Diabetes Mellitus Cases on the Rise

November is Diabetes Awareness month and the Centers for Disease Control and Prevention has published its most recent findings on the prevalence of Diabetes Mellitus in the United States.  Currently it is estimate that 25.8 million people (children and adults) suffer from diabetes here in the United States.  The number of diagnosed cases of diabetes has increased in all fifty states from 1995 – 2010.  More specifically, there was a 50% or more increase in diabetes cases in 42 of 50 states during that 15-year span with 18 states experiencing a 100% or more increase.  Type 2 Diabetes has accounted for 90% – 95% of the increase in diabetes cases in the United States.  A further breakdown of the results can be found HERE.  If you would like specific data for your state and/or county check out the CDC Diabetes Interactive Atlases. 

There are three types of diabetes mellitus:  type 1, type 2 and gestational.  For the purpose of this post I will focus on comparing type 1 and type 2 diabetes mellitus.  The following table highlights key information as available from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Diabetes Information Clearinghouse.

	Type 1	Type 2
Definition	The body makes little to no insulin because the body destroys its own beta insulin cells in the pancreas	The body cannot utilize the insulin it produces because the insulin has become dysfunctional and does not remove sugar (glucose) from the blood
Diagnosis/Factors	Autoimmune condition; genetic and environmental factors could also play a role	Genetic, obesity, physical inactivity, metabolic syndrome
Onset	Rapid (within weeks)	Slow (years)
Warning signs	Increased thirst and urination, weight loss, extreme tiredness, constant hunger	Feeling tired or ill, frequent urination (especially at night), unusual thirst, frequent infections, slow wound healing, weight loss
Affected groups	Can affect any age, but most cases diagnosed between 5 – 25 years	Traditionally common in overweight, inactive adults, but as childhood obesity increases so have the cases of type 2 diabetes in young people
Dependency	Insulin dependent	Not insulin dependent
Cure	None	Physical exercise, healthy diet and weight loss
Treatment	Insulin injections, diet modifications, regular physical activity; key is controlling glucose levels	Diet, exercise, weight loss, medication (some cased do require insulin injections)

TYPE 2 DIABETES AND YOUTH OBESITY

Currently 1 in 400 children and adolescent have been diagnosed with diabetes (type 1 and type 2).  Historically, it was more common for youth and young adults to be diagnosed with type 1 diabetes and unlikely that they would be diagnosed with type 2, leading to type 1 diabetes initially being referred to as juvenile diabetes.  As the number of diabetes cases grows, cases of type 2 diabetes in young people are increasing.  Type 1 diabetes is still more prevalent, but the rate of type 2 diabetes is increasing.  It appears that as rates of pediatric obesity increases, cases of type 2 diabetes increase.  According to the 2011 Diabetes Fact Sheet:

• During 2002 – 2005 15,000 youth were diagnosed with type 1 annually and 3,600 youth were diagnosed with type 2 diabetes annually.
• Among youth aged <10 years, the rate of new cases was 19.7 per 100,000 each year for type 1 and 0.4 per 100,000 for type 2 diabetes.  Among youth aged 10 years or older, the rate of new cases was 18.6 per 100,000 each year for type 1 and 8.5 per 100,000 for type 2 diabetes.
• Type 2 diabetes was extremely rare among youth aged < 10 years; while still infrequent, rates were greater among youth aged 10 – 19 years than in younger children.
• For youth aged 10 – 19 race influences the frequency of type 1 and type 2 diabetes; for non-Hispanic white youth the rate of new cases was higher for type 1 than for type 2 diabetes; for non-Hispanic black and Hispanic youth had similar rates for both type 1 and type 2 diabetes; for Asian/Pacific Islander and American Indian youth the rates were higher for type 2 than type 1 diabetes.

DIABETES MELLITUS AND EXERCISE

It is important to understand the role of exercise in the treatment of both type 1 and type 2 diabetes.  Exercise can be a key factor in maintaining a healthy lifestyle for anyone who has diabetes, but understanding how exercise affects glucose and insulin levels is important to maximizing the positive role of exercise in overall health and proper management of diabetes.

For athletes and others who are living with type 1 diabetes it is important to work with their health care provider and/or diabetes educator to develop a treatment plan specific to exercise.  Understanding how exercise specifically affects insulin and glucose levels will help participants understand what sort of nutrition is required before, during and after exercise.  It also helps participants understand what adjustments to insulin dosages are required before, during and after exercise.  Each person responds differently to exercise so the nutrition/insulin-exercise plan must be individualized.  Recent research shows that resistance and aerobic exercise improves glucose control in those with type 1 diabetes.  This means exercise can be an important key in managing type 1 diabetes consistently.  Resources that can help give some basic information on exercising with type 1 diabetes include the following:

National Athletic Trainers’ Association Position Statement:  Management of the Athlete with Type 1 Diabetes Mellitus

Care of Children and Adolescents with Type 1 Diabetes (American Diabetes Association)

Physical Activity/Exercise and Diabetes (American Diabetes Association)

For those living with type 2 diabetes exercise is very important because it is a key component of the overall treatment plan.  Exercise combined with a well managed diet is the best combination for those who need to control their weight in an effort to manage (and potentially eliminate) type 2 diabetes.  There has been increasing attention paid to management of this condition as its prevalence continues to grow.  For recommendations on safely exercising with type 2 diabetes review the following resources:

Physical Activity/Exercise and Diabetes (American Diabetes Association)

Exercise and Type 2 Diabetes American College of Sports Medicine and American Diabetes Association:  Joint Position Statement

As the obesity epidemic continues to grow, so will the number of diagnosed diabetes cases (particularly type 2).  Exercise plays an important role in decreasing the likelihood (or delaying onset) of type 2 diabetes and improving the glucose response of those living with type 1 diabetes.  It is important to take an educated approach to exercise and management of diabetes.  Living with diabetes doesn't keep you from participating in your favorite sports; your favorite sport could help you improve your overall health.

Submitted by Heather L. Clemons, MS, MBA, ATC