Western Habits Spike Diabetes Rate Experts Say Combat Disease With Lifestyle Changes and ëABCsí by Gina Shaw Last summer, physicians met in Montreux, Switzerland, for the first International Diabetes Federation Media Summit. Their message: Diabetes is rapidly becoming a worldwide pandemic. In the United States, diabetes rates jumped a record 6 percent in 1999. Around the world, theyíve climbed by about 11 percent within the past five years. Currently about 151 million people around the world have diabetes, and if current trends continue, that number is likely to double by 2025, according to the World Health Organization. As certain trappings of the Western lifestyleófast food, television, video games and driving everywhereóbecome more popular around the world, theyíre bringing with them some of the negative health consequences that Americans have been experiencing for some time now. Type 2 diabetes, which typically occurs in middle-aged and older people, makes up 90 percent to 95 percent of the cases of diabetes around the worldóand itís a ìlifestyle disease.î This means that you are far more likely to develop type 2 diabetes if you are overeatingóparticularly a very fatty diet, if you donít get much exercise, and if you smoke. With obesity rates and sedentary lifestyles a growing trend around the world, particularly in Europe, where 5 percent of the populationó22.5 million peopleóhas diabetes, experts predict that the disease will continue to gain footholds in areas where it has previously not been a problem. In large African cities, diabetes rates have also been climbing: Dar Es Salaam, Tanzania, has seen its diabetes rate climb from 1 percent to 6 percent over the last 10 years. And the World Health Organization reports that in developing countries people seem to be acquiring type 2 diabetes earlier, between the ages of 45 and 64, during some of the most productive years of their lives. Speaking at the media summit, professor Sir George Alberti, president of the IDF, warned that people risk severe health consequences when they donít take diabetes seriously. ìPeople refer to it as mild diabetes, or having ëa little bit of diabetes,í but in fact the mortality and morbidity from type 2 is enormous.î People with type 2 diabetes have a much greater risk of heart disease, stroke, peripheral vascular disease and amputations, for starters. Particularly dangerousóand deadlyóis the link with cardiovascular disease: It is the leading cause of death in people with diabetes, and statistics show that people with diabetes are two to four times more likely to develop cardiovascular disease than people without diabetes. Nearly 80 percent of people with diabetes are likely to die of cardiovascular complications. Reducing a personís risk of developing type 2 diabetesóand preventing it from spiraling out of control once it has developedódepends, not surprisingly, on lifestyle. If a day full of Big Macs with cheese fries, deskbound work and the Thursday night line-up in front of the television can lead to the onset of type 2, it makes sense that adding healthy habits can turn that trend around. Simple thingsósuch as taking the stairs instead of the elevator, walking five blocks to the drugstore instead of driving, and making sure that daily meals have a lot of ìcolor,î that is, the oranges, reds, yellows and leafy greens of fruits and vegetablesócan add up to armor against diabetes. For people whoíve already developed type 2 diabetes, educators work with them to develop specific, manageable plans for changing those habits and developing a healthy lifestyle. ìWe help people write a plan with their individual goals,î said Donna Knisely, certified nurse specialist and certified diabetes educator and diabetes program coordinator at the Virginia Hospital Center-Arlington. ìFor example, one goal might be to eat the recommended three to five fruits and vegetables every day. To make it achievable and measurable, theyíll plan to buy cut-up vegetables at the store and shop twice a week to get fresh produce. ìAnother goal might be regular exercise, and the specific plan might be to put the gym bag and exercise shoes in the car, so they can get to the gym three times a week.î The point, said Knisely, is to be very concrete with goalsóa plan that can be helpful for people who havenít yet developed diabetes, but whose habits put them at risk for doing so. Itís also critical that physicians understand the basics of diabetes. In the United States, a recent national survey found that more than 90 percent of the countryís primary care physicians could not correctly name the top-three tests that a person with diabetes should have on a regular basis. Because more than 90 percent of Americans with diabetes receive their care from a primary care physician, not a diabetes specialist, this lack of knowledge is particularly alarming. The survey, commissioned by the Washington Hospital Center in Washington, D.C., found that although nearly all of the physicians named hemoglobin A1c (which measures blood glucose) as one of the three key tests for diabetic patients, only 24 percent mentioned cholesterol and just 5 percent mentioned blood pressure. These three tests, according to the National Diabetes Education Program, are the ìABCsî of diabetes management, helping to keep the disease under control and reducing the risk of deadly complications. As part of a new U.S. public education program, Be Smart About Your Heart: Control the ABCs of Diabetes, sponsored by the National Diabetes Education Project and the American Diabetes Association, people with diabetes can get a new free educational brochure and wallet card that helps track their ABCs by calling (800) 438-5383. Research shows that with relatively small decreases in blood glucose, blood pressure and cholesterol, people with diabetes can live much longer and healthier lives. Gina Shaw is the medical writer for The Washington Diplomat.