Good patient care requires teamwork. At Downstate's Diabetes and Vascular Treatment Center, Dr. Rochelle Chaiken (r.) confers with nurse-educators Sandra Hirsch (c.) and Efigenea Sandoval.

Diabetes is one of the leading causes of death and disability in the United States, affecting 16 million people. New York State Department of Health data from 1997 indicate that approximately one out of every twelve people-more than 8 percent of the population of the state-has diabetes. And most important, about half of those individuals don't know they have it.

About the disease
Diabetes mellitus is a metabolic disorder that causes high levels of glucose (sugar) to form in the bloodstream. When blood sugar remains elevated for long periods of time, blood vessels and organs of the body are damaged. This can lead to serious complications, such as heart attack, stroke, blindness, kidney failure, nerve damage, and the need to amputate limbs due to gangrene-a result of impaired healing ability in people with advanced cases of diabetes.

Fewer than 5 percent of people with diabetes have type 1 diabetes, which usually develops before the age of 20. Often referred to as childhood diabetes, it requires the lifelong use of insulin. In contrast, up to 95 percent of diabetes patients have type 2 diabetes, which usually occurs in mid-life or even later and does not always require insulin treatment. The prevalence of type 2 diabetes increases with age. For example, among women between the ages of 45 and 54, about 5 out of every 100 have type 2 diabetes. But the numbers double for women who are 65 or older: roughly 10 out of every 100 women in this age group have the disease.

"A major problem that has always faced people at risk for type 2 diabetes is that in its early stages the disease has little or no symptoms," explains Dr. Rochelle Chaiken, associate professor of medicine at SUNY Downstate and director of the Diabetes Clinic of Kings County Hospital Center. "Until recently, the average person with diabetes went undiagnosed for six to eight years. This is frightening, given the severe health effects of diabetes."

A third form of the disorder is gestational diabetes, which affects 2 to 5 percent of pregnant women in the United States. Uncontrolled, it can damage both mother and fetus. It is one of many reasons women should seek prenatal care early in their pregnancies. A study conducted in Illinois found that African American women in the sample were 80 percent more likely than white women to experience diabetes during pregnancy. Although gestational diabetes usually disappears following delivery, women who experience it are at increased risk of developing type 2 diabetes later in life.

Diabetes in Brooklyn
The prevalence of diabetes in Brooklyn is considerably higher than the national average. This is probably due to a combination of genetic and lifestyle factors. The ethnic composition of Brooklyn is heavily African-American, and this group (including Caribbean-Americans) as well as Hispanic-Americans have a genetic predisposition to develop type 2 diabetes at approximately twice the rate of whites. Non-Hispanic black women have the highest rate of all. Besides being more likely to develop the disease, African-Americans also tend to develop type 2 diabetes at an earlier age than whites. Researchers believe that a high-fat diet and too little exercise contribute to the higher rates of type 2 diabetes in Brooklyn. The obesity that often results from these lifestyle factors increases the risk of diabetes for people of all ethnicities.

Brooklyn residents are more likely to suffer from serious complications due to diabetes than are those who live in other parts of New York State. According to the Department of Health, in 1996 the rate of end-stage kidney disease one of the major causes of death due to diabetes was two times higher in Brooklyn than in all of New York. Between 1991-1995, the mortality rate due to these complications increased in Brooklyn as well as in the rest of the state (see Figure 1).

A healthier future
The encouraging news is that national guidelines have been established that will enable health professionals who screen patients for diabetes to detect the disease at an early stage. "The new guidelines for diabetes screening will help us diagnose people earlier and get a handle on the disease so that we can, hopefully, prevent its complications," Dr. Chaiken says.

Figure 1

Everyone over the age of 45 should be screened for diabetes, and those under 45 who have risk factors for diabetes should seek screening at regular intervals. Take the self-assessment test on this page. If you have any of these risk factors, ask your doctor to determine your fasting blood glucose level.

Besides being tested, what steps can you take to help prevent diabetes? "The ideal is to do all the things that are part of a healthy lifestyle for everyone," says Dr. Chaiken. "Get regular exercise and maintain a healthy weight for your height by eating a diet that is low in saturated fat and high in vegetables and fiber."

Diabetes treatment has improved significantly over the last three years. The results of research have given physicians and patients better tools to manage the disease. Thanks to their ability to test their own glucose levels regularly at home, people with diabetes now can take steps to keep blood sugars as near normal as possible, reducing damage to blood vessels and organs.

Better drug treatments are now available. New drugs for type 2 diabetes can be taken by mouth, and they work differently than those relied on in the past. Used in combination, the new drugs, along with a healthy diet, are usually effective for controlling blood sugar.

"The advances in treatment are very promising," says Dr. Chaiken. "Together, with early education about diabetes and earlier diagnosis, people with diabetes will live longer and healthier lives."