Retrospective #250: “40% of American Adults Will Develop Diabetes”

When I was growing up, I remember Doris Day singing “Que será, será.” I was 15 years old (in 1956), and I thought of it as an optimistic song that held the promise of a future of boundless opportunity and possibilities. Remember the lyrics?

When I was just a little girl	When I grew up and fell in love		Now I have Children of my own
I asked my mother	I asked my sweetheart		They ask their mother
What will I be	What lies ahead		What will I be
Will I be pretty	Will we have rainbows		Will I be handsome
Will I be rich	Day after day		Will I be rich
Here's what she said to me	Here's what my sweetheart said		I tell them tenderly
Que sera, sera	Que sera, sera		Que sera, sera
Whatever will be, will be	Whatever will be, will be		Whatever will be, will be
The future's not ours to see	The future's not ours to see		The future's not ours to see
Que sera, sera	Que sera, sera		Que sera, sera
What will be, will be	What will be, will be		What will be, will be
			Que Sera, Sera

At the time it never occurred to me that the actual message of the song, contained in the response, was “fatalistic,” which it clearly was. It just never occurred to me. I think that’s because I grew up in a privileged environment. I believed the answer to the question was, in large part, up to me. As I grew older, I often thought about how chance played a role in my career, but I still considered that I had free will and that I chose the path in life that I travelled and the “things” that came of it.

The title of this blog post challenges that premise. It is a simple declaration, from researchers at the Centers for Disease Control and Prevention (CDC), that “approximately 40% of American adults will develop diabetes in their lifetime.” And that, “In Hispanic men and women, and non-Hispanic black women, the projected increased risk is even higher, over 50%...” These findings came to my attention through a 2014 Diabetes-in-Control news item reporting on a paper in The Lancet.

The Lancet’s hypothesis was that since diabetes incidence has increased and mortality (in the total population) has decreased greatly in the USA, there would therefore be “substantial changes in the lifetime risk of diabetes.” So besides estimated “remaining lifetime diabetes risk,” the study also looked at “life-years lost due to diabetes” and “years spent with and without diagnosed diabetes.” “Because of the increasing diabetes prevalence, the average number of years lost due to diabetes for the population as a whole increased by 46% in men and 44% in women. Years spent with diabetes increased by 156% in men and 70% in women,” The Lancet’s statistical analysis concluded.

The Lancet’s INTERPRETATION of the CDC’s report and their (The Lancet’s) FINDINGS:

“Continued increases in the incidence of diagnosed diabetes combined with declining mortality have led to an acceleration of lifetime risk and more years spent with diabetes, but fewer years lost to the disease for the average individual with diabetes. These findings mean that there will be a continued need for health services and extensive costs to manage the disease, and emphasise the need for effective interventions to reduce incidence” (emphasis added).

The Lancet’s and the CDC’s projections are a dispassionate analysis of statistical trends - exactly what a study like this is supposed to do. And the call for “the need for effective interventions to reduce incidence” of diabetes should be a clarion message to the medical establishment. Instead, the message that I think the medical establishment gets is “that there will be a continued need for health services…to manage the disease.” In other words, job security for the medical establishment in managing (i.e., treating) the increasing numbers of diabetics who need treatment for the progressive course of their disease.

Okay, I am cynical and maybe a bit unfair. I don’t doubt that The Lancet is sincere about “the need for effective interventions to reduce incidence.” Can they be blamed for a myopic view of what such interventions might be? Or for confining their perspective to pharmacological treatments? New drugs? Surgery? After all, as a medical research journal, they only report on public health policy and nutrition research. But if the government only seems willing to support research in line with predetermined dogma of “good” public health policy and nutrition, what hope is there that the outcome for the patient will be other than, “Whatever will be, will be.” Que será, será.