Posted: November 5, 2010

Hampton Roads is ground zero for a quiet but deadly epidemic. The culprit is diabetes, and it's a growing problem.

November - National Diabetes Awareness Month - seems like the ideal time to consider the scope of the problem, look at some things employers and employees can do to fight the disease, and review some of the exciting research taking place here in Hampton Roads.

Diabetes is expensive for patients and employers alike. According to the Virginia Department of Health, hospital costs alone in Virginia in 2006 - the last year for which numbers are available - exceeded $225 million for diabetic patients, at an average discharge cost of $19,000 per patient.

Diabetes also is a debilitating condition. It is the leading cause of blindness and the leading cause of renal failure. Nerve damage resulting from diabetes is a leading cause of limb amputations. Many people with diabetes suffer from heart disease.

And the incidence of diabetes is soaring. From 1995 to 2007, the Virginia population grew by 16 percent while the prevalence of diabetes rose a staggering 95 percent. A new study published in October 2010 by the Centers for Disease Control and Prevention predicts that the incidence of diabetes in the U.S. may double or even triple by 2050.

The local picture is just as dire. The incidence of diabetes in most South Hampton Roads cities is above the state average. Add to that the fact that Portsmouth had the highest rate of fatalities among diabetics in Virginia in 2006 - more than twice the state average and three times that of some more affluent communities - and we have a big problem.

So what can we do about it?

There are a wide range of effective treatments for diabetes, including maintenance of blood sugar and treatment for its many complications. But diabetics on average get only about half the recommended clinical care. So regular consults with a physician trained to care for the disease are a must. More than 5 million Americans are diabetic but unaware of their disease. So, again, regular visits with a physician and proper medical care can help.

Diet also plays a central role both in the cause and treatment of diabetes. If you are overweight, you are much more likely to develop Type 2 diabetes. A healthy diet, combined with regular exercise, is a good way to treat diabetes, or, if you're not already diabetic, to avoid the disease.

Eating healthy can be a challenge with all the unhealthy food choices available today. We are fortunate to have outstanding nurses and a trained dietician to help patients with diabetes make healthy food choices. We also were thrilled when Norfolk chef Todd Jurich recently agreed to team with the EVMS Strelitz Diabetes Center to create diabetes-friendly meals for his Norfolk restaurant, Bistro.

Most exciting for us, though is the promise of research, including some projects under way in our own labs.

In Type 1 diabetes, the body's immune system attacks the insulin-producing beta cells in the pancreas that supply our bodies with the hormone insulin. In mice, we have successfully stopped this autoimmunity process while jumpstarting the beta cells to begin producing insulin again.

One target we have focused on is a protein known as 12/15 Lipoxygenase (12/15 LO), which can lead to the death of pancreatic beta cells. Again, working in mice, we have discovered that when the gene that produces 12/15-LO is deleted, few mice develop Type 1 diabetes. We're now trying to understand how this process works so we can develop new medications to stop the activity of this protein.

Obesity and inflammation play a role in the development of Type 2 diabetes and cardiovascular disease. In fact, four out of five diabetics die of cardiovascular disease. We have a number of projects that are looking at this link and how to stop heart disease.

One of the most common complications of diabetes is nerve death, known as neuropathy. Our research is searching for the factors that contribute to neuropathy and to tailor therapies to counteract the effects.

At every turn, our goal is to confront this epidemic head on and translate our research findings into treatment therapies as quickly as possible.

We believe that with innovation and hard work, we can turn the tide on this devastating disease.

Jerry L. Nadler MD is professor and chair of internal medicine at Eastern Virginia Medical School and director of the EVMS Strelitz Diabetes Center. To reach him call 446-5908 or visit www.evms.edu/diabetes.