An American Epidemic: Diabetes: The Silent Killer: Scientific Research Shows a 'Persistent Explosion' of Cases-Especially among Those in Their Prime

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Something terrible was happening to Yolanda Benitez's eyes. They were being poisoned; the fragile capillaries of the retina attacked from within and were leaking blood. The first symptoms were red lines, appearing vertically across her field of vision; the lines multiplied and merged into a haze that shut out light entirely. "Her blood vessels inside her eye were popping," says her daughter, Jannette Roman, a Chicago college student. Benitez, who was in her late 40s when the problem began four years ago, was a cleaning woman, but she's had to stop working. After five surgeries, she has regained vision in one eye, but the other is completely useless. A few weeks ago, awakening one night in a hotel bedroom, she walked into a door, setting off a paroxysm of pain and nausea that hasn't let up yet. And what caused this catastrophe was nothing as exotic as pesticides or emerging viruses. What was poisoning Benitez was sugar.

Benitez is a representative victim of what many public-health experts believe will be the next great lifestyle-disease epidemic to afflict the United States: diabetes. (Technically, type-2 diabetes, which accounts for 90 to 95 percent of all cases.) At five feet one and 140 pounds, Benitez is overweight; 85 percent of all diabetes sufferers are overweight or obese. She was born and reared in Mexico; Hispanics and blacks are more likely to contract diabetes than Caucasians. As the American population becomes increasingly nonwhite and obese, the disease is rapidly spreading. A study by doctors from the Centers for Disease Control and Prevention startled people last week with the finding that the prevalence of diagnosed cases of diabetes increased by a third (from 4.9 to 6.5 percent) between 1990 and 1998. But demographics explain only part of this "persistent explosion" of cases, says Dr. Frank Vinicor, director of the CDC's diabetes division; even among Caucasians--even those of normal weight--the rates are on the rise. The actual number is almost surely higher, since many cases go undiagnosed for years.

But the most alarming statistic in the CDC study was the breakdown of cases by age. For people in their 40s, the incidence of diabetes increased 40 percent over the eight years; for people in their 30s, it went up nearly 70 percent. "It's becoming a disease of the young," says Dr. Arthur Rubenstein, a leading endocrinologist and dean of the Mount Sinai School of Medicine in New York. In that light, Roman is an even more significant example. She is only 18, and she has type-2 diabetes, too.

In fact, until recently the disease Roman and her mother have was known as adult-onset diabetes, because it usually struck people middle-aged or older. The other kind was "juvenile" diabetes, now called type 1, which is an entirely different disease altogether. But in America, getting fat is no longer a prerogative of adults, and diabetes, which is strongly linked to obesity, is spreading down the age ladder. The rise in type-2 disease among teenagers is "extraordinarily worrying," says Rubenstein, because diabetes can take decades to reveal its most appalling effects--including ulcerating sores, blindness, kidney failure, strokes and heart disease. "If people become diabetic at age 10 or 15 or 20," he says, "you can predict that when they are 30 or 40, they could have terrible complications." You can also predict that they are going to need a lot of expensive health care; on average, medical-care spending for diabetics runs $10,000 to $12,000 annually--three to four times higher than on healthy people, every year for life. A number of promising new drugs and therapies may make diabetes easier to live with, but it will be a medical miracle if they end up saving money.

Diabetes is a disorder of the very engine of life, a subtle calamity at the molecular level. Its hallmark is a failure to metabolize glucose, the ubiquitous sugar molecule carried by the bloodstream to fuel every part of the body. …