. Blood sugar comes from the food you eat. In order for this energy to fuel your cells, you need a hormone made in the pancreas, called insulin, while a second hormone, glucagon, works with the insulin to control the level of blood glucose.
Type 1 diabetes: immune system attacks
If you have type 1 diabetes, your immune system which normally fights infection, instead attacks and destroys the cells in the pancreas that make insulin. As a result, the pancreas stops making insulin.
Without the necessary insulin for glucose to fuel the cell, the blood glucose rises to deadly levels very quickly, within a few days or weeks. To survive, you must replace this insulin with daily injections of insulin. It is also important to exercise and follow a careful diet to avoid hypoglycemia—when glucose levels drop below normal.
Type 2 diabetes: not enough insulin and insulin resistance
In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well (called insulin resistance). This type of diabetes can take a long time, even years, to develop. The symptoms may be mild and may even be ignored until a person develops diabetes-related health problems like blurry vision or heart disease.
Common treatments are medications and lifestyle changes that include healthier diets, weight loss, and exercise. Some individuals with type 2 diabetes also require insulin injections.
More than 100 million U.S. adults are now living with diabetes or prediabetes
- 30.3 million Americans – 9.4 percent of the U.S. population have diabetes.
- Over 85 million have prediabetes, a condition that if not treated often leads to type 2 diabetes within five years.
- The percentage of adults with diabetes increases with age, reaching a high of 25.2% in adults age 65 and older.
- In 2015, diabetes was the 7th leading cause of death in the U.S.
2. What are the “twin” epidemics?
As obesity and overweight rates have skyrocketed in the US and other Western countries, diabetes rates have also risen. The American Society for Metabolic and Bariatric Surgery (ASMBS) refers to diabetes and obesity as the “twin epidemics.”
Some basic facts about diabetes and obesity (according to a 2013 ASMBS fact sheet):
- More than one-third (35.7%) of adults are obese; this rate has tripled between 1960 and 2010.
- Obesity is a major independent risk factor for developing diabetes, and more than 90% of type 2 diabetics are overweight or obese..
- Modest weight loss, as little as 5% of total body weight, can help to improve type 2 diabetes in patients who are overweight or obese.
3. Who is at risk for diabetes?
If you are obese or overweight and you do not exercise regularly, you are at higher risk for developing type 2 diabetes. Simply carrying fat stores on the body causes a low-grade inflammation. The more fat a person stores on the body, the greater the degree of chronic inflammation. This inflammation takes a toll on the body, resulting in various metabolic diseases like diabetes.
Extra fat around the belly is especially significant since it is linked to insulin resistance, heart disease, and type 2 diabetes. Check out this Prebiotin blog about obesity-induced inflammation.
To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts from the National Institute of Diabetes and Digestive and Kidney Disease.
4. Which groups of people are most at risk for diabetes?
A major disparity in risk for diabetes exists among racial groups, with non-Hispanic whites and individuals of Chinese heritage having lower prevalence rates for diabetes than other groups.
The following prevalence rates are from the CDC National Diabetes Statistics Report, 2017 – CDC.
- American Indians/Alaska Natives have the highest prevalence – 15.1%
- Non-Hispanic blacks – 12.7%*
- Mexicans – 13.8%
- Puerto Ricans – 12.0%
- Cubans – 9.0%
- Central/South Americans – 8.5%
- Non-Hispanic whites – 7.4%
- Asian Indians – 11.2%
- Filipinos – 8.9%
- Chinese – 4.3%
- Other Asian groups – 8.5%
* Not only are African Americans at greater risk for getting diabetes; they are also more likely to suffer serious complications from the disease, from end-stage renal disease (ESRD) to amputations. African Americans are also twice as likely to die from diabetes.
Prevalence also varies by education level, an indicator of socioeconomic status. Specifically, the breakdown of individuals with diagnosed diabetes:
- 12.6% of adults with less than a high school education
- 9.5% of those with a high school education
- 7.2% of those with more than a high school education
In a recent study to investigate potential causes for this health disparity, researchers analyzed biological, neighborhood, psychosocial, socioeconomic, and behavioral risk factors in 4,200 participants of the CARDIA (Coronary Artery Risk Development in Young Adults) study. Partially supported by NIH’s National Heart, Lung, and Blood Institute (NHLBI), participants, age 18-30, were recruited throughout the U.S. Obesity seemed to be driving the differences in diabetes risk and severity.
5. Are kids at risk for diabetes?
It used to be called “adult onset diabetes.” However, since the 1980s, childhood obesity rates have tripled. According to the CDC, 18.5% children (or 13.7 million) are now obese, and one-third of all children are overweight. As a result, adolescents and children as young as 10 are increasingly being diagnosed with type 2 diabetes.
Hispanics and non-Hispanic blacks, with obesity prevalence rates of 25.8% and 22% respectively, are at even at higher risk.
“Because of the early age of onset and longer diabetes duration, youth are at risk for developing diabetes-related complications at a younger age. This profoundly lessens their quality of life, shortens their life expectancy, and increases health care costs.” – Giuseppina Imperatore, M.D., Ph.D., Epidemiologist, CDC Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion in CDC Report: Diabetes on the Rise Among Children, Teens
Early Onset Diabetes: The Alarming Consequences
A CDC epidemiologist summarizes the alarming consequences of early onset diabetes in a 2017 CDC report: “Because of the early age of onset and longer diabetes duration, youth are at risk for developing diabetes related complications at a younger age. This profoundly lessens their quality of life, shortens their life expectancy, and increases health care costs.”
The CDC notes that more than 75% of children with type 2 diabetes have a close relative who has it, too. Often this is because families share lifestyle habits like food choices and lack of physical activity that put them at risk. As the following infographic shows, parents can help prevent or delay type 2 diabetes with a few basic lifestyle changes. Research has shown that adding Prebiotin to a child’s diet can also reduce weight gain and disease risk.
6. What is the impact of diabetes on society?
In addition to intangible costs from pain and suffering, diabetes imposes a substantial financial burden on society. In a 2018 article in Diabetes Care, “Economic Costs of Diabetes in the U.S. in 2017,” the authors concluded that the total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity.
“After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes.” – from “Economic Costs of Diabetes in the U.S. in 2017” in Diabetes Care.
The article notes that care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.
Some related statistics regarding people with diagnosed diabetes:
- Medical expenditures about 2.3 times higher than what expenditures would be in the absence of diabetes
- Indirect costs including increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population
- Reduced productivity for those not in the labor force ($2.3 billion)
- Inability to work because of disease-related disability ($37.5 billion)
- Lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion)
The authors point out that the primary growth of diabetes-related medical costs is among the population aged 65 and older, contributing to a growing economic cost to the Medicare program. The article concludes, “After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes.”
7. What can I do to prevent diabetes?
Diabetes is closely related to obesity. Fat stores and inflammation go hand-in-hand. Simply carrying fat stores on the body causes a low-grade inflammation. The more fat a person stores on the body, the greater the degree of chronic inflammation. This inflammation takes a toll on the body, resulting in various metabolic diseases like diabetes and inflammatory diseases. Of course, fat loss can reduce obesity-induced inflammation, but weight loss is difficult for many people.
About 90% of individuals with diabetes are also obese. The best approach to weight loss is to make small lifestyle changes that can have an amazing impact on reducing calories that lead to obesity, from drinking less soda, to reducing portion size and integrating more servings of vegetables and fruits into the diet. Exercise is of course a necessary component to maintain a healthy weight.
For details on how to stay leaner and reduce the risk of disease, go to Prebiotin’s blog on the gut microbiota and obesity-induced inflammation.
8. How can Prebiotin help prevent diabetes?
The collection of gut bacteria and how they function together is known as the intestinal microbiome. With the correct balance of bacteria, you feel healthier and have a reduced risk for disease.
When undesirable bacteria are predominant, you have an abnormal makeup of colonic bacteria called dysbiosis. It is now well known that patients with type 2 diabetes have dysbiosis of the colon which promotes and accelerates their diabetes.
Research has demonstrated that as a result of dysbiosis, you may experience:
- Increased intestinal permeability of the colon wall (leaky gut)
- Inflammation within colon wall and throughout the body
- Toxins entering the blood stream (because of damaged or inflamed intestinal wall) causing illness
- Weight gain from the increased calories produced within the colon by the different bacteria that make up the dysbiotic complex
- Increased insulin resistance leading to diabetes.
The next round of research was focused on therapeutic approaches to modulating the microbiota of diabetic patients to determine if the symptoms and course of diabetes improves. Researchers found that prebiotics, including oligofructose-enriched inulin (Prebiotin), improved the balance of bacteria in the microbiome, with more of the beneficial Bifidobacteria and Lactobacilli bacteria.
Why we need an abundant supply of short-chain fatty acids (SCFA).
Researchers who study obesity have also demonstrated that beneficial intestinal bacteria ferment prebiotic fibers to produce short-chain fatty acids (SCFA). Obese individuals have lower levels of SCFAs than leaner individuals, with increased disease risk.
Through diet improvements and prebiotic fiber supplementation (like Prebiotin), SCFA-producing bacteria will flourish and produce even greater amounts of SCFA. As a result, inflammation in the gastrointestinal tract is reduced—as is the risk for diabetes.
Considering the many desirable benefits of prebiotics for obesity and the microbiome—and their excellent safety profile—anyone with metabolic syndrome or obesity-induced inflammation should seriously consider adding Prebiotin to their daily diet after consulting with their healthcare professional.
* Gabriele Amersbach is a science writer with over 25 years of experience writing on health and science topics. As writer/editor for Prebiotin, she supports website and marketing efforts for Prebiotin.
American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018 May;41(5):917-928. doi: 10.2337/dci18-0007. Epub 2018 Mar 22.
Chow EA, Foster H, Gonzalez V & McIver L. The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations. Clinical Diabetes. 2012 Jul; 30(3): 130-133. https://doi.org/10.2337/diaclin.30.3.130
den Besten G, van Eunen K, Groen AK, et al. The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism. Journal of Lipid Research. 2013;54(9):2325-2340. doi:10.1194/jlr.R036012.
McArdle MA, Finucane OM, Connaughton RM, McMorrow AM, & Roche HM. Mechanisms of obesity-induced inflammation and insulin resistance: insights into the emerging role of
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Teng K-T, Chang C-Y, Chang LF, Nesaretnam K. Modulation of obesity-induced inflammation by dietary fats: mechanisms and clinical evidence. Nutrition Journal. 2014;13:12-12. doi:10.1186/1475-2891-13-12.
Zhao L, Zhang F, Ding X, et al. Gut bacteria selectively promoted by dietary fibers alleviate type 2 diabetes. Science. 09 Mar 2018;359(6389): 1151-1156. DOI: 10.1126/science.aao5774.
ASMBS – Type 2 Diabetes and Obesity: Twin Epidemics
CDC: Childhood Obesity Facts
CDC National Diabetes Statistics Report, 201
CDC Report: Diabetes on the Rise Among Children, Teens
National Diabetes Statistics Report, 2017 – Estimates of Diabetes and Its Burden in the United States
NIH NIDDK, Risk Factors for Type 2 Diabetes: Body Mass Index Charts
NIH Research Matters: Factors contributing to higher incidence of diabetes for black Americans, Jan 9. 2018