Diabetes Statement

Diabetes is increasingly being referred to as the epidemic of the New Millennium. Nearly 16 million Americans are afflicted with the disease, and one-third of this number remains undiagnosed and untreated. In 1999, 800,000 new cases were reported, and the cost to the nation in medical expenses, disability, work loss, and premature mortality was more than 100 billion dollars.

The suffering experienced by people with diabetes and their families is devastating. It is THE leading cause of adult blindness, amputations, and kidney failure, both nationally and globally. Heart disease, stroke, nerve damage, and other complications often result if this disease is allowed to proceed unchecked. Further, as witnessed by the increasing number of children diagnosed with the disease, diabetes clearly is an affliction which takes its toll on young lives as well.

The impact on Santa Barbara County mirrors that of the nation. A survey published by the Santa Barbara County Health Assessment Task Force in April 2000, indicated that almost 5% of the County’s adult population has been diagnosed with diabetes. The survey goes on to state that “there is compelling evidence that for every two people diagnosed with diabetes, there is another person who has the disease but does not know it.” This is consistent with surveys reported nationally. Among Hispanic respondents in Santa Barbara County, more than 7% have been told that they have diabetes. The report concludes that more than 19,000 people in Santa Barbara County have been diagnosed with diabetes, while an additional 9,500 people have the disease but are not aware of it.

A comparison with the incidence of diabetes in Santa Barbara even five years ago is instructive. A report entitled “The Burden of Diabetes in Santa Barbara County” issued by the California Diabetes Control Program, and based on prevalence rates in the 1984-1993 California Behavioral Risk Factors Surveys, estimated that in 1995, 13,500 adults had been diagnosed with the disease. Another 6,700 adults had diabetes but remained undiagnosed.

The increase in the incidence of diabetes in Santa Barbara County (both reported and unreported) in less than a decade has been 41%. This figure is given additional credence by the earlier survey’s estimate that the number of people in Califomia with diabetes will double by the year 2020. The same survey also pointed out that the disease disproportionately burdened older people, people of color, and women– all groups whose numbers are expected to rise in the future. The statewide incidence for older Hispanic women (55+) was estimated to be 18.3%. Among Native Americans the figures are even more grim. Some tribes reported an incidence of diabetes of almost 50% among adults. It is not a question IF they will develop the disease, but WHEN that concerns them.

The one ray of hope in this bleak scenario is that diabetes can be both prevented and controlled. Early screening, coupled with increased awareness of the risk factors for both type 1 and type 2 diabetes can do much to reduce the incidence and impact of the disease. In type 1 diabetes, the pancreas cannot do its job because it is under attack by the immune system, which destroys the highly specialized insulin producing beta cells in the pancreas. Insulin, of course, is the key to healthy utilization of blood sugar by the body’s cells. In essence, type 1 diabetes represents a shutting down of the insulin production at its source, and the person with type 1 must learn to externally supply the appropriate amount of insulin to the body as needed in order to maintain healthy blood sugar levels. It is an exacting task, requiring injections or the use of an insulin pump, thoughtful meal planning and exercise, as well as frequent monitoring of blood sugar levels.

While type1 diabetes is caused by a lack of insulin production, in type 2 diabetes individuals may suffer from insulin resistance, where the body cannot make full use of its available insulin. For others, the pancreatic beta cells are sluggish, and do not produce enough insulin to keep blood sugar levels normal. Additionally, there may be problems with the hormonal signaling system underlying blood sugar control, causing the liver to release glucose even when blood sugar levels are in fact elevated. Not all individuals suffering from type 2 will require insulin injections or oral medications. Initial treatment often includes education about home blood sugar monitoring as well as medical nutrition therapy and exercise counselling. Risk factors for type 2 include older age, higher levels of body fat, and sedendary lifestyles that cause loss of muscle. These factors are of particular concern to people in Santa Barbara County who live with the threat of developing type 2 diabetes.

The April 2000 survey cited earlier indicated that 30% of adults and 28% of children in Santa Barbara County are overweight. Almost 25% of adults rate their level of physical fitness as fair or poor, and 46% say that they do not get enough exercise. A startling 84% of adults and 90% of children do not get the recommended five servings of fruits and vegetables each day, with fast foods, loaded with fats and excessive amounts of carbohydrates, often taking their place.
Another area of concern is healthcare coverage among Santa Barbara County residents. Currently, 21% of adults and 19% of children lack any kind of coverage, and are therefore much less likely to get preventive care and more likely to delay seeking care when they are ill. Those most in need of health care services seem to fall through the cracks or get lost in the system. People who are at risk for type 2 diabetes need early screening to detect high blood sugar levels, and need advice about proper nutrition and healthy lifestyle choices in order to prevent or delay the development of diabetes. Those already diagnosed with the disease need to be educated about how to control blood sugar levels through diet, medication, stress reduction and appropriate exercise. Similarly, those living with this chronic medical condition need help and support in dealing with psychosocial issues that are intimately connected with the disease.

People who are diagnosed with diabetes often go through a series of emotional stages involving denial, anger, frustration, depression, and grief. These feelings, if not attended to, inhibit attempts to control the disease, and prevent those afflicted from becoming full partners in ongoing treatment and self-management of the disease.

People with diabetes must make continual choices, 24 hours a day, if they are to successfully manage their disease. They need to take control of their lives if they are to avoid the inevitable complications caused by untreated or uncontrolled diabetes. They need to educate themselves about treatment strategies, available resources, proper nutrition, appropriate lifestyle changes, and the importance of a health care team approach in order to succeed in their attempts to manage and cope with their illness. They need to go through a process of normalization, understanding that the feelings they have about the disease are not uncommon and can be talked about and resolved. They need, above all, to empower themselves by accepting responsibility for their futures.

The Diabetes Resource Center of Santa Barbara County was founded in the year 2000 as a comprehensive approach to the problems posed by diabetes in our community, targeting at risk individuals and their families, as well as those already suffering from the disease. Its mission is to prevent and control diabetes and its complications by promoting public awareness of the disease, early detection through screening, encouragement of appropriate lifestyle changes, knowledge of treatment options, referrals to resources, and access to education and support networks.

Currently sharing office space with the Artificial Kidney Center in downtown Santa Barbara, the DRC’s facility seeks to synergistically link together many of the community organizations devoted to providing these services. This collaboration hopes to bring those served by the center in contact with health care teams, including psychosocial counselors, nutrition advisors, diabetes educators, and fellow diabetics in a non-clinical setting, treating both the disease and its emotional impact.