Diabetes becomes a disease of the young

Jun 27, 2011 By Mary Brophy Marcus

Some people say aiming to look sleek in your swimsuit or wedding duds is the biggest motivator for losing weight. But Mike Durbin's incentive for dropping pounds beats all.

Three years ago, at age 24, Durbin's doctor told him he had type 2 diabetes and . More than 300 pounds at the time, Durbin knew that if he didn't take action, he faced the possibility of an early death.

"I was probably pushing about 340 when I was first diagnosed. As far as the physical changes go, within about three months or so of being diagnosed I dropped about 40 pounds," says Durbin, of Fort Wayne, Ind., who takes a dozen medications now. Always a meat-and-potatoes kind of guy, he says he had to learn to eat in moderation and now opts for sugar-free foods more often.

The experience has changed how he looks at his personal life, too. Durbin and his girlfriend of nine years postponed the idea of marriage, and he is not sure about starting a family.

"I don't like the thought that I could have a kid and he could end up with diabetes down the road. And one of the troubling thoughts I have is if something were to happen to me, (his wife) would be left alone as a mother. You really have to stop and think about these things," Durbin says.

Experts are becoming increasingly concerned about the growing number of people in their 20s and 30s coping with type 2 diabetes, which used to be rarely seen in those under 40.

As diabetes becomes more prevalent in young people, the long-term complications of the condition - like and , , blindness and - are more likely to occur at younger ages, too, says David Kendall, chief scientific and medical officer for the (ADA).

"Children and , and young middle-aged people, are the groups in which the rates are apparently growing the fastest," Kendall says.

Leading diabetes experts will gather Friday in San Diego for the group's 71st Scientific Sessions to present new research and discuss the explosion of diabetes, which afflicts an estimated 25.8 million adults and children in the United States.

The obesity epidemic - the fallout of people eating more junk food and getting less exercise - is an obvious factor in the rise in diabetes cases among the young, says Martin Abrahamson, chief medical officer at Joslin Diabetes Center in Boston.

But there may be more to it, Kendall says. "We used to just say it was the obesity issue, but I think there's a complexity to it. We can say now that there are also more higher-risk people" living in that higher-risk environment.

He says research suggests there are single genes and clusters of genes that probably make some people more likely to develop diabetes when they gain weight, while others can add pounds and not develop diabetes. Scientists are trying to unravel who's most vulnerable.

According to the Centers for Disease Control and Prevention, 3.7 percent of 20- to 44-year-olds have diabetes. Many of those cases are type 2, when either the cells in the body don't respond to insulin (which helps convert food into energy) or when the pancreas has trouble making enough insulin. In 2010, about 465,000 in that age group were newly diagnosed.

Complications of the disease are more likely to occur in middle age if not sooner, especially in young adults who don't take care of themselves or have access to medical care, says Ann Albright, director of the CDC's Division of Diabetes Translation.

"The longer you live with the disease, the more likely you are to develop the complications. If you develop diabetes at a young age, the chances are greater of complications at a younger age," Albright says.

Diabetes will shorten the lives of men diagnosed at age 30 by an average of 14.5 years; if diagnosed at age 20, by 17 years, the CDC says.

For women diagnosed at 30, diabetes shortens life by an average of 16.5 years; if diagnosed at 20, by 18 years.

"Today diabetes is the commonest cause of blindness in the Western world. It's the commonest cause of end-stage kidney disease, and non-traumatic lower limb amputations. People who have have a two- to threefold greater risk for developing cardiovascular disease and stroke," Abrahamson says.

Eric Choi, chief of vascular surgery and director of the Limb Salvage Center at Temple University School of Medicine in Philadelphia, fears that if young diabetics don't get the care they need, by middle age they'll be marginalized - unable to get jobs or participate fully in life like their peers.

"We're seeing more and more younger diabetic patients who require limb salvage work," Choi says. He says his medical team performed 40 or 50 amputations this past year. "Easily 10 were in patients 45 and under. That's a troubling trend."

Choi is particularly concerned for young minority adults who have higher rates of type 2 than whites, according to CDC data, and may be more likely to accept diabetes and its complications because that's what parents and older relatives might have done in the past.

Choi heads a team at Temple working on diabetes-prevention campaigns in the community. He and his team also are using medical techniques, including angiogenesis - growing new blood vessels - in at-risk diabetes patients when they spot vulnerable wounds to help stop further limb damage.

When a young diabetes patient comes through the emergency department doors, he is placed on a diabetes care fast track, which offers nutrition coaching, a vision check-up, and a cardiovascular workup, among other care, all in one shot because, Choi says, if a patient walks out the door between appointments, he is less likely to return.

Albright says young adults with diabetes haven't been extensively studied. She is part of an ADA team looking at this 18- to 30-year-old "transition" group.

A lot of changes occur in those years that can affect health, she says, especially in someone with a chronic illness: They move out of family homes and away from parents who help monitor health, they enter college and workplaces where food choices are sometimes poorer and where people may not be supportive, they change insurance plans or go without health coverage, and some marry and have children.

Albright says the Patient Protection and Affordable Care Act, which became law in March 2010, has expanded coverage for some in this vulnerable age group. According to the ADA, previously, insurance companies could deny coverage to people with diabetes or charge more for insurance. Under the new law, however, young adults with diabetes can now stay on their parents' plans until age 26. By 2014, young patients with diabetes will be able to buy coverage from any insurer and will be protected from being denied because of their diabetes.

There's "no question" the more effectively you manage diabetes, the more likely you'll live a longer, healthier life, Albright says. That means taking medications, seeing your doctor regularly, monitoring blood sugar often, eating healthfully and exercising, she says.

Alexa Hammes, 30, of Hudson, Mass., says that's what she's trying to do since being diagnosed in January. "I was desperately sick. I would commute an hour or more a day both ways, and I couldn't go a half-hour without taking a nap. I couldn't get enough water to drink."

She joined a diabetes management and weight-loss program at Joslin Diabetes Center. Now, instead of having just coffee for breakfast, she drinks a protein shake formulated for people with diabetes. She works out at the gym almost every day and rides her horse for exercise; she also uses the healthy menus the program suggests.

"The menu options are absolutely delicious. One favorite is the turkey-and-bean wrap, another is the salsa chicken over whole-wheat pasta," says Hammes, who has dropped two clothing sizes.

Durbin, who works as an information technology professional, says he turns to his blog and Twitter to help cope with diabetes and his heart problems at a time in life when most people his age aren't thinking at all about life-threatening illnesses.

"There's definitely a huge mental health component to living with diabetes and congestive . It's a whole lot to deal with at one time," he says. "Most of the inspiration and encouragement I get comes from the online diabetes community."

Says Albright: "You can't achieve perfect control. But the better you take care of yourself, the better shot you're giving yourself at a life without those serious complications."

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