A Remarkable Change: Youth and Adult Type II diabetes

Diabetes in Colorado youth rises; future uncertain

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Raquel Villa, 17, checks her blood sugar level at her home in Federal Heights, Colo., on 6/5/12 as she manages Type II diabetes she developed when she was 12. Villa is one of a number of youngsters with Type II diabetes, previously a disease only affecting adults.(Joe Mahoney/The I-News Network)

Almost every week across Colorado, a child is diagnosed with a potentially deadly disease that used to occur only in adults.

These young patients are developing type 2 diabetes – what used to be called “adult onset” diabetes. The disease is strongly linked to obesity, and it used to take decades to develop in adults. But in the past two decades, the degenerative disease suddenly began showing up in children.

“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.

What’s not known is how big a disaster it could be.

“We have no idea what this disease is going to do in terms of numbers,” said Dr. Michael McDermott, president of the American Diabetes Association – Colorado Leadership Board. “We don’t even have data that could be possibly accurate, since we’ve never had a generation that grew up obese.”

It’s not yet apparent, however, that the entire state sees the urgency. Show more text →

“The Institute for Alternative Futures (IAF) has prepared estimates of the burden of diabetes in the years 2000, 2010, 2015 and 2025, for each of the 50 states plus 13 major metropolitan areas. Commissioned by Novo Nordisk, this free and easy-to-navigate data source can be used by policy makers and legislators, reporters, members of the diabetes community, and the general public.”

Click the image below to visit their interactive map on the increased number of Americans and Coloradans with diabetes and the projected associated costs.


$8.3 billion diabetes cost projection would dwarf earlier estimates

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If Colorado’s future holds a double-digit portion of people with diabetes, the effects on both their lives and the state’s health system will be devastating.

And that will impact Coloradans who never develop the disease.

“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.

The Colorado Health Institute forecasts that by 2030, one in eight Coloradans will have diabetes.

At that rate, the disease will cost Colorado $8.3 billion a year, according to a Health Institute analysis for the I-News Network.

The Institute for Alternative Futures, a non-profit co-founded by famed author and futurist Alvin Toffler, analyzed the cost in human terms of Colorado’s future diabetes damage in its report 2025 Diabetes Forecasts:

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

That’s more than triple the $2.5 billion cost calculated by the American Diabetes Association for 2006. The price tag 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.

To put that in context, Colorado’s entire Medicaid budget for 2012 was $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 agreed, and said Colorado’s current trajectory is “really bad.”

If the fight against obesity, and associated complications such as diabetes, doesn’t succeed, “our health care system would be a lot more crowded,” he said.

“We would find it harder to get to see a doctor,” Kaplan said. “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.”

Pilot program’s battle against obesity, intense and long-term

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There’s no silver bullet when it comes to fighting childhood obesity and type 2 diabetes. As the story of one effort shows, the fight has many fronts and the victories may be small.

When she was named medical director for Community Health Services in southern Adams County about four years ago, Dr. Sarah Winbourn took a look at the statistics for children in her area.

“I discovered that our overweight and obesity rate was about twice what it was in Colorado,” she said. It was about 43 percent.

Something, she knew, needed to be done. She said the overweight young people she referred to the Shapedown Program at Children’s Hospital Colorado were often not diligent enough in their follow-through to make any real progress.

“We were kind of helpless to really help our patients,” Winbourn said.

She contacted a former colleague, Dr. Matthew Haemer, an assistant professor in pediatrics at the University of Colorado School of Medicine, and the medical director at the GoodLIFE Clinic at the Children’s Hospital Colorado.

Community Health Services


“I said, ‘We need help, will you help us?’ And he said yes,” Winbourn said.

With Haemer’s help, and a grant from the Colorado Health Foundation, the broad-based Healthy Living Program was developed in the Commerce City area.

It includes intensive six-week healthy living classes for families – with nutritional cooking, parenting skills and exercise components. The classes are offered through area recreation centers. The program also reaches into the schools. At school-based health centers in Adams School District 14, they collect students’ body mass index data, established student wellness committees, added salad bars in lunchrooms and promote healthier snacks.

More complete data on the program’s long-term effectiveness won’t be available until after next May, but Haemer has reported that early results show children participating in six-week pilot sessions saw their average body mass index decrease from 24.8 to 24.4.

Numbers to quantify success may look modest right now, said Winbourn, but “we are headed in the right direction.”

“I’ve definitely seen kids in the two years of the Healthy Living Program who have gone from being obese, to no longer being obese,” Winbourn siad. “It’s a handful of kids, but still, we’ve helped those kids.”

Said Haemer: “I actually have very good confidence that the battle can be won, but it’s a question of time and the amount of resources that we as a society put into it. I think the long-term costs of obesity and economic costs, are such that we can’t afford not to.”

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Raquel Villa and her physician talk about dealing with Type II diabetes.


Charlie Brennan

About the reporter….Charlie Brennan is an award-winning journalist with more than 30 years’ experience, most notably as a reporter at the Rocky Mountain News in Denver, where he covered an array of beats and high-profile assignments over a span of more than 20 years. Brennan’s career highlights at the Rocky Mountain News ranged from covering the JonBenet Ramsey case to embedding with the U.S. Army during the 2003 U.S. invasion of Iraq. He is a past winner of the Colorado Associated Press Editors and Reporters First Place for Investigative Reporting, 2006, and in 1981 was runner-up for the American Society of Newspaper Editors Deadline Writer of the Year.