Diabetes Dramatically on the Rise Among Teenagers - Seattle Post Intelligencer (blog)

Nearly a quarter of American children and adolescents is developing type 2 diabetes or has already the disease, according to a study by the Centers for Disease Control and Prevention (CDC), published in the journal Pediatrics. Diabetes and other metabolic conditions seem to spread more rapidly among the young and are harder to treat than in adults.

The study also found that over 50 percent of overweight and obese teenagers had at least one risk factor for cardiovascular disease such as high cholesterol and high blood pressure. Prediabetes and diabetes rates rose faster than other lifestyle-related diseases among adolescents. “This was unexpected, especially since obesity has been leveling off,” said Dr. Ashleigh May, a researcher at the CDC and lead author of the study report.

The term “prediabetes” refers to higher than normal blood sugar levels and the possibility of developing type 2 diabetes and other risks factors for heart disease, stroke and kidney disease, according to the CDC.

Not too long ago, type 2 diabetes was known as adult onset diabetes because it was virtually unheard of affecting children. But with the growing childhood obesity epidemic in recent years, more youngsters are being diagnosed with the disease every year.

Even normal-weight children are not completely safe. Of those thinner kids, 37 percent have at least one heart risk factor, said Dr. May. “Anyone who’s eating a diet high in sugar and fat will likely have problems, even if it isn’t apparent in their weight,” said Dr. Dorothy Becker, chief of endocrinology and diabetes at Children’s Hospital of Pittsburgh. “If they don’t make a change, then they’ll carry all of these risk factors into adulthood, and that’s like having a ticking time bomb over your head. You don’t necessarily know when it’s going to go off, but it’s likely that it will,” she added.

Dr. Mark Hyman, chairman of the Institute for Functional Medicine and founder of The UltraWellness Center as well as bestselling author of “The Blood Sugar Solution,” agrees. “One in three children born today will have diabetes in their lifetime. We are raising the first generation of Americans to live sicker and die younger than their parents. Life expectancy is actually declining for the first time in human history,” he warned.

Even the distinction between prediabetes and diabetes he considers as meaningless. “Prediabetes is not ‘pre’ anything,” he said. “It is a deadly disease driving our biggest killers – heart attacks, strokes, cancer, dementia and more. So if your doctor has diagnosed you with prediabetes or metabolic syndrome, don’t think that you are only at risk for something “in the future,” such as diabetes or heart attack. The problem is happening right know.”

In response to study reports like these, the American Academy of Pediatrics (AAP) has recommended that children and adolescents undergo regular check-ups of their blood pressure and cholesterol levels.

The good news is that these developments are largely reversible and avoidable in the future through dietary changes and lifestyle improvements. “The big message here is that children and teenagers need more help with following a healthy diet and staying physically active,” said Dr. May.

Obviously parents are the first line of defense when it comes to their children’s health and well-being. But society has a role to play as well – nutrition and health education in all public schools being one of them.

In all likelihood this latest CDC study will be dismissed (like most others) in the public discourse as just another “doomsday” report that can be ignored. In truth, however, an entire generation’s future is at stake. If we continue on the path we are currently on, we are going to become a nation where being sick is normal and good health is the rare exception. It doesn’t have to come to that.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter and on Facebook.

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Diabetes care in 'state of crisis'

Diabetes care in England is in a "state of crisis" with less than half of people with the condition getting the basic minimum care, a new report warns.

According to the State of the Nation 2012 report, published by Diabetes UK, there are some areas where just 6% of people with diabetes are getting the regular checks and services recommended by the National Institute for Health and Clinical Excellence (Nice).

The report details how not getting these checks has helped fuel a rise in rates of diabetes-related complications such as amputation, blindness, kidney failure and stroke.

These complications account for about 80% of NHS spending on diabetes and are one of the main reasons that treating diabetes costs about 10% of the entire NHS budget, Diabetes UK said.

The report also shows that a National Service Framework for diabetes - setting out the healthcare which diabetes patients should get - has been in place for 11 years but has not become a reality.

Diabetes UK is calling on the Government to urgently deliver a plan to implement these standards.

Barbara Young, chief executive of Diabetes UK, said: "We already know that diabetes is costing the NHS a colossal amount of money, but this report shows how in exchange for this investment we are getting second rate healthcare that is putting people with diabetes at increased risk of tragic complications and early death.

"Whether showing the number of children with Type 1 diabetes who are only diagnosed at accident and emergency or highlighting the thousands of preventable diabetes-related amputations performed every year, the report shows that diabetes healthcare has drifted into a state of crisis.

"It is a compelling case for change. Above all, the wide variation in standards of care shows the need for a national plan to be put in place for giving people with diabetes the kind of healthcare that can help prevent complications, as well as a greater focus on preventing Type 2 diabetes."

Care Services Minister Paul Burstow said: "There is still much to be done to help tackle diabetes and root out poor care. That is why we are working on a new long term conditions strategy with diabetes as an exemplar. Our focus is on prevention and education, with more done to get earlier diagnoses and to help people manage their conditions themselves. This report and our new strategy will help local NHS services act so that diabetics get the care they need and deserve."

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Report reveals diabetes 'lottery'

Treatment for diabetic patients is a postcode lottery with a massive variation in quality of care from one region to another, a report has revealed.

In some regions, only 6% of sufferers received the recommended levels of care compared to 69% in the highest-achieving primary care trusts (PCTs), a National Audit Office (NAO) report found. But not a single PCT delivered the nine basic care processes which reduce the risk of diabetes-related complications such as blindness, amputation or kidney disease.

The worst offenders were Mid Essex and Swindon PCTs where less than 9% of patients were given the nine basic tests which are recommended by the Department of Health (DH). The report said that the DH is not holding poorly performing PCTs to account.

The authors say: "The department holds information to assess performance but there is a lack of accountability for PCTs who fail to ensure that the recommended standards of care are met."

It also claims that the NHS does not "clearly understand" the costs of diabetes at a local level and is therefore finding it difficult to deliver diabetes services in the most effective way. Across England only half of people with diabetes received the recommended standards of care in 2009 to 2010.

The report says: "People with diabetes require regular review of clinical indicators of disease progression. Despite the DH setting clear standards for good diabetes care, analysis from general practice records in the 2009-10 National Diabetes Audit found that under half (49%) of people with diabetes received all the care processes recommended for the monitoring of risk factors for tissue damage.

"Without regular monitoring and treatment, this damage can lead to complications such as blindness, amputation and kidney disease."

The review into the management of adult diabetes services in the NHS in England states that up to 24,000 people die each year from avoidable causes relating to diabetes. It said that there is poor performance in expected levels of care, low achievement of treatment standards and high numbers of avoidable deaths.

Care Services Minister Paul Burstow said: "There is no excuse for delivering anything but the best diabetes care. Nice (National Institute for Health and Clinical Excellence) guidance and Quality Standards set out what good care looks like. By exposing poor practice and shining a light on best practice, we are determined to drive up standards for everyone."

Barbara Young, chief executive of Diabetes UK, said it was a "national disgrace" that only half of people with diabetes received the recommended standards of care in 2009/10.

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Diabetes care provision 'crisis'

People with diabetes need to check their blood sugar Campaigners are warning that diabetes care in England is in "crisis" - with less than half of people getting the basic care they need.

Diabetes UK warns there are some areas where only 6% of people are getting the recommended regular checks and services.

Its head said the State of the Nation 2012 report showed people with diabetes were getting "second rate care".

Ministers said the report would encourage local NHS services to act.

Amputation

Diabetes is a condition in which the amount of glucose in the blood is too high because the body cannot use it properly.

Type 1 diabetes develops if the body cannot produce any insulin and usually develops by the age of 40.

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly and in most cases is linked with being overweight.

Between 2006 and 2011 the number of people diagnosed with diabetes in England has increased by 25%, from 1.9m to 2.5m.

Almost all - 90% - have type 2 diabetes.

Continue reading the main story

We could save money by reducing the number of complications and make life immeasurably better for people with diabetes.”

End Quote Barbara Young, Chief executive, Diabetes UK It is also estimated that up to 850,000 people have diabetes but are unaware of it.

Diabetes is now the biggest single cause of amputation, stroke, blindness and kidney failure.

Spending on the condition accounts for around 10% of the NHS budget.

Diabetes UK says that because so many people are missing out on the relevant checks, there has been a rise in complications such as amputation, blindness, kidney failure and stroke.

Such complications account for about 80% of NHS spending on diabetes, it says.

A National Service Framework for diabetes was drawn up in 2001, but the charity says its recommendations are not being followed.

Regular checks

Diabetes UK wants better risk assessment and early diagnosis for people with the condition.

It says a national audit found only 50% of people with diabetes get all the recommended health checks - ranging from 6% in the worst areas to 69% in the best.

For children with diabetes, just 4% have all their annual checks, they claim.

Barbara Young, Chief Executive of Diabetes UK, said: "This report shows how in exchange for this investment we are getting second rate healthcare that is putting people with diabetes at increased risk of tragic complications and early death.

"Above all, the wide variation in standards of care shows the need for a national plan to be put in place for giving people with diabetes the kind of healthcare that can help prevent complications, as well as a greater focus on preventing Type 2 diabetes.

"By taking the longer-term approach of investing in making sure people get the basic checks and services, we could save money by reducing the number of complications and make life immeasurably better for people with diabetes."

Care Services Minister Paul Burstow said there was still much to be done to tackle diabetes.

"Our focus is on prevention and education, with more done to get earlier diagnoses and to help people manage their conditions themselves.

"This report and our new strategy will help local NHS services act so that diabetics get the care they need and deserve."

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Diabetes timebomb: Only half of NHS patients receiving acceptable care

Less than half the people with diabetes in England receive all the recommended health checks which would reduce the risk of serious complications such as blindness, amputations and kidney disease.

In some regions, only 6 per cent of patients received the nine basic health checks, which monitor patients for tissue damage, compared to 69 per cent in the highest-achieving primary care trusts (PCTs), according to the National Audit Office (NAO) report.

Around 24,000 people in England die from avoidable diabetes complications every year, but the variations in care standards mean a person’s risk of being admitted to hospital or dying from diabetes significantly depends on where they live.

The worst offenders were Mid Essex and Swindon PCTs where less than 9 per cent of patients were given the nine basic tests, including blood tests, retina screening and foot examinations, recommended by the Department of Health since 2001 and the National Institute of Clinical Excellence.

But not a single primary care trust carried out all the health checks recommended for diabetic patients, in essence playing Russian roulette with blindness, amputations, stroke and kidney disease.

In addition, less than one in five patients achieve the safe levels for glucose, blood pressure, and cholesterol, which are all known to increase the risk of diabetic complications.

The report strongly suggests that the DH has failed to get a handle on the spiralling costs of diabetes. According to the NAO’s conservative estimate, diabetes cost the NHS in England £3.9bn in 2009/20 – three times the government’s official figures.

Detecting potential problems earlier, by carrying out the health checks and treating people in the community, would save the NHS £170m every year by slashing hospital admissions, according to the NAO.

“[From] the low achievement of treatment standards and high number of avoidable deaths we conclude that diabetes services in England are not delivering value for money,” the report concludes.

The DH is also criticized for failing to get a grip of the problem nationally and for not holding poorly performing PCTs to account.

The number of people with diabetes doubled between 1994 and 2009 to 3.1million. This is expected to rise by a further 23 per cent by the end of this decade. Nine out of 10 cases have type 2 diabetes, the risk of which increases with age and is strongly linked to obesity and ethnicity.

Amyas Morse, head of the NAO, said: "The DH has failed to deliver diabetes care to the standard it set out in 2001. This has resulted in people with diabetes developing avoidable complications, in a high number of preventable deaths and in increased costs for the NHS.

"The expected 23 per cent increase by 2020 in the number of people in England with diabetes will have a major impact on NHS recourses unless the efficiency and effectiveness of existing services are substantially improved."

Barbara Young, chief executive of Diabetes UK, said the report was a “damning indictment” of the current approach to diabetes.

“Much of the colossal amount of money being spent on it is being wasted. Escalating diabetes costs threaten to wreck the NHS budget so this is an issue that affects all of us, not just people with diabetes.”

Care Services Minister Paul Burstow said the NAO report confirms what the Coalition already know. "By exposing poor practice and shining a light on best practice we are determined to drive up standards for everyone. We are already working on a new outcomes strategy covering long term health conditions and are committed to publishing a companion document on diabetes later this year"

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Essex: Diabetes report reveals post-code lottery of care

By Laurence Cawley

DIABETES treatment is a postcode lottery with one of Essex’s health areas being cited as one of the nation’s worst areas in a report by the National Audit Office (NAO), it emerged last night.

Published today, the NAO survey highlights a massive variation in care quality from region to region.

In some regions, only 6% of sufferers received the recommended levels of care compared to 69% in the highest-achieving primary care trusts (PCTs).

Not a single PCT delivered the nine basic care processes which reduce the risk of diabetes-related complications such as blindness, amputation or kidney disease.

The report highlighted Mid Essex PCT as one of the worst performers with less than 9% of patients getting the nine basic tests recommended by the Department of Health (DH).

Mid Essex last night hit back saying the figures used by the NAO - which relate to 2009-2010 - are out of date, did not factor in the PCT’s use of a different test to the one audited and did not reflect the care now being given to people with diabetes.

According to the NAO, the DH was not holding poorly performing PCTs to account.

The authors say: “The Department holds information to assess performance but there is a lack of accountability for PCTs who fail to ensure that the recommended standards of care are met.”

The report says: “People with diabetes require regular review of clinical indicators of disease progression.

Amyas Morse, head of the NAO, said: “The DH has failed to deliver diabetes care to the standard it set out as long ago as 2001.

“This has resulted in people with diabetes developing avoidable complications, in a high number of preventable deaths and in increased costs for the NHS.

“The expected 23% increase by 2020 in the number of people in England with diabetes will have a major impact on NHS recourses unless the efficiency and effectiveness of existing services are substantially improved.”

A spokeswoman for Mid Essex PCT said: “We have looked closely at this audit and it does not present a true picture of diabetic care in our area in 2012.

“The National Diabetes Audit (NDA) is based on 2009/10 data. It shows that NHS Mid Essex is in the mid range for seven out of the nine care processes that have been measured but there are two care processes that have significantly reduced our overall score.

“One relates to a routine blood test for creatinine that GPs order for diabetic patients. We believe that diabetic patients in mid Essex are receiving this test routinely as our Quality and Outcome Framework Figures (QOF) from our GP practices indicate this. It seems that this information was not captured by the NDA system in 09/10.

“The second relates to protein testing. The test used in mid Essex was different to the one in the national audit but was equally as effective so people with diabetes in mid Essex were not disadvantaged. We now commission the protein test that the NDA measures.

“Since 2009/10 progress has been made in a number of the care process areas. We are also making a number of improvements to diabetic care that are not measured by this audit including developing more integrated commissioning for diabetic patients so that local access to services improves and care is more ‘joined up’.

“A handbook for diabetic patients, to enable them to record and plan their care more effectively has been developed and piloted. We will be distributing this to all GP practices in mid Essex by August 2012.”

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Diabetic heart and stroke deaths down 40% - UPI.com

For people with diabetes, the death rates for heart disease and stroke dropped substantially -- 40 percent -- from 1997 to 2006, U.S. researchers found.

Ann Albright, director of Centers for Disease Control and Prevention's Division of Diabetes Translation, and colleagues analyzed 1997-2004 National Health Interview Survey data involving 250,000 adults who were linked to the National Death Index.

Although adults with diabetes still are more likely to die younger than those who do not have the disease, the gap was narrowing due to better diabetes management, healthy lifestyle changes and better cardiovascular disease treatment.

The study published in the journal Diabetes Care also found people with diabetes were less likely to smoke and more likely to be physically active than in the past.

Although people with diabetes had better control of high blood pressure and high cholesterol, obesity levels among people with diabetes continued to rise.

"Taking care of your heart through healthy lifestyle choices is making a difference, but Americans continue to die from a disease that can be prevented," Albright said in a statement. "Although the cardiovascular disease death rate for people with diabetes has dropped, it is still twice as high as for adults without diabetes."

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