'A staggering problem'

Incidence of diabetes is worsening, and the elderly and minorities are at particular risk

December 15, 2008|By Donna M. Owens | Donna M. Owens,Special to The Baltimore Sun

Ray Gilbert once spent his days behind the lens of a camera, using his keen eye to capture images and turn them into photographs.

But a diagnosis of diabetes in 1985 would irrevocably alter life for Gilbert, a former photographer with the Afro American newspaper in Baltimore. In 1996, after more than a decade of not "doing all I was supposed to be doing," to control his diabetes, that lack of attention caught up with the West Baltimore resident.

"I was driving one night along Route 301, when all of a sudden my eyes started bleeding," recalls Gilbert, 56. "I couldn't see. By the grace of God, I was able to pull over to the side of the road safely. It was frightening."

Gilbert was treated at the Wilmer Eye Institute at Johns Hopkins Hospital. There, doctors told him that he had diabetic retinopathy, a diabetes-related eye disease, which damages the delicate blood vessels inside the eye, causing them to leak, bleed and become blocked.

Despite performing surgery to repair his retinas, doctors could not completely save his sight. Today, Gilbert is legally blind.

"I can't read or drive, although I can do many other things," he says. "I would tell anybody that you definitely must keep your diabetes under control. You've got to stay on top of it."

Diabetes is a chronic condition in which the body doesn't properly produce or use insulin - the hormone needed to transport glucose (or sugar) from the blood into cells the body uses for energy. That defect in insulin production causes sugar to build up in the body.

The disease has dramatically worsened for Americans, according to the Centers for Disease Control and Prevention in Atlanta. Earlier this year, the CDC released data which showed that about 24 million Americans - or about 8 percent of the population - have the disease, an increase of more than 3 million in just two years.

Moreover, another 57 million people are estimated to have blood sugar abnormalities called pre-diabetes, which puts them at increased risk for developing the condition, experts say.

"Diabetes is a staggering problem," says Dr. Mansur Shomali, program director of the Endocrinology, Diabetes, & Metabolism Training Program at Union Memorial Hospital. "While millions of Americans have diabetes, here in Maryland we also have significant numbers."

According to 2006 statistics posted on the Maryland Department of Health & Mental Hygiene's Web site, more than 334,000, or nearly 8 percent, of adults statewide had diabetes. Another 143,000 more adults were estimated to have diabetes, but didn't yet know it.

Nationwide, among adults, the CDC figures note that diabetes increased in both men and women, and in all age groups, but the disease disproportionately affects the elderly: Almost one-quarter of the population aged 60 or older had diabetes in 2007, acording to recently released figures.

The rate of diagnosed diabetes is highest among Native Americans and Alaska natives (16.5 percent), followed by blacks (11.8 percent) and Latinos (10.4 percent). By comparison, the rate for Asian Americans was 7.5 percent, with whites at 6.6 percent.

"Genetics and environmental factors play a role," says Shomali, citing some of the risk factors for the disease. "But so do things like physical inactivity, being overweight and diet."

While experts stress that diabetes is a manageable condition, it nonetheless is the seventh-leading cause of death in the country. Baltimore ranks 11th among 54 major cities nationwide for diabetes mortality, according to the city Health Department.

Sometimes benignly referred to as "sugar," diabetes can cause serious health problems, from heart disease to kidney failure, amputations and the blindness Gilbert experienced.

A new study from the CDC projects that the number of adults 40 and older with diabetic retinopathy, the leading cause of blindness among working-age adults, will reach 16 million in 2050, up from 5.5 million in 2005. Diabetics are also more prone to developing cataracts and glaucoma, the study notes, and older Latinos and blacks are expected to be disproportionately affected.

When the body's cells aren't getting the glucose that they need, certain signs and symptoms may result. They can include frequent urination, excessive thirst, weight loss, weakness and fatigue and tingling or numbness in the hands, legs or feet, called neuropathy. Blurred vision, dry, itchy skin and cuts or bruises that take a long time to heal are also signs that something could be wrong.

"It's important to be tested, especially if your parents or siblings have diabetes," Shomali says. "That's a big red flag."

Types of diabetes

Diabetes is actually a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action or both.

Type-1 diabetes (previously called insulin-dependent diabetes mellitus, or juvenile-onset diabetes) develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make insulin that regulates blood glucose.

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