“Jaw dropping,” are just some words Janiel Werner, clinical dietitian at Palo Pinto General Hospital, used to describe findings and projections from a report published last week by the Texas Health Institute.

The report “Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas” gives a look into the future of diabetes among Texans. It signifies an oncoming “diabetes epidemic” in Texas and estimates the disease will quadruple in the state by 2040.

“Diabetes is a modern-day epidemic recently referred to as a 'public health humiliation,'” the THI report begins.

Unless steps are taken to contain the reach of diabetes, it states the growing impact of the disease will constitute “a significant threat to the financial solvency of the Texas public and private health infrastructure.”

What is diabetes?

With diabetes, the body does not produce or properly use insulin, a naturally produced hormone. Insulin is required for the body’s tissues to have access to sugar, starches and other foods for energy.

According to the report, there are three main forms of diabetes:   

• Type 1 diabetes is usually, but not always, diagnosed in children and young adults as a result of an autoimmune disorder.

• Type 2 diabetes is the most common form of diabetes and accounts for 90-95 percent of the cases diagnosed today. Historically diagnosed in adults, this form of diabetes is now also being diagnosed in children.

• Gestational diabetes occurs when a pregnant woman, who may never have had diabetes before, experiences elevated blood sugar levels during pregnancy. When left untreated, the woman and child run substantial risk of a complicated birth process, ranging from premature birth to the birth of a child with excessive weight. Development of the condition also greatly increases the mother’s risk of developing diabetes again later in life.

“In this area, Type 2 diabetes is the most common,” Werner explained. “Unfortunately we don’t have a definitive answer as to what causes the disease.

“What we do know is that it is multi-factorial, meaning there are some things we cannot control, like your genetics and what you may have inherited from your family.

“With that being said there are lots of things that put you at risk for diabetes that you can control, for instance, lifestyle and environmental choices,” Werner added. “You can prevent or delay the onset of Type 2 diabetes through a healthy lifestyle – change your diet, increase your level of physical activity, maintain a healthy weight.

“Diabetes often goes undiagnosed because many of its symptoms seem so harmless,” Werner added.

She said symptoms of diabetes include:

• Type 1 – frequent urination, unusual thirst, extreme hunger, unusual weight loss, extreme fatigue and irritability.

• Type 2 – any of above symptoms, plus frequent infections, blurred vision, cuts/bruises that are slow to heal, tingling or numbness in the hands and feet and recurring skin, gum or bladder infections.

Findings

THI states its publication is “a call to action and a suggested blueprint for change for policy makers and other stakeholders concerned about the overall health of Texans and Texas communities.”

“Type 2 diabetes is preventable, but annual incidence rates continue to grow, and the associated costs of treating diabetes and its complications represent a significant threat to the financial solvency of the Texas public and private health infrastructure,” adds the report. “The reach, impact and diabetes-associated costs to the State of Texas, its taxpayers and those suffering from the disease must be addressed.

“Despite numerous efforts to improve the social and lifestyle factors that often lead to diabetes, the age-adjusted incidence rate for diabetes among Texas adults almost quadrupled between 1995-1997 and 2005-2007, according to a study by the Office of the State Demographer,” states the report summary.

“This translates into approximately 156,000 new cases of diabetes each year. The State Demographer projects a quadrupling of the number of adult Texans with diabetes from approximately 2.2 million in 2010 to almost 8 million by 2040,” it adds.

The obesity rate of Texans is growing and many are now obese by the time they reach young adulthood, which puts a larger population at risk for developing diabetes.

The report illustrates that in young adults the obesity rate doubled and the diabetes rate tripled in less than one decade.

Another report finding focused on diabetes disparities among racial and ethnic minorities. More than two-thirds of the 1.6 million new cases of diabetes in America this year will occur in Hispanics, African-Americans and Native Americans.

THI proposes a series of solutions for Texas government to take in the near term.

“We recognize that in the current budget environment resources are tight and thus recommend several strategies to address the diabetes epidemic that we think can be implemented with no or minimal cost,” said Klaus K. Madsen, THI's Vice President of Programs.

“This report outlines steps Texas can take immediately to better understand and control the epidemic of diabetes,” said Dr. Victor Gonzalez, director of Valley Retina Institute in Brownsville, Chair of the Texas Diabetes Council and a participant during a series of roundtable meetings addressing the THI report.

“If we do not stem or stop the current growth rate of diabetes, I am not sure that the healthcare system will be able to absorb or afford the projected eight million adult Texans with diabetes in 2040,” he added. “The longer you live undiagnosed with diabetes or with pre-diabetes, the greater risk you have for complications resulting in very high medical costs for yourself and your employer.”

“Ultimately, this is going to affect the economy of our state. It is imperative that we screen, diagnose, treat and manage diabetes as early as possible,” said Dr. Gonzalez.

Diabetes locally

Werner said she hopes the THI report is “the tipping point Texas and Palo Pinto County need to use as a catalyst for change.”

One finding in the report summary states that diabetes rates are highest in the state's border and rural counties.

In 2010, the report estimates 11.9 percent of Texans will have diabetes. In Palo Pinto County an estimated 12.3 percent of the 2010 population will have the disease and in Parker County the estimate is 10.9 percent.

The rate of diabetes is expected to grow to to 23.2 percent in 2040 for Palo Pinto County and 23.9 percent in 2040 for Parker County, which surpasses the 2040 state forecast of 23.8 percent.

“The numbers are disturbing to say the least. Here in Palo Pinto County the report indicates that the percentage of people with diabetes is higher than the entire state average. The fact that one in four adults will be diagnosed with diabetes by 2040 is jaw dropping,” she said.

The THI publication projects Palo Pinto County will have 2,692 individuals with diabetes in 2010, 4,072 in 2020, 4,868 in 2030 and 5,530 in 2040, for a change rate of 106 percent. The rate in Parker County increases from 10,247 individuals with diabetes in 2010 to 53,199 in 2040, for a 419 percent change rate.

While education and research help define the issue, Werner said curbing the trend requires individuals to act.

“Texans must take personal responsibility for their health as a people or our health care system will not be able to bear the weight of the consequences,” she said. “Awareness is an ongoing priority, but it’s time to take action in the prevention and early intervention of diabetes. Diabetes self-management education is essential to advancing the care and prevention of long-term complications. Information is power. Diabetes can and should be prevented,” Werner added. “Seek out help if you have diabetes and get screened or tested if you are at risk.

“As your dietitian here at Palo Pinto General Hospital, I and the rest of our health care team are here to help. We offer free diabetes classes on the last Tuesday of every month at 6 p.m. starting in January,” she added. “Our diabetes self-management education program is available as an out-patient service as well.”

The Texas Health Institute press release and report “Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas,” contributed to this article. Staff writer

Libby Cluett can be reached at (940) 325-4465, ext. 3422, or lcluett@mineralwellsindex.com.

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