By Charlie Brennan
One in eight Coloradans likely will have diabetes by 2030, according to new estimates from the Colorado Health Institute, and the epidemic will cost the state an estimated $8.3 billion a year.
“It’s a known, predicted disaster if we do nothing – if we just sit back and watch,” said Chris Lindley, director of the Prevention Services Division of the Colorado Department of Public Health and Environment.
Few Coloradans seem to share Lindley’s sense of urgency, however.
Polls of the 1,000 Coloradans participating in Gov. John Hickenlooper’s TBD Colorado initiative have found that proposed remedies for the obesity epidemic sweeping the state receive precious little support.
Among 10 public policies to consider implementing in the next two years, anti-obesity measures ranked lowest. Healthy food choices for students were backed by fewer than 7 percent of TBD participants, while physical education in schools was supported by only 6 percent.
Yet across the state, the evidence of this health emergency is mounting.
‘You can die from this’
Raquel Villa was 12 years old and in seventh grade when she was diagnosed with type 2 diabetes. She weighed 250 pounds.
“I didn’t really know what it was,” the now-17-year-old Denver resident said. “I just know that it’s a disease that if you’re not careful, you can die from it. It can get out of control. You can lose body parts from it.”
Raquel’s doctor is Philip Zeitler, chief of endocrinology at Children’s Hospital Colorado and an expert in type 2 diabetes among children. He was a co-author in 1996 of the first U.S. study documenting a marked increase in the disease among young people internationally.
He sounded the alarm about a coming epidemic of childhood type 2 diabetes, but by 2000, the numbers of children diagnosed each year had leveled off, Zeitler said, and have remained relatively flat both in Colorado and across the nation.
About 50 Colorado children are diagnosed with type 2 diabetes each year, Zeitler estimates. Nationwide, slightly fewer than 4,000 children are diagnosed with type 2 diabetes annually, according to the Centers for Disease Control and Prevention.
“That’s still 4,000 more than what we used to see,” Zeitler said.
“It may be that childhood obesity is leveling off,” said Dr. Richard Hamman, professor and founding dean of the University of Colorado School of Public Health. “But it is leveling off at a pretty high level, and it is not clear where those trends are going to go, particularly with minority populations.”
Demographics predict higher incidence
Colorado’s changing demographics make predicting the future both difficult and worrisome. The numbers that predict higher incidence are all rising in Colorado:
- Colorado children historically have been less obese than others, but childhood obesity rates have been rising faster here than almost anywhere in the nation. The most recent data available from 2007 show that 14 percent of Colorado children are obese.
- Type 2 diabetes is more prevalent in minority populations, and while the portion of African Americans and American Indians in Colorado is expected to remain steady, the population of Latinos is expected to nearly double by 2030, according to data from the State Demography Office.
- Type 2 diabetes also is more prevalent among poorer populations and the 2010 census found poverty rates among children had risen in every county in Colorado. Now one in six Colorado kids lives in poverty.
“I think it is difficult to be sure what the prevalence of diabetes will be in the future, as it is difficult do extrapolate from current rates of rise,” Zeitler said.
Indeed, estimates vary widely on how many Coloradans will develop diabetes. The Colorado Health Institute’s estimate of one in eight by the year 2030 is relatively conservative. Dr. Mark Wallace, executive director of the Weld County Department of Public Health & Environment who was tapped as an expert in the statewide TBD process, thinks the number will be closer to one in four.
The estimates include both type 1 and type 2 diabetes.
Type 1 is believed to be related to an environmental trigger, such as a virus, and accounts for only 5 percent of diabetes cases. Type 2, which is often related to obesity, develops over time when a person’s pancreas can no longer produce enough insulin, the hormone that regulates blood sugar.
Dr. Michael McDermott, the local Diabetes Association president and director of the Endocrinology and Diabetes Practice at University of Colorado Hospital, said he believes many people “are underestimating, because they’re not looking at the kids and teenagers. We’re estimating that growth based on adults.”
“If we don’t begin to look at it, if we don’t change things, we’re going to go from 6.5 percent having diabetes to a place where 25 percent of our adults do – and that starts with childhood obesity,” Wallace said.
Economic impact enormous
The $8.3 billion per year price tag for diabetes is more than triple the $2.5 billion cost calculated by the American Diabetes Association for 2006. The estimate includes $5.3 billion in medical costs and another $3 billion in indirect expenditures, such as absenteeism, “presenteeism” (reduced productivity while at work) and lost productivity caused by early death.
“We’re not going to be able to afford these medical costs or the human cost, if we don’t turn around this epidemic,” said Dr. Sandy Stenmark, Kaiser Permanente Colorado’s physician lead for pediatric cardiovascular health.
To put the anticipated costs in context, Colorado’s entire Medicaid budget for 2012 is $5 billion. The state’s entire 2012 General Fund – the main checking account of the state – is $7 billion.
Dr. Robert Eckel, a professor of medicine, physiology and biophysics at the University of Colorado School of Medicine, emphasized the degree to which diabetes patients would clog the medical-care pipeline.
“People with diabetes need regular assessments, more clinic visits, more eye visits, more foot exams, more blood work,” he said. “There is ultimately the need for surveying complications of diabetes including almost every organ of the body, including cognitive impairment. And we’re concerned about the kidneys and the potential complications of end-stage liver disease, and orthopedic surgeons will have an increased caseload … Of course there is also heart attack and strokes.
“There’s a cascading domino effect in terms of the cost-burden going forward.”
Gabriel Kaplan, director of Prevention, Health Policy Systems and Analytics for the state health department, said if the fight against obesity and associated complications such as diabetes, doesn’t succeed, “our health care system would be a lot more crowded.
Diabetes costs 2025 from the Institute for Alternative Futures
- Diabetes cases statewide: 596,170 (nearly the equivalent of Denver’s population today)
- Annual deaths: 4,370 (nearly the total of U.S. military members who’ve died in Iraq since 2003)
- Cost to the state: $6 billion (more than the current state Medicaid budget)
- Visual impairment: 74,800 cases (more than the entire population of Loveland)
- Amputations: 1,040 legs a year
- Kidney failure: 865 cases annually
“We would find it harder to get to see a doctor. We would find it harder to get into a hospital. We would find it harder to get scheduled for routine services. There would just be a whole ton of people needing services, far more than what we commonly experience.”
Raquel Villa shares a mobile home with her father and younger brother on Denver’s west side. The vital tools of her health maintenance are arrayed on a table in front of her.
She slips a fresh test strip into the meter that will read her blood glucose level. She lances the tip of one finger, depositing a drop of her blood on the end of the strip. A moment later, the meter registers a number.
Raquel weighs less now than when she was diagnosed. When she was in eighth grade, her mother – battling brain cancer and diabetes – had to move into a nursing home. Raquel went to live with an aunt.
“I lost 75 pounds when I lived with her, and my diabetes was really good,” said Raquel, who has pursued physical hobbies such as ROTC, to stay active.
“The doctors were really impressed, and it was really in control and I didn’t have to worry about it as much and that’s when I got off the insulin. And I started being physically active and eating right.”
Zeitler, Raquel’s doctor, is watching her health closely. His latest published study shows that type 2 diabetes develops more rapidly in children than adults and also is less treatable – meaning children are more likely to have substantial health problems related to diabetes when they reach adulthood.
Still, Raquel tries to remain optimistic.
“If I was at the point where I could lose an arm or a leg – or like some people, their teeth or something like that – then I would be scared,” she said. “If I had out-of-control diabetes, I would be scared to die. But I’m not at that point. So, I’m not scared of anything.”
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