November 21, 2003

Minority children at risk, diabetes experts warn

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Left to right: Drs. William H. Dietz, of the CDC, Daryl K. Granner, director of the Vanderbilt Diabetes Center; Kwame Osei of Ohio State University Medical Center; and Ralph DeFronzo, of the University of Texas Health Science Center at San Antonio. Dietz, Osei and DeFronzo spoke at a national meeting in Nashville last week, which was sponsored by the Meharry-Vanderbilt Alliance. Mary Donaldson

Minority children at risk, diabetes experts warn

Unless the epidemic of diabetes in children is stopped, many of them may require kidney dialysis by the time they reach their 20s and 30s, experts warned this week during a national diabetes conference in Nashville. Overcoming Diabetes Health Disparities, attended by several nationally-known diabetes experts, was sponsored by the Meharry-Vanderbilt Alliance.

“We’re not ready for a disease like this, where the biological clock on complications starts in the youngest known case of type 2 diabetes that I’m aware of — at 4 years old,” said Dr. James R. Gavin III, chairman of the National Diabetes Education Program.

At greatest risk: Hispanic- Americans, African-Americans and Native Americans who are putting on weight and developing type 2 diabetes faster than their Caucasian counterparts. Yet little is being done to identify and treat people with early signs of the disease before it damages their kidneys, eyes, hearts and nervous systems.

“If you treat (pre-diabetes) and try to prescribe medication, you don’t get reimbursed,” said Dr. Ralph DeFronzo, chief of the division of diabetes at the University of Texas Health Science Center at San Antonio. “No HMO is going to pay for it.”

Minority groups are disproportionately affected by diabetes and complications of the disease. The purpose of the conference, which was co-sponsored by the National Institutes of Health, was to share information and help finds ways to reduce these disparities. The conference concluded Saturday at the Loews Vanderbilt Hotel.

Fortunately, the situation is changing, said Alan D. Cherrington, Ph.D., chair of the Department of Molecular Physiology and Biophysics at Vanderbilt and president-elect of the American Diabetes Association.

New diagnostic criteria for the high levels of circulating blood sugar that can predict the development of diabetes are being implemented, and that should help doctors obtain reimbursement for treating the condition, Cherrington said.

An estimated 17 million Americans have diabetes. The challenge will be finding additional money in an already strapped health care system to pay for treating an additional 43 million people who are at high risk for developing the disease, he added.

Medical treatment is only part of the solution, said Gavin, president of Morehouse School of Medicine in Atlanta.

The primary risk factor for the development of type 2 diabetes is obesity. One recent national study, the Diabetes Prevention Program, showed that moderate exercise and weight loss reduced by 58 percent the incidence of type 2 diabetes in people at high risk for developing the disease.

Companies like Kraft Foods and Coca-Cola are re-examining the make-up and the portion sizes of the foods they sell. “They hear the hoof beats,” Gavin said during his keynote address on Thursday. “Either there’s going to be draconian legislation driven by economic necessity, or we’re going to have to make some consumer choices.

“We’re not going to rebuild airplanes to make seats that can accommodate these spreading butts,” he continued. “Desks in schools were not designed for jumbo-sized children … I think we will succeed because we must. We’ve got to make better decisions about how we’re going to live, because we can’t keep living like this.”

Speakers advocated a return of regular physical education programs and less junk food in school, better planning of neighborhoods to encourage people to walk more, and greater involvement of patients in the management of their own health care.

“It’s very nice to talk about socioeconomic [factors]. It’s very nice to talk about access [to health care],” said Dr. Kwame Osei, director of the Department of Endocrinology, Diabetes and Metabolism at Ohio State University Medical Center in Columbus. “But I want to know that the drug is going to work for you. n