New York Facing Epidemic of Diabetes, Health Officials Say

By JENNIFER STEINHAUER

New York City is facing an epidemic of diabetes, health officials said yesterday, pointing to new figures showing that nearly 8 percent of adults in the city have the disease, double the rate of eight years ago.

This rate, which mirrors national trends, is particularly high in the city's poorest neighborhoods, where obesity rates are also extremely high, according to data collected by the city's Department of Health in a study last spring of 10,000 New Yorkers that the department says is the largest health survey ever conducted in the city.

For example, the study found that in East New York, Brooklyn, more than 31 percent of the residents are obese, and 13 percent have diabetes. In the South Bronx, 27.3 percent are obese and 13.9 percent have diabetes. The disease was least prevalent on the Upper East Side, where less than 2 percent of residents are diabetic, and only 7 percent are considered obese.

Last year, diabetes was the sixth-leading cause of death in New York City, although city health officials said that the number of people who die from diabetes is probably underestimated.

"We don't use the word epidemic lightly," said Dr. Thomas R. Frieden, the city's health commissioner. "This data gives us a remarkable sense of the diversity and disparity between rich and poor in the city," he added. "Of all diseases New Yorkers suffer, diabetes and H.I.V. have the greatest disparities of race and class."

In the city, 12.2 percent of Hispanics have diabetes, as do 10.8 percent of non-Hispanic blacks. Whites who are not Hispanic have the lowest rate — 5 percent — and Asians are second to last, with 6.8 percent. The Bronx leads the city in diabetics, with 11.5 percent of residents having the illness, while 4.6 percent of Staten Island residents have it.

Dr. Frieden said the city would undertake an aggressive effort against the increase in diabetes rates. He has made addressing chronic diseases a focus of his department since he was appointed last year.

In the study, which was conducted in 33 communities, researchers concluded that more than 675,000 city residents have diabetes, although almost a third are unaware that they have the disease.

Dr. Frieden and other Health Department officials said that the most common causes of adult-onset diabetes include a lack of exercise and poor eating habits, both of which lead to obesity. Indeed, nearly 80 percent of New Yorkers with diabetes are overweight, the study found.

"These increases are due to a very marked alteration in our lifestyles," said Dr. Francine Kaufman, the president of the American Diabetes Association. "Very few people have physical activity and many eat too much."

Nationwide, 7.8 percent of adults have diabetes, and that rate has also doubled in the last several years, she said.

Perhaps more alarming, between one quarter and one half of children nationwide with diabetes have Type 2 diabetes, which is often related to obesity, according to Dr. Kaufman, who is also an endocrinologist at the Children's Hospital of Los Angeles. New York health officials estimate that in the city the rate is closer to 50 percent.

"Children are exercising so much less than they were before, because a lot of school programs have been cut," Dr. Kaufman said. "The parks and places children can go after school have markedly deteriorated. Children are on the Internet and playing video games. There are the same kind of trends for adults."

Dr. Kaufman also pointed to the decrease in the prices of fast food and growing portion sizes, as well as increased access to junk food in schools, as contributing to the rise of diabetes.

In Los Angeles, the public school system is currently changing the contents of its vending machines to offer healthier alternatives to soda and candy, a strategy that Dr. Frieden said the city might consider. City officials are also exploring the idea of removing fast-food outlets from the city's public hospitals.

City officials were startled to see that many doctors in private practice and in city hospitals fail to manage the care of diabetics, and do not do basic things like take regular blood-sugar readings of their patients. For instance, only 15 percent of respondents in the study with self-reported diabetes knew their blood-sugar level. This has led researchers to conclude that thousands of New Yorkers are at risk for developing serious complications, many of them potentially life-threatening, like heart disease, kidney failure and problematic pregnancies.

There are two main types of diabetes, Type 1 and Type 2. Type 1, which results from the body's failure to produce insulin, usually occurs during childhood or adolescence. Type 2, the most common form of the disease, usually occurs after age 45, and stems from insulin resistance (the body failing to use insulin properly), combined with relative insulin deficiency. Type 2 diabetes can often be controlled through diet, nutrition and lifestyle changes, according to the American Diabetes Association.

Dr. Frieden said that the city would take aggressive steps to educate city doctors and hospital workers about diabetes management, and would begin by pushing the public hospitals to get certified in special diabetes-management techniques, as other hospitals in the nation have done. While studies show that even modest weight loss and increased exercise can greatly reduce the symptoms of Type 2 diabetes, Dr. Frieden said, it was more realistic to focus on managing the disease then on pushing people to lose weight.

"One of the key things we have to do in public health is focus on clearly winnable battles," he said. Because there are no evidence-based models for getting people to lose weight, he said, "That's not a suitable area for a public health campaign."

He did say, however, that his office would try to encourage doctors, especially pediatricians, to educate their patients about suitable body weights. For example, he said that a pediatrician he talked to in Bushwick, Brooklyn, lamented that many of his Hispanic patients have severely overweight children and ask for supplements to fatten them up, because they believe plumpness is a sign of good health.

Copyright 2003 The New York Times Company

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