SPECIAL | Type 2 diabetes is preventable. So why are more people getting it?

The U.S. spends more than $300 billion a year to address diabetes, accounting for one of every four dollars spent on health care. We've known how to prevent it for decades now. Yet the number of people who get it continues to skyrocket. What’s going on? USA TODAY's Health team spoke with scores of experts and patients to understand why, despite solutions, more Americans continue to struggle with Type 2 diabetes. Health Reporter Karen Weintraub joins the podcast to describe the complexities of this nation-wide crisis.

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Hit play on the player above to hear the podcast and follow along with the transcript below.This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

Dana Taylor:

Hello and welcome to 5 Things. I'm Dana Taylor. Today is Thursday, October 5th, 2023, and this is a special episode of 5 Things. More than one in 10 Americans have been diagnosed with type 2 diabetes, and another four in 10 are at risk for it. The country spends more than $300 billion a year to address diabetes, accounting for one of every $4 spent on healthcare. The personal tolls from the disease are even worse. Heart attacks, amputations, blindness, kidney disease, double the risk of premature death. Experts say the most frustrating aspect of the disease is that it has long been preventable and controllable, and still despite well-known treatments and prevention approaches, rates of type 2 diabetes have soared, especially over the past 15 years, particularly among young working age adults. What's going on? USA Today Health reporter Karen Weintraub and her colleagues traveled across the country talking to researchers, clinicians and patients to find out why. Karen, thank you so much for being here.

Karen Weintraub:

Thanks so much for having me.

Dana Taylor:

So we know how to prevent diabetes and have now for decades. Why are rates of type 2 diabetes still climbing?

Karen Weintraub:

A lot of it has to do with the food that we're eating. It is not as nutritious as it might be. We eat a lot of processed food, and it has a lot of calories and not a lot of healthy nutrition.

Dana Taylor:

Well, this series illustrated some shocking stories of people's health deteriorating and then hitting a scary breaking point. The man that you interviewed, James Haynes, who had walked all day on a rusty nail and didn't notice is one that I found to be particularly intense. Is it typical that diabetes 2 sneaks up on patients, and after speaking with so many about their personal stories, what patterns did you find?

Karen Weintraub:

For sure, it sneaks up on people. Even people whose parents had it who know that they're at risk are surprised when they get diagnosed. I think it's in a way because it's so common, people don't expect it, but also people tend to underestimate how serious it really can be. It's not like a broken leg, it's not something that's so obvious in your life. It just happens as a result of a lot of small choices that people make that are compounded over months or years. James, I agree. That was a heartbreaking story to me. I feel terrible for him. He's had a really, really awful couple of years, and yet he has incredible spirit. It was wonderful talking to him and hearing how he's persevering despite this really, truly terrible situation that he's been in. Amputations and doctors who hadn't really listened to him, haven't paid attention to him.

Dana Taylor:

Was preventative education just not reaching the people who are most at risk?

Karen Weintraub:

I mean, that's part of it. Lack of education, understanding what to eat, what to exercise, lack of access. Poverty is hugely correlated. It's easy to say, "Eat whole foods, eat fresh fruits and vegetables," but the access really isn't there. For one of the stories I traveled to rural Mississippi, and it's ironic, it's a farming community, but all of the produce produced there is intended for major markets. It's all industrial products, and none of it is for the local community. I had to drive 20 minutes to find a carrot, and so it really is hard to eat healthy. The roads don't have sidewalks. There are no gyms in these places. Even the watering holes, I was like, "Oh, maybe you could go swimming." There are alligators in the watering holes, so the things that seem maybe obvious to those of us who live in big cities or who have advantages really aren't feasible for a lot of folks.

Dana Taylor:

Where's the healthcare system seeing the most success in treating diabetes?

Karen Weintraub:

So really when the approach is multifaceted is when it succeeds, when people get education to help them improve their nutrition, when they get access to healthy food and to exercise opportunities, when they are given medication that's effective, and something called continuous glucose monitors can be very helpful. They can show you over the course of a day when your blood sugar is going up or down. I talked to one doctor who said that he had a patient for years, he was telling the guy, "Sodas and pizza will drive up your blood sugar," and the man was like, "Yeah, yeah, yeah." He gave him a continuous glucose monitor and the next time the patient came in, he said, "Oh, you wouldn't believe what happens to me when I eat pizza and drink soda," just seeing it in his own blood sugar drove it home in a way that the doctor nagging him for years didn't get across.

What we saw was it was this combination of factors that really helped support people. Another major problem in American healthcare is the lack of coordination. So if you have diabetes, you have a primary care physician, you might have an endocrinologist, you have a cardiologist, you have an ophthalmologist, you have a kidney specialist, nephrologist, so you have all of these different specialists involved in your care. They often don't speak to one another. You have to make appointments and change those appointments, and sit in waiting rooms for hours. It's quite a burden to have a disease like this and really stay on top of it.

Dana Taylor:

Okay. So let's talk about the systemic barriers now for people dealing with the disease. What are those barriers and who's impacted?

Karen Weintraub:

The striking thing is type 2 diabetes, which is what we're mostly talking about, it accounts for about 90 to 95% of diabetes. It used to be called adult onset diabetes. They had to change that a number of years ago because so many young people were getting it. Now, a full quarter of adolescents is at risk for type 2 diabetes now, so it is no longer an adult onset disease. It used to strike people as they aged in their 60s and 70s. It's now hitting people in their 30s and 40s in their prime working years. And so when you have to go to see six different doctors when you're also juggling a full-time job, that's really challenging. In terms of the systemic issues or talking about issues like the food system where it becomes very difficult to find healthy food and access healthy food, the medical system where it's difficult to get good care and consistent care and doctors who can communicate with each other across specialties, poverty is a huge factor.

Racism is a factor for many people. So it's a compounding of these systemic issues that make it particularly difficult for a lot of people to deal with diabetes, and also this sense of just being on your own. It's a condition that affects you all day long, every day of your life, every meal, every piece of food you put in your mouth, every time you exercise or walk up a flight of stairs, it can affect you. And so it really is part of every minute of your life, and a lot of people really are on their own in dealing with that, and that can be very lonely and very scary and hard.

Dana Taylor:

Well, you referenced a study that showed that it's less expensive to cut off a person's limb than to save it and losing a limb, of course, presents a whole host of other challenges, including for many the ability to work and care for themselves. How are experts weighing cost versus quality of life issues?

Karen Weintraub:

So unfortunately, our medical care system is typically reimbursed for procedures. Doctors get paid more when they do something to somebody rather than when they spend time helping somebody understand why they need to exercise more or how to eat more nutritiously. Doctors also aren't really taught much about good nutrition. I think I heard one statistic that Medical School includes two hours of obesity education and nutrition education. So really it's not their fault either. They're not informed, so the system is not designed to help people avoid these disastrous problems, and in fact, it's designed the opposite way.

Dana Taylor:

Well, Karen, you mentioned that you traveled to a county in Mississippi. It's a place where one in five people have diabetes. That area of the Mississippi Delta is a food desert and a medical one too. Can you describe those terms and explain the role of those two realities in the rise of diabetes?

Karen Weintraub:

In Holmes County where I spent several days, the nearest even fast food place is a 10 or 15 minute drive. A big box grocery store might be 45 or 50 minutes away, so it's really quite hard to access healthy food there. Not so hard to find a soda, but harder to find a bottle of water. Historically also, African-American communities have eaten, from the slavery days, we heard stories about people because they were always given the second choice, the last choice food. The diet was developed around these fattiest and poorest quality meats, and so people seasoned it with a lot of salt, for instance. And so the African-American diet is typically very heavy in unhealthy fats and salts, and it's very hard to access healthy food in this community.

And in medical care, I talked to one doctor who did decide to locate in this county. He said he was the first pediatrician in nine years to be in that county. There are only 22 endocrinologists in the state of Mississippi specializing in diabetes, even though Mississippi has one of the highest rates in the country, so it's quite challenging. The nearest hospital is 30 miles away and it's in danger of closing. The closest full service hospital is almost a full hour away. So it really is difficult to find high quality medical care, urgent care when people need it.

Dana Taylor:

So what's the latest with new medicines and helping to make diabetes more manageable?

Karen Weintraub:

So drugs that you may have heard of for weight loss, something called Ozempic and Mounjaro are very effective for diabetes. They were initially approved for diabetes, and they have been making a big difference. We do have pretty good drugs, medications for diabetes. They can help lower people's A1C as a measure of blood sugar, and they can help bring it down by a percentage or two. So those are a big part of the solution. They can also be used in combination. They are expensive and people who don't have insurance can't afford them, and some people with insurance may have expensive copays and can't afford them.

Dana Taylor:

Well, the last story in this series focuses on the hope that remains in America's battle against diabetes. What are some innovative solutions that are working and how can they be expanded to reach the millions who need the support and help?

Karen Weintraub:

So education programs along with medications, along with continuous glucose monitors can be very helpful for people. There are also programs that provide food boxes for people or Food is Medicine programs that deliver healthy food to people's doorsteps. One woman I talked to, it helped her diabetes, it helped her inflammation, it helped her heart disease, and it helped make her feel better physically and emotionally to get those food boxes. So it sounds simple in a way, and it sounds low tech, but can really be transformative for some people.

Dana Taylor:

Karen, did anything surprise you or stick out to you in your reporting?

Karen Weintraub:

One of the things that jumped out at me in Mississippi was just how much people are trying to help each other themselves and their neighbors. I was really impressed by that. We talk in this country about how polarized we are and how we're all out for ourselves, and there was a community that was really devoted to each other, and I thought that was very moving. The toll of diabetes is really striking to me, just how it can really destroy people's lives. Losing limbs, which obviously makes it hard to get around, hard to hold down a job, hard to feel like a functional member of society. They call it diabetes distress where you just feel useless, feel depressed, in part because of the biology of the disease, but also just the sense of hopelessness. And hopefully this series will show people that there is a possibility it's not hopeless, and there are things that people can do even at late stages of the disease to improve their outcomes. But there's also a lot that we can do as a society to help folks who have diabetes.

Dana Taylor:

Thank you so much for joining us, Karen.

Karen Weintraub:

Thanks for having me.

Dana Taylor:

Thanks to our senior producer Shannon Rae Green for production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [email protected]. Thanks for listening. I'm Dana Taylor. Taylor Wilson Will be back tomorrow morning with another episode of 5 Things.