10,000 new instances of diabetes in Md.

Rise in state, U.S. figures no surprise, disease experts say

By Frank D. Roylance | Sun reporter

June 26, 2008

More than 10,000 Marylanders were newly diagnosed with diabetes over the government's most recent two-year reporting period for local government, reflecting a sharp jump in incidence of the disease nationally, according to federal health authorities.

The number of people diagnosed with diabetes across the United States jumped by more than 3 million between 2005 and 2007, according to new estimates from the U.S. Centers for Disease Control and Prevention.

As stark as the figures might appear to the public, the news surprised few in the health care field.

"We've seen diabetes rates increase over the past decade, and rates are going to continue to go up," said Dr. Thomas W. Donner, director of the Joslin Diabetes Center at the University of Maryland Medical Center.

"We as a population have become much more sedentary and more overweight," he said. And both factors contribute directly to the development of fat deep in the abdomen, leading to insulin "resistance" and eventually to Type 2 diabetes.

Diabetes is a metabolic disorder that impairs the body's ability to properly use and store sugar. It can lead to serious complications, such as heart disease, kidney failure, blindness, nerve damage, amputations and death.

In Maryland, the CDC estimates that the total number of diabetes cases climbed from 288,000 in 2003 to 299,000 in 2005 - the latest county-level data available. These estimates have risen almost 80 percent since 1994.

The highest incidence of diabetes in the state in 2005 was in Baltimore City, where almost 50,000 people were estimated to have the disease. Many more are believed to be at risk for developing it.

"Diabetes is an enormous public health challenge and will require both expanded access to preventive medical care and community-level changes to turn the tide," said Dr. Joshua M. Sharfstein, Baltimore's health commissioner.

He said Baltimore's high incidence of diabetes reflects its high percentage of African-American residents and high rates of poverty. Blacks have almost twice the rates of diabetes as whites for reasons that are not yet well-understood. Poverty often limits access to both health care and a healthy diet - both critical to preventing and controlling diabetes.

Prince George's County, which had a similar percentage of African-American residents in the 2000 Census, but a larger population and lower poverty rate than the city, had a lower incidence of diabetes (8.8 percent). Even so, it had the highest estimated number of diagnosed cases - more than 52,000 people in 2005.

Kent, Dorchester, Garrett, Caroline and Allegany counties had the next-highest rates of diagnosed diabetes cases in Maryland in 2005. The lowest rates were in Montgomery (5.9 percent), Frederick (6.5 percent) and Howard (6.8 percent).

Addressing the issue will be a challenge, said UM's Thomas Donner.

"We're all very busy. It's hard to get people started on a physical exercise regimen" and committed to a diet with fewer calories, lower in fats and higher in fiber, he said. That sort of diet can also be more expensive.

But the impact of lifestyle changes can be major, according to studies of patients who have pre-diabetes - abnormal blood sugar levels that don't quite reach the diabetes range.

Those studies have shown that losing 7 percent of one's weight and exercising for 30 minutes a day, five days a week led to a 58 percent reduction in the development of full-blown Type 2 diabetes. That's a better result than with medication.

"There is hope out there," Donner said.

The national diabetes estimates are 2007 updates to the National Diabetes Fact Sheet. The county numbers are derived from CDC surveys and U.S. Census data.

Diabetes is the nation's seventh-leading cause of death. It was listed as the underlying cause of death, or a contributing factor, on 233,600 death certificates in 2005.

The CDC now estimates that nearly 24 million Americans have been diagnosed with the illness. That's almost 8 percent of the population, up from less than 5 percent in 1994.