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Diabetes is a serious health concern in our country, and the American Diabetes Association and the Centers for Disease Control and Prevention (CDC) have the statistics to prove it.

Consider these alarming facts. In 2007, the CDC reported that 23.6 million Americans have diabetes, 5.7 million cases of which are undiagnosed. Diabetes cost our nation an estimated $174 billion last year alone … that’s more than the Iraq war.

The disease has become one of the leading causes of death in the United States despite the fact that diabetes is frequently underreported on death certificates. Diabetes is also responsible for an estimated $116 billion in medical costs, not to mention the billions in reduced work productivity.

The statistics are staggering, but the bottom line is clear. The diabetes epidemic is costing our country billions in hospitalizations and having a dramatic impact on the lives of nearly one in 10 Americans.

Although these numbers are telling, what is even more dramatic is what they mean to the people who are diagnosed. I see patients referred to me in my clinic every day with the diagnosis of diabetes. It’s not an easy illness to accept. My patients are mothers, fathers, grandparents and children. Regardless of their age or ethnicity, the diagnosis is life changing.

With complications such as heart disease, stroke, blindness, nerve damage, kidney disease and amputations, diabetes directly or indirectly touches almost every person in our society. Many individuals first become aware that they have diabetes only after developing one of its life-threatening complications. The good news is that we can prevent these complications with early detection, education and appropriate treatment.

In order for physicians to move forward in both preventing and treating diabetes, it is important to understand the history of diabetes and diabetes treatment. Insulin was first discovered in 1921 by Drs. Frederick Banting and Charles Best. (Dr. Banting received the Nobel Prize in 1923 for this work.) This discovery was a major breakthrough because doctors could now prevent patients from dying within two years of diagnosis, which was the typical prognosis at that time; but it inadvertently stalled research in diabetes for more than 50 years. The discovery of insulin convinced many that diabetes was a disease that needed no further research, even though the long-term complications of diabetes were still unknown at the time.

The next major breakthrough came in the 1980s, when doctors discovered that home glucose monitoring would allow patients to monitor and manage their own diabetes. Together with the development of the HbA1C test, which is an indirect measurement of the patients’ average blood sugar over a two-month period, home glucose monitoring proved that diabetes was a disease that could be controlled effectively in many instances.

In the 1990s, the Diabetes Control and Complication Trial (DCCT) demonstrated once and for all that complications from diabetes could be lessened by better control of blood sugar. This landmark study was chaired by Nashville’s Dr. Oscar Crofford, a Vanderbilt researcher and professor. Prior to the study, many physicians thought that close regulation of the patients’ blood sugar was not especially important.

Today, diabetes treatment has continued to evolve and advance. We are able to offer a variety of new treatments, including many new drugs which have become available within the past few years to treat both type 1 and type 2 diabetes. These include exenatide (Byetta), an incretin mimetic, and sitagliptin (Januvia), a DPP-4 blocker, along with many more that are under development. New types of insulin are now available along with insulin pumps and glucose sensors. These advances in insulin delivery may fulfill the dream of creating an artificial pancreas, a development that would greatly improve the quality of life for many people with diabetes.

Diabetes patients are also fortunate to have access to services from mail-order diabetes testing supply companies that make it easier for them to manage the disease. I am a member of the advisory board of one of these suppliers, AmMed Direct, which is based in Nashville. With new treatment options and a shared mission to promote diabetes awareness and prevention, I’m hopeful we can work to reduce the disturbing statistics I mentioned earlier.

As physicians, we play a pivotal role in reducing the diabetes epidemic by identifying at-risk patients and making sure they receive the appropriate screening tests. It is especially important to monitor any patients who are between 45 and 64 years of age, are overweight for their height, have a family history of diabetes, or are African-American, Latino, Native American, Asian-American or Pacific Islander.

One out of four people with diabetes do not know they have the disease. It is imperative that we, as physicians, encourage our patients to consider their risk factors for diabetes so we can reduce this percentage and save lives. Being diagnosed with diabetes is life changing, but the disease is frequently manageable if detected early. We must make diabetes self-management education a top priority. Many of our patients’ lives depend on it.


Lawrence Wolfe, MD, a board certified endocrinologist, is a professor of Clinical Medicine at the Vanderbilt University Medical Center and on the staff of the Vanderbilt Eskind Diabetes Center. He also serves as the senior member of the Advisory Board of AmMed Direct, one of the nation’s leading direct-to-consumer diabetes testing supplies and services organizations.

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