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RE: [IP] CDC: Diabetes becoming epidemic : Rise in cases linked t o increasing...
Lindsey [mailto:email @ redacted] wrote:
> Type 1 diabetes needs to be recognized much
> more than it is.
But the epidemic really is type 2, not type 1, particularly in young people.
Nearly 90% of diabetics are type 2, and it is type 2 that is showing the
dramatic increase in incident (new) cases.
This opens the door for a little discussion about public health versus
personal health. Public health is concerned with the "big picture". It
often leaves people thinking that we in public health are not interested in
them or their health problems. There may be a grain of truth in that. Most
of us, as individuals, recognize that being diagnosed with a disease like
diabetes, whether type 1 or type 2, is highly significant for that person
and her or his family. However, it may not be of public health
Let me give an example using a different disease: bacterial meningitis.
Meningitis is a very serious disease with a case fatality rate a little
under 10% when treated properly. Untreated, it has a case fatality rate of
over 50%. Every year there are a few cases in Georgia, and fatalities are
not as rare as we would like. However, in the eight years that I've been
here, it has not reached the point of public health significance, even
though the death of a child or loved one to this disease is devastating.
Public health is concerned with prevention, not treatment. Having said
that, there are three general levels of prevention: phases I, II, and III.
Phase I is prevention of the condition outright. This is done by
immunization or promoting life style changes (i.e. exercise, diet,
anti-smoking campaigns, etc.). Phase II is concerned with treating a
condition in order to prevent long term complications. Phase III is the
management of complications to reduce their impact.
Back to diabetes . . . the combination of the incidence rate with the strong
statistical associations with other factors (weight, activity level,
ethnicity, and sex) means that a strong intervention program may be
productive in reducing the incidence of type 2 diabetes. Obviously, no one
can change their sex or ethnicity (sex change surgery will not alter the
genetic makeup of an individual).
As yet, there are no strong statistical associations between type 1 diabetes
and any known factors, including genetic. That, combined with a relatively
much lower incidence rate, means that the money and efforts, which are
limited, are better spent on type 2 diabetes, at least from a public health
Now, as a type 1 diabetic, I can certainly agree that I wish there were more
known about this damned disease, and more options for effective management,
up to and including a true cure. But given the resources available (and
foreseeable availability, even if funds were to double), attacking type 2
diabetes has the more compelling position for public health resources.
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The opinions expressed are my own and do not necessarily represent those of
my wife who runs this house and makes more important decisions than I do.
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