Diabetes represents one classic "co-morbitiy" with obesity, but also one that is frequently cited for its impact on healthcare and, by extension, healthcare costs.
Co-Morbidities Linked to Obesity
When we eat, we either take in glucose directly or the body converts complex carbohydrates to glucose. However, the body’s cells can’t take in and utilize glucose to make energy unless insulin is present. Following a meal, as glucose levels in the blood start to rise, the clusters of Islets of Langerhans cells in the pancreas start to send out insulin. Insulin binds to protein receptors on the surface of muscle cells, telling the cell’s glucose transporters to bind to the cell surface and allow glucose molecules into the cell. In obese people, the transporter cells start slowing down, responding more slowly to insulin signals until they stop working entirely, creating the condition known as Type 2 diabetes.
Type 1, or juvenile, diabetes has nothing to do with overweight or obesity. In Type 1, the child’s immune system attacks the insulin-producing cells in the pancreas, crippling insulin production and causing blood sugar levels to soar. Insulin, often in the form of daily injections, is required or the individual will die.
Type 2, or adult-onset, diabetes normally occurs in adults. However, Type 2 is now showing up so often in the obese child population that physicians are dropping the ‘adult-onset’ part of the name as misleading and outdated. Type 2 diabetes affects nearly 10% of adults and an increasing number of children. It is the leading cause of blindness and kidney failure, and ranks in the top five on the national list of causes of mortality. Type 2 diabetes is not considered a disease like cancer or lupus; it is actually a cluster of symptoms which arises when the muscle and fat cells become resistant over time to insulin’s cellular communications. The good news is that in many cases Type 2 can be reversed with a modified diet and increased exercise—or with bariatric surgery. Unlike Type 1 diabetes, if a person is diagnosed with Type 2, and then loses the symptoms, the individual is no longer a diabetic.
Metabolic syndrome often seems to underlie Type 2 diabetes and atherosclerotic vascular diseases. However, most, but not all, Type 2 diabetics have insulin resistance (IR), but the converse is not true: IR does not always lead to the development of diabetes. In fact, most people with IR do not develop diabetes. Diabetes arises in the obese individual when the increased ingestion of sugary, high-carbohydrate foods results in consistently higher circulating levels of insulin. The body loses its ability to recognize that the insulin is present, leading to increased resistance to insulin. The resulting hyperinsulinemia is a key factor in the development of glucose intolerance, which leads to Type 2 diabetes—as well as a number of other conditions, including hypertension, polycystic ovary syndrome, and the eventual development of atherosclerotic cardiovascular disease manifesting as stroke, myocardial infarction and other disorders.
The cost of treating the symptoms associated with Type 2 diabetes is one of the major concerns of healthcare systems worldwide. According to a 2007 report, “State of Diabetes Complications in America,” presented at the American Association of Clinical Endocrinologists’ (AACE) 16th Annual Meeting, in 2006 approximately $22.9 billion was spent on the direct medical costs related to complications from Type 2 diabetes. The report also estimated the annual healthcare expenses for a person with Type 2 diabetes as nearly three times the healthcare costs of the average American without diabetes. These are conservative numbers in that they only take into account the direct costs. Complications from Type 2 may include congestive heart failure, stroke, blindness and other eye damage, chronic kidney disease, and foot and peripheral circulatory problems, which often lead to amputations. It is largely preventable and usually reversible, although some people develop the symptoms due to family history or other factors. The cost of treating the complications is why governments and healthcare companies are looking so eagerly for solutions. Effective solutions to the problems of overweight and obesity would be huge moneymakers for the companies, and could save billions of dollars in healthcare costs.
The above is an excerpt from "Worldwide Market for the Clinical Management of Obesity, 2007-2015." Report #S825. See also "Products, Technologies, Markets and Opportunities in Diabetes Management Worldwide, 2005-2015." Report #D500.