[sirI]

NEW YORK (Reuters Health) Jun 20 - The incidence of type 2 diabetes has doubled over the past three decades, according to a report in the June 27th online issue of Circulation.

"This corresponds to an absolute increase in the incidence of diabetes of about 2.5% during the '90s compared to the '70s," lead author Dr. Caroline S. Fox, from the National Lung, Heart, and Blood Institute, Framingham, Massachusetts, said in a statement. "Most, but not all, of the increase in diabetes occurred in people who were obese -- those with a BMI of 30 or more."

http://www.medscape.com/viewarticle/...9060&src=nldne

[fergus51]

I'm actually surprised that it's only a 2.5% absolute increase. I would have thought it was higher.

[mercyteapot]

What should really be alarming people is the increase of Type II in children. It makes me want to cry.

[masstudent]

I have been spending most of my time on the prenursing student borad but I saw your post on the last 24 hours board and wanted to respond. I came across an interesting book at my local library that talks about obesity and diabetes. My knowledge about diabetes is limited but I thought it was an enlightening book and is great for a lay person. The title and author is Diabesity : The Obesity-Diabetes Epidemic That Threatens America--And What We Must Do to Stop It by Francine R., Md Kaufman

For the diabete educators here is a question of mine, how can one person who is extremely overweight not have diabetes or be prediabetic but another be ten pounds over weight and be prediabetic? Does exercise have anything to do with it? Also how do you convince a prediabetic that it is not just sugar they have to worry about eating. That alcohol and other carbohydrates are just as necessary to watch?

[VickyRN]

Originally Posted by vtprenursingstudent

I have been spending most of my time on the prenursing student borad but I saw your post on the last 24 hours board and wanted to respond. I came across an interesting book at my local library that talks about obesity and diabetes. My knowledge about diabetes is limited but I thought it was an enlightening book and is great for a lay person. The title and author is Diabesity : The Obesity-Diabetes Epidemic That Threatens America--And What We Must Do to Stop It by Francine R., Md Kaufman

For the diabete educators here is a question of mine, how can one person who is extremely overweight not have diabetes or be prediabetic but another be ten pounds over weight and be prediabetic? Does exercise have anything to do with it? Also how do you convince a prediabetic that it is not just sugar they have to worry about eating. That alcohol and other carbohydrates are just as necessary to watch?

Excellent questions. I am not a diabetes educator, but it is my understanding that the alarming rise in the incidence of type 2 DM and its relationship to the obesity epidemic has to do with insulin resistance and the metabolic syndrome ("big gut, small butt syndrome," which is the precursor to type 2 DM and cardiovascular disease), and the actions of a newly discovered hormone named leptin. Insulin and leptin are the major hormones governing metabolism. Physical activity decreases insulin resistance and can aid in both preventing type 2 diabetes mellitus and managing the disease. Why some overweight people develop type 2 DM (and the tragic cardiovascular sequelae) and others do not is related to the complex interplay between their genetic predisposition and certain environmental factors (some known, such as exercise, and others yet to be discovered). And you are correct in saying it's not just eating too much simple carbohydrates, but the person's entire lifestyle and family history which come into question. Here are some excellent links:

http://www.physsportsmed.com/issues/...104/birrer.htm

http://jcem.endojournals.org/cgi/content/full/88/9/4232

http://www.mercola.com/2004/dec/1/leptin1.htm

http://www.mercola.com/2001/jul/14/insulin.htm

http://www.mercola.com/blog/2005/mar...ity_are_linked

Researchers at the University of Michigan and Harvard University found new evidence in mice that may explain the link between obesity and type 2 diabetes and help them understand why some obese people never develop diabetes while many others do. Leptin is the key, because it regulates blood sugar through two different brain-body pathways: One controlling appetite and fat storage and another that tells the liver what to do with its glucose reserves.
The study found it may take disruptions to both pathways to bring on full-blown diabetes and overwhelm the body's ability to control blood glucose levels via the action of insulin.

http://www.mercola.com/2005/apr/2/leptin_diabetes.htm
http://www.sciencedirect.com/science...b280d8b7e0fb38

[indigo girl]

There is much written about this epidemic of industrialized countries. Immigrants to these countries, who have switched to our type of food instead of their native diets, are developing metabolic syndrome, and going on to become diabetics. Clearly, it is what we are eating. Many docs are pointing the finger at the food industries increasing use of high fructose corn syrup (HFCS) which is cheaper to use than sugar.

The incidence of childhood diabetes is on the increase and is very alarming.
This is a complex problem, and I am sure that HFCS, is not the only cause. However, we are the fast food nation, and our kids love fast foods. My mom loved convenience food. It was a sign of affluence, and being modern. Our affluence is killing us.

The traditional food pyramid model is also at fault. Teaching people about complex carbs, and glycemic load (rather than glycemic index) would be more helpful. I've noticed many, many cookbooks, and how-to books coming out now about this, but I suspect that I'm on all the health-conscious mailing lists. Unfortunately, most people do not have access to that kind of information. They simply are not aware that they are in any kind of danger from what they are eating. And that is a national tragedy in the making.

[VickyRN]

Another factor is the distribution of body fat in overweight people:

"Apple"-type fat distribution (abdominal/ visceral fat) is considered much more dangerous than "pear"-type distribution.

http://www.metabolic-syndrome-instit...ex_html#lien_b

http://www.metabolic-syndrome-instit...sociated_risks

One breakthrough in the field of overweight management is the discovery and recognition of the Metabolic Syndrome, which is diagnosed conditional to a person exhibiting three of the five following risk factors:

• A waist circumference of greater than thirty-five inches for a woman or forty inches for a man
• High serum triglycerides of 150 or above
• A low HDL or "good" cholesterol of below 50 in women or below 40 in men
• Blood pressure of 130/85 or higher
• A fasting blood sugar level of 110 or higher.

People with Metabolic Syndrome have what is called abdominal adiposity or the "apple" distribution of body fat. When excess fat is stored in the abdomen it causes changes in the rest of the body. Most notably, the muscle cells of the body develop insulin resistance. This means that the body still produces insulin but the cells of the body are insensitive to it and act like it is absent.

http://www.seekwellness.com/weight/overview.htm