Diabetes is an epidemic growing in the U.S. at an alarming rate. According to the Centers for Disease Control and Prevention (CDC), approximately 34.2 million Americans — just over 1 in 10 — have diabetes. In the last 20 years, the number of adults diagnosed with diabetes has more than doubled, and it is estimated 88 million American adults have prediabetes, many who don’t even know it.
Dr. Georges Argoud, a board-certified endocrinologist affiliated with Sharp Community Medical Group, explains that diabetes develops when there is a deficiency of insulin or a decrease in the body’s response to insulin, which regulates blood glucose.
Here, Dr. Argoud addresses your top questions about diabetes, the seventh leading cause of death in the U.S. and the No. 1 cause of kidney failure, lower-limb amputations and adult blindness.
What is the difference between Type 1 and Type 2 diabetes?
Type 1 diabetes — commonly referred to as Type 1 — occurs because the body’s immune system destroys the cells in the pancreas, which produce insulin. Type 1 occurs in children, adolescents and young adults, usually before age 30.
While a family history of Type 1 may contribute to a predisposition to the disease, the risk factors for Type 1 are still being defined.
Type 2 diabetes occurs in patients who inherit a metabolic imbalance, including resistance to the effect of insulin to allow blood glucose to enter cells. Typically, this type of diabetes is diagnosed in patients over the age of 45.
Risk factors for Type 2 diabetes include:
- Having prediabetes
- Being overweight or obese
- Being age 45 or older
- Consuming a high-fat and high-calorie diet
- Having a low level of good cholesterol
- Having a sedentary lifestyle
- Having a family history of diabetes
- Being African American, Hispanic/Latino American or Asian American
“Unfortunately, younger people are getting Type 2 diabetes more now than before due to the increasing prevalence of obesity,” Dr. Argoud says.
How is diabetes treated?
The most common treatment for Type 1 diabetes involves frequent measurement of one’s glucose levels, often with a continuous glucose monitor, and insulin administered through a pump.
“Continuous glucose monitoring devices have revolutionized diabetes management and are very popular,” Dr. Argoud says. “A device measures glucose continuously through a painless, small catheter placed under the skin, allowing people with Type 1 diabetes to track blood glucose values minute by minute. This critical feedback allows them to avoid low blood sugar, to treat high blood glucose more intensively, and to make decisions about meals and medications.”
When it comes to Type 2, the first step is a focus on nutrition and exercise, but often the oral medication metformin, which lowers blood sugar levels by improving the way the body handles insulin, is required. However, recent studies have shown that newer agents called SGLT-2 inhibitors, which stop the kidneys from reabsorbing glucose, or Glucagon-like peptide 1 receptor agonists, which work to decrease appetite, are preferred, especially for patients with chronic cardiovascular or kidney disease. These medications are combined with healthy lifestyle modifications.
“If you are living with diabetes, it is important to learn which foods are exacerbating high blood sugar and try to substitute with healthier choices,” Dr. Argoud says. “You should be conscious of the need to decrease weight, try to regularly exercise, monitor glucose and take your medications as prescribed.
To improve your diet, Dr. Argoud recommends increasing vegetable servings — noting that a trend toward a plant-based diet is showing promise — decreasing snack and fast foods, limiting the quantity of carbohydrates in meals, replacing saturated fats with olive or canola oil, and limiting your portions and total caloric intake.
What is prediabetes?
According to Dr. Argoud, prediabetes is defined by having blood glucose values — determined through a hemoglobin A1C test, which measures a 3-month average of blood glucose levels — above 5.6%, but lower than the threshold for diabetes, which is 6.5%.
Healthier nutrition and weight loss have been shown to be the most effective approach to treat prediabetes and prevent diabetes. However, for those struggling with these goals or who experience a rise in their blood glucose, the drug metformin is also an option.
“Many patients transition from having prediabetes to diabetes,” Dr. Argoud says. “A prediabetes diagnosis can become a wake-up call to buckle down and work on lifestyle changes, including diet and exercise.”
How does having diabetes affect a COVID-19 infection?
People with diabetes are at an increased risk for severe complications due to COVID, which can lead to hospitalization, ventilator treatment and death. However, your risk of serious illness can be decreased if your diabetes is well-managed.
These risks can also be greatly diminished by receiving a COVID-19 vaccine as well as following additional precautions, such as wearing a face mask when in indoor public locations, avoiding people who are sick and washing your hands often. Additionally, Dr. Argoud notes that the current guidelines recommend the COVID-19 vaccine for those age 5 and older and a COVID booster dose for those age 18 and older with diabetes.
“Some people with diabetes become discouraged,” Dr. Argoud says. “However, I strongly encourage you to keep appointments with your providers, try to make progress through lifestyle changes and avail yourself of the modern advances to managing diabetes with monitoring technology and medications. The disease will continue to be a challenge to control, but we can trust that science is always improving the methods of management and treatment of diabetes.”
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