A woman with Type 2 diabetes prepares to inject herself with insulin at her home in Las Vegas. Overweight or obese Americans should start getting screened for diabetes and prediabetes earlier, at age 35 instead of 40, according to national guidelines updated on Tuesday, Aug. 24, 2021. (John Locher, Associated Press)
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ATLANTA — The year 2021 marks 100 years since the discovery of insulin, a game-changing drug in the fight against diabetes.
Despite a century of advancements in treatment, education and prevention, World Diabetes Day 2021 occurs in the wake of grim statistics. One in 10 adults around the world — some 537 million people — are currently living with diabetes, according to figures recently released by the International Diabetes Federation.
By 2024, the IDF predicted that the number of people with diabetes is expected to rise to 1 in 8 adults.
“As the world marks the centenary of the discovery of insulin, I wish we could say we’ve stopped the rising tide of diabetes,” IDF President Dr. Andrew Boulton told CNN. “Instead, diabetes is currently a pandemic of unprecedented magnitude.”
Nearly 7 million adults have died worldwide in 2021 so far due to diabetes or its complications, the IDF estimated — that’s more than 1 in 10 global deaths from any cause.
That doesn’t count the lives lost to the novel coronavirus, which has been particularly deadly for people living with diabetes. A study published in February found having either Type 1 or Type 2 diabetes tripled the risk of severe illness and death from COVID-19.
“And if you want another startling statistic, as many as 40% of the people that have died in the U.S. from COVID-19 had diabetes,” said Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association.
The pandemic also took a toll on how well people have managed their diabetes over the past year and a half, said Boulton, who is also a professor of medicine at the University of Manchester in the UK.
“My fear is we’re going to see a tsunami in the next two years of diabetes and its complications because people have missed their screening appointments due to fear of catching COVID-19,” he said.
Is COVID-19 a trigger for diabetes?
As bad as these numbers are, experts are concerned that COVID-19 might contribute to an even greater problem.
“There may be more people developing diabetes because of COVID,” Gabbay told CNN.
Boulton echoed that concern: “There may be a specific COVID-induced diabetes, although there is some debate on that at the moment.”
A global analysis published in 2020 found as many as 14% of people hospitalized with severe COVID-19 later developed diabetes. Another review published this October found examples of new-onset Type 1 or Type 2 diabetes in babies, children and adults infected with COVID-19.
“Whether new-onset diabetes is likely to remain permanent is not known, as the long-term follow-up of these patients is limited,” the study reported.
It’s very possible that COVID-19 is not the culprit. Blood sugar abnormalities could be triggered by the stress of an infection and the steroids used to fight COVID-19 inflammation, Gabbay said.
Another explanation is that the person may have had pre-diabetes — some 88 million Americans currently do, according to the American Medical Association and the U.S. Centers for Disease Control and Prevention. The organizations have partnered with the Ad Council to create a new public service campaign: “Do I Have Prediabetes?“
People also may have had diabetes that was not previously diagnosed. The IDF estimates that of the 537 million adults living with diabetes around the world, almost half (44.7%) are as yet undiagnosed.
But there is also evidence that SARS-CoV-2, the virus that causes COVID-19, can bind to the ACE2 receptors in the islet cells of the pancreas — the organ that produces the body’s insulin, Boulton and Gabbay told CNN.
“The virus attacks those cells in the pancreas and interferes with their production of insulin, so that may be another mechanism,” Gabbay said. “And those individuals that are diagnosed in the hospital with diabetes for the first time, through whichever mechanism, sadly do worse.”
Early identification is key
Reversing the rising tide of diabetes cases requires early identification. Nipping Type 2 diabetes in the pre-diabetic stages is preferred, since it’s before the body begins to suffer damage from irregular blood sugars and lifestyle changes are easier to implement.
Studies in Finland a few decades ago found that people with “very slight elevated blood sugar” who followed a sensible diet and regular exercise “had a 54% reduction in proceeding to Type 2 diabetes,” Boulton said.
“And it didn’t have to be flogging yourself in the gym,” he added. “It’s sensible exercising, walking instead of riding the bus and walking up the stairs instead of taking the elevator, that can do the trick.”
Two recent studies found that adding about a third of a cup of fruit or vegetables to your daily diet could cut your risk of developing Type 2 diabetes by 25%, while higher consumptions of whole grains, such as brown bread and oatmeal, could cut the risk by 29%.
Even full-flown diabetes can be put into remission, Gabbay said, with a regime of diet, exercise and stress reduction and proper use of medications.
“People in remission may still be at risk for some of the long-term complications, and therefore, they still need to be monitored, with quarterly blood tests, a yearly eye and foot test, and yearly screening for kidney disease and cholesterol levels,” he said.
To determine if you are at risk for Type 2 diabetes, the American Diabetes Association has a 60-second online test. After answering a few questions about family history, age, gender and physical activity, the test spits out an answer.
Being over age 60, overweight, having had gestational diabetes while pregnant, having a family history of diabetes, currently living with high blood pressure and a lack of physical exercise all raise your risk.