Time for a Victory Lap or Time to Raise the Levees: A Perspective on Complication Reduction and New-Onset Diabetes
- James S. Wrobel, DPM1 and
- Gayle E. Reiber, PHD2
- From the 1Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan; and
- 2Health Services Research and Development; Rehabilitation Research and Development, VA Puget Sound, and Departments of Health Services and Epidemiology, University of Washington, Seattle, Washington
- Corresponding author: James S. Wrobel, jswrobel{at}med.umich.edu. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
The Mississippi River is a small piddling stream as it leaves Lake Itasca, Minnesota. As it meanders southward along its 2,300 mile journey, it is joined by 250 different tributaries that ultimately drain one-third of the continent. These widen the river, increase the flow, and strain the system of levees and spillways that contain the “Big Muddy.” It then passes on to the Gulf of Mexico.
There is a striking analogy between the U.S. diabetes population and the Mississippi River. Early in life the prevalence of diabetes is small as is the Mississippi at its origin. The population increases in number, age, and girth, and is enriched with high-risk minorities. Over time, many people with prediabetes transition to diabetes and develop one or more of its complications. The 2010 U.S. Census cites improvements in overall longevity, particularly in males, meaning people with diabetes are living longer and contributing to the expanding diabetes prevalence. Tributaries of people with undiagnosed, newly diagnosed, and established diabetes join the rush of the river. Increased volume and velocity put pressure on the levees and strain the system of locks and dams that regulate the river and protect the communities along its banks. The river finally passes on to the Gulf of Mexico.
U.S. 40-year diabetes population projections by Boyle et al. (1) are sobering. Using census, birth, death, and net migration data, plus estimates and standard errors for the U.S. adult population aged …
