Diabetes in The Next Decade: Predictions

In the last decade the total number of people with diabetes in the United States (over age 20) grew from 15.3 million to 26.8 million, according to the International Diabetes Federation Atlas.  In other words, the number of diabetics jumped from 8% of the adult population to 12.3%. And things don’t look like they’re getting any better.  The Centers for Disease Control and Prevention (CDC) predicts that in the United States one in three people will have type 2 diabetes by 2050 if current trends continue. We spoke to leading endocrinologists and diabetes advocates to find out what they think the future holds for diabetes trends and care.  And most importantly, is there anything we can do to keep the CDC’s prediction from becoming reality?

Dr. Zachary Bloomgarden on the CDC’s prediction and diabetes treatments in the coming years:

Will we be able to take steps in the next decade that can stop the CDC’s prediction from becoming a reality?

It has been known for many decades that lifestyle modification can prevent (and ameliorate) existing type 2 diabetes (see the 1975 famous article by Kelly West).  So the question is, what can we do to encourage/motivate/activate people to exercise and eat right?  I am more and more convinced that technology will offer help in this.  Smartphone-based apps will track walking and jogging (and their accelerometers can be used as pedometers).  They will help empower diet by letting people know what they’re actually consuming, and will convey information in a variety of ways.  Smartphones (or, just SMS) will send information back and forth from people to healthcare providers (or, maybe, to groups like ASweetLife with suitable confidentiality protection) to allow feedback on an individual, small-group, and large-group basis.  And, pharmacologic treatment is advancing (see below) and should offer more benefits.  So, let’s not despair!

Will oral medications remain the leading treatment for type 2 diabetes, or will injectable drugs like insulin, Symlin, and incretins become standard type 2 therapies?

Nobody wants to take shots!  I am interested in weekly, monthly, 3-monthly implanted approaches as being potentially very important.

Will there be changes in the kinds of insulin we use?  Better insulin?  Safer insulin?  Faster insulin?

Insulin is pretty good presently, and it’s not clear than newer insulins (faster, slower, more predictable, etc) will make a huge difference.  I’m very interested, but don’t see this as the big answer.

Will the artificial pancreas be a standard treatment?

I eagerly await improvements in the continuous glucose monitoring devices which will allow their reliable use in insulin dose adjustment, but a true artificial pancreas that takes into account variations in food intake and activity is likely a long way off.

What about islet cell transplants?

The adverse effects of immune-suppressive therapy seem to me to far outweigh the adverse effects of diabetes for the foreseeable future, so I am not optimistic that this will be realistic (other than in persons requiring immune suppression for kidney transplants).

Will all of the information available online to patients change the doctor/patient relationship?

Maybe see answer to the first question above.  But the real answer is that a caring human being (which defines the essence of a healthcare professional) can make a huge difference in helping people with illnesses (or at risk of developing illnesses), and this has not changed since Hippocrates, and undoubtedly long before.

Dr. Richard M. Bergenstal, American Diabetes Association President of Medicine & Science on the CDC’s prediction:

The American Diabetes Association is convinced that if patients, clinicians, employers, insurers and researchers all work together we can slow the skyrocketing epidemic of diabetes and the dire predictions of the CDC will not be realized.  This will take clinicians willing to identify individuals with pre-diabetes (those at high risk for diabetes – for instance, if you have an A1c that is from 5.7-6.4%) and diabetes educators having time to explain how modest activity (walking 30 minutes 5 days a week) and weight loss (15-20 pounds) can cut the risk of developing diabetes in half. In addition we need employers to facilitate a culture of healthy lifestyles by setting up exercise facilities or providing incentives for employees to participate in a lifestyle change program in the community. At least one insurer has already decided to cover a diabetes prevention program delivered at the community level, following a rigorous proven curriculum (Diabetes Prevention Program model at the YMCA).  Patients need to encourage their health insurance company to also cover well researched diabetes prevention programs.  Diabetes prevention – just like effective diabetes care – is a team effort. A focus on diabetes prevention will reduce the number of people developing diabetes but there will still be over 24 million individuals with diabetes who also need effective team care to reduce the burdens of diabetes.  Individuals with diabetes or at risk for diabetes need to have a good discussion with their health care team regarding positive steps they can take to STOP Diabetes and consider joining the ADA’s online blog, Diabetes Stops Here at http://diabetesstopshere.org/.  By 2050, with a push for adequate funding of diabetes research, today’s talented young diabetes investigators may well have discovered new innovative strategies that also can help prevent and effectively treat diabetes.

Diabetes Blogs and Social Media:

Ten years ago patients played a much smaller role in their diabetes care, and we received most of our information from our doctors.  Thanks to the Internet, blogs and the new world of social media, all that has changed.  We asked two leading bloggers/diabetes advocates about the future of the diabetes online community.  Ten years from now will blogs and social media still influence us in the same way? Where will the diabetes community be in the next decade? Will more and more people with diabetes join the discussion?  Will new blogs keep appearing?

Scott K. Johnson, author of Scott’s Diabetes Journal:

Ten years from now I think patients will be viewed as the empowered member of their health care team.  Today the doctors are seen as the leaders and decision-makers.  Doctors will be expected to continue to be experts in their field, and as empowered patients we will know if we have a good team-member in them or not.  We won’t settle for less than spectacular.  Patient powered resources will still influence us a great deal.  We want to relate to other people, and know that we aren’t alone in what we are dealing with.  I see the diabetes online community still influencing healthcare and social media.  We are a strong voice!  I think that more and more people will continue to join, and find new ways to participate.  And we will find ways for everyone to contribute something, in their own ways.  Some are natural writers, others are natural leaders, and others are natural supporters.  Everyone has a role, and we need all of them.  It’s all about the community, and the connections we have with each other.

Kerri Morrone Sparling, author of SixUntilMe:

I think that the Internet has given diabetes patients a way to connect that stems far past their local zip codes.  Now, support doesn’t have location barriers, and neither does information.  The key, I hink, is to make sure you are getting information from reliable, credible sources and to take all information with a grain of salt and a double-check with your medical team.  Ten years from now, diabetes patients may be able to take their seven minutes with their doctor and really run with that information, thanks to support from online venues. … Wait a second … who needs ten years?  That’s happening now!

Where do you see the diabetes community in the next decade?

I think the diabetes community will be a community in full bloom, with people from all kinds of backgrounds coming together to support one another in their quest for better health.  I think people in the community currently may be dealing with some emotional and physical diabetes complications, and our need for the support of the online community will grow with every year we mark as diabetics.

Will more and more people with diabetes join the online community?

A cure would be a nice thing, to keep the membership low, but I believe that more and more people with diabetes will be turning to the Internet as part of their diabetes care regimen.

Will new blogs keep appearing?

I think blogs will come … and go … but the diabetes online community will remain strong as a result of dedicated bloggers, new voices, commenters, lurkers, patient communities, and offline support.  Living well with diabetes is more than just managing medications and tracking blood sugars.  It’s about staying emotionally healthy, and the diabetes community fills that need in so many ways.

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

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Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)