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Diabetes epidemic

Photo: Gabe Patten, left, information systems coordinator for the College of Pharmacy, demonstrates a new insulin inhaler with help from Keith Campbell. (Photo by Becky Phillips).

Diabesity n. – An epidemic of obesity and diabetes that is sweeping America.

Coined by Francine Kaufman, M.D., diabesity is a set of conditions afflicting nearly 1.3 million Washington residents. It is estimated that at least 270,000 have been diagnosed with the disease, while 100,000 have undiagnosed diabetes and at least 900,000 may have prediabetes. According to the Washington State Department of Health, diabetes has doubled in Washington since 1990 and is responsible for more than $1 billion in diabetes-related hospital charges annually.

The current health-care system was not designed to adequately handle such a flood of patients with chronic diseases — especially one as complex as diabetes.

To more effectively deal with the wide range of social, health, policy and demographic factors that contribute to the increased prevalence of the disease, the Washington State Diabetes Plan was established in 2005. The plan consists of 10 goals — to be addressed over a five-year period — aimed at the prevention and control of diabetes among the people of Washington. (See ONLINE @ www.doh.wa.gov/cfh/diabetes/diabetes_plan.htm.)
In addition, the Washington State Diabetes Network was created to acknowledge the individuals and organizations working on the plan in numerous public, private, tribal, community and academic settings — including WSU.

Involved from the start
Keith Campbell
, Fosberg Distinguished Professor in the College of Pharmacy, has been involved with the state diabetes plan from the beginning. Having lived with type 1 diabetes for 57 years, Campbell has invested his career in educating the public about the disease. Named Outstanding Diabetes Educator by the American Diabetes Association in 1989, Campbell has become a powerful spokesman for diabetes on a number of fronts. In addition, the R. Keith Campbell Endowed Chair in Diabetes Care is being established in the College of Pharmacy.

Campbell’s contribution to the plan began in the late 1970s when the Centers for Disease Control recognized diabetes as a national problem and invited each state to apply for  federal diabetes research grants. Washington was one of eight states initially funded and Campbell was named chair of a medical advisory board for the Washington State Diabetes Control Project.
The project brought health-care workers together from all over the state and initially sponsored diabetes awareness campaigns. With steady improvements in coordination, collaboration and communication over the years, the project evolved into the Washington State Diabetes Plan.

Helping the state
“As a land-grant university, WSU offers a unique opportunity to be involved in the plan on many levels,” said Campbell. “In rural areas, we could have extension agents trained to confront the high diabetes rates in migrant workers, for example. Compared to Caucasians, the incidence of diabetes is three times higher in Hispanic populations and three to four times higher in Native American populations,” he said.

“In addition to diabetes education, the institution offers research capabilities and the advantage of interdisciplinary collaboration between departments such as nursing, pharmacy, food science and human nutrition, sociology, veterinary medicine and others.”

In a step to further maximize this collaboration, the WSU Diabetes Initiative was formed in the fall of 2005. Under the leadership of Linda Garrelts Maclean, interim chair, pharmacotherapy, WSU Spokane Health Sciences, and Sue Butkus, extension nutrition specialist at the Puyallup Research and Extension Center, faculty members from across the university system meet to discuss diabetes research as well as explore and promote new opportunities for collaboration. The initiative includes members from nursing, nutrition, exercise physiology, pharmacy, extension, health policy administration, informatics and the Area Health Education Center. 

Doubling in 10 years
Diabetes occurs when the body cannot regulate the amount of sugar (glucose) in the blood. In type 1 diabetes, the body stops producing insulin or produces too little insulin to regulate blood glucose levels. It is believed to be caused by a dysfunction in the prenatal immune system, possibly caused by exposure to toxins or a virus in utero.

In type 2 diabetes, the pancreas secretes insulin, but the body is partially or completely unable to use it. This is called insulin resistance. The body tries to overcome this resistance by secreting more and more insulin.

People with insulin resistance develop type 2 diabetes when they can no longer secrete enough insulin to cope with the higher demands. Type 2 carries a strong genetic link but can be triggered by obesity, a high-fat diet and a sedentary lifestyle.
“The main thing is, people are taking in massive amounts of calories they don’t need and are no longer exercising like they used to,” said Campbell.
“Right now, 25 percent of the population is obese and the trend is getting worse — one in every three babies born today will develop diabetes in their lifetime. One dollar in every $5 spent on health care is for diabetes, or about $134 billion per year. The number of diabetes patients in the world could double in the next 10 years.”

Changing behavior
Yet, diets alone are not the answer.

“Most people who lose weight on a diet tend to weigh more a year later,” said Campbell. “The only way to effectively lose weight is to exercise while eating a healthy diet.

“Though we have been educating people for over 30 years now, obesity and diabetes are continuing to soar,” he said. “There is a huge gap between telling people to eat right and having them actually do it.

“A big area of research right now involves trying to understand what will change a person’s behavior. What will compel people to invest the energy needed to make a permanent lifestyle change?”

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