TIME diabetes

Why 3 in 10 People with Diabetes Don’t Know They Have It

The surprising similarities between diabetes and HIV/AIDS

New research on diabetes suggests that nearly 30% of adults with diabetes remain undiagnosed—the same rate as people with HIV. And just like many HIV patients, only about 20% of diabetes patients are treated satisfactorily, finds the new study published in the Annals of Internal Medicine.

The study used the cascade of care method, which aggregates data on people’s treatment for a particular disease and has been used to guide treatment of HIV/AIDS. Study leaders say that the new diabetes research is the first time the method has been applied to another disease.

The research found a lot of similarities between the two diseases and how they’re managed. To start, the consequences can be grave for patients who don’t receive treatment for either disease. HIV/AIDS weakens the immune system and allows patients to develop other ailments, while diabetes can lead to problems with the kidney, heart and brain. Researchers showed where people with diabetes fall through the cracks on the path from the onset of a condition to the development of other serious illnesses. Millions aren’t diagnosed, more than a million people haven’t been to the doctor in years despite a diagnosis and millions of others don’t take the proper medication.

“As health care systems move from fee-for-service to fee-for-quality, something like the cascade can really aid in that shift and help both providers and patients be more motivated and spot the gaps and close the gaps in care,” said study co-author Mohammed Ali, an assistant professor at Emory University. Incentives could encourage both patients and health care providers to screen and then treat diabetes.

“They’re extremely similar because they both require patients to be extremely proactive in managing their own condition,” said Ali, specifically citing diet, exercise and taking medication. “If you’re a good patient, you’re actually going to prevent a lot of those diseases that come with diabetes and a lot of those bad outcomes that come with HIV.”

As electronic records make it easier for doctors to look at large sets of data, the cascade-of-care method has potential to aid in understanding where the health system has failed at treating diseases, Ali said.

“This should be easy to do for anything,” he said.

Corrected Nov. 11, 2014: This piece has been updated. An earlier version of the story mischaracterized statements from Ali.

MONEY Health Care

The 7 Biggest Health Problems Americans Face—And Who is Profiting

Bottles of prescription medicine in cabinet
Kim Karpeles—Getty Images/age fotostock

Here are the most-prescribed drugs in America.

Americans include two health-related issues among the 10 most important problems facing the U.S., according to a recent Gallup survey. Healthcare in general ranked fourth on the list, with Ebola coming in at no. 8. But is Ebola really among the biggest health problems for Americans? Not when we look at the chances of actually being infected.

So, what are the actual biggest health problems that Americans face? One way to answer this question is to look at what drugs are prescribed the most. Here are the seven top health problems based on the most-prescribed drugs in the U.S., according to Medscape’s analysis of data provided by IMS Health.

1. Hypothyroidism

AbbVie’s ABBVIE INC. ABBV 3.3287% Synthroid ranks at the top of the list of most-prescribed drugs. Synthroid is used to treat hypothyroidism, a condition caused by an underactive thyroid gland.

The American Thyroid Association estimates that 2%-3% of Americans have pronounced hypothyroidism, while 10%-15% have a mild version of the disease. Hypothyroidism occurs more frequently in women, especially women over age 60. Around half of Americans with the condition don’t realize that they have hypothyroidism.

2. High cholesterol and high triglycerides

Coming in at a close second on the list is AstraZeneca’s ASTRAZENECA PLC AZN 0.4716% Crestor. The drug is used to help control high cholesterol and high triglyceride levels.

According to the American Heart Association, nearly 99 million Americans age 20 and over have high cholesterol. Elevated cholesterol levels are one of the major risk factors for heart attacks and strokes. The problem is that you won’t know if you have high cholesterol unless you get tested — and around one in three Americans haven’t had their cholesterol levels checked in the last five years.

3. Heartburn and gastroesophageal reflux disease

AstraZeneca also claims the third most prescribed drug in the nation — Nexium. The “purple pill” helps treat hearburn and gastroesophageal reflux disease, or GERD, also commonly referred to as acid reflux.

Around 20% of Americans have GERD, according to the American Society for Gastrointestinal Endoscopy. A lot of people take over-the-counter medications, but that’s not enough for many others. Medscape reported that over 18.6 million prescriptions of Nexium were filled between July 2013 and June 2014.

4. Breathing disorders

The next two highly prescribed drugs treat breathing disorders. GlaxoSmithKline’s GLAXOSMITHKLINE PLC GSK 0.0431% Ventolin HFA is used by asthma patients, while the company’s Advair Diskus treats asthma and chronic obstructive pulmonary disease, or COPD.

More than 25 million Americans have asthma. Around 7 million of these patients are children. Meanwhile, COPD, which includes chronic bronchitis and emphysema, ranks as the third-leading cause of death in the U.S.

5. High blood pressure

Novartis NOVARTIS AG NVS -0.3044% claims the next top-prescribed drug with Diovan. The drug treats high blood pressure by relaxing and widening blood vessels, thereby allowing blood to flow more readily.

Around one-third of American adults have high blood pressure. Many don’t know that they are affected, because the condition doesn’t usually manifest symptoms for a long time. However, high blood pressure can eventually lead to other serious health issues, including heart and kidney problems.

6. Diabetes

Several highly prescribed drugs combat diabetes, with Sanofi’s SANOFI S.A. SNY 1.2454% Lantus Solostar taking the top spot for the condition. Lantus Solostar is a long-acting basal insulin that is used for type 1 and type 2 diabetes mellitus.

According to the National Diabetes Statistics Report released in June 2014, 29.1 million Americans had diabetes in 2012. That’s a big jump from just two years earlier, when 25.8 million Americans had the disease. Diabetes ranks as the seventh leading cause of death in the U.S.

7. Depression and anxiety

Eli Lilly’s ELI LILLY & CO. LLY 0.8383% Cymbalta fell just below Lantus Solostar in number of prescriptions. Cymbalta is the leading treatment for depression and generalized anxiety disorder.

The Anxiety and Depression Association of America estimates that 14.8 million Americans ages 18 and older suffer from a major depressive disorder each year. Around 3.3 million have persistent depressive disorder, a form of depression that lasts for two or more years. Generalized anxiety disorder affects around 6.8 million adults in the U.S.

Common thread for common diseases

One thing that stands out about several of these common diseases affecting millions of Americans is that many people have one or more of these conditions — but don’t know it. This underscores the importance of getting a checkup on a regular basis.

Regardless of what the Gallup survey found, the odds of you getting Ebola are very low. On the other hand, the chances of you or someone in your family already having one of these seven conditions could be higher than you might think. Perhaps the truly biggest healthcare challenge facing Americans is knowing the status of their own health.

TIME Innovation

Five Best Ideas of the Day: November 10

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Food touches everything in our lives. Yet we have no national food policy. That must change.

By Mark Bittman, Michael Pollan, Ricardo Salvador and Olivier De Schutter in the Washington Post

2. Electronic Medical Records should focus more on patient care and less on meeting the needs of insurance companies and billing departments.

By Scott Hensley at National Public Radio

3. Anonymous social media often hosts vicious harassment targeting women and minorities. A new plan to monitor threats online is working for a solution.

By Barbara Herman in International Business Times

4. “You can’t wear a Band-Aid for long, particularly when the wound keeps bleeding.” Two years after Hurricane Sandy, New York is far from stormproof.

By Lilah Raptopoulos in the Guardian

5. China and the U.S. should take aim at a new “grand bargain” to head off tensions and mistrust in their relationship.

By Wei Zongyou in the Diplomat

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Diet/Nutrition

Soda May Age You as Much as Smoking, Study Says

The link between soda and telomere length

Nobody would mistake sugary soda for a health food, but a new study published in the American Journal of Public Health just found that a daily soda habit can age your immune cells almost two years.

Senior study author Elissa Epel, PhD, professor of psychiatry at University of California San Francisco, wanted to look at the mechanisms behind soda’s storied link to conditions like diabetes, heart attack, obesity, and even higher rates of death. She studied telomeres, the caps at the end of chromosomes in every cell in our body, from white blood cells. Shorter telomeres have been linked to health detriments like shorter lifespans and more stress, cardiovascular disease, diabetes and cancer, the study notes.

Epel and her team analyzed data from 5,309 adults in the National Health and Nutrition Examination Survey (NHANES) from about 14 years ago. They found that people who drank more sugary soda tended to have shorter telomeres. Drinking an 8-ounce daily serving of soda corresponded to 1.9 years of additional aging, and drinking a daily 20-ounce serving was linked to 4.6 more years of aging. The latter, the authors point out, is exactly the same association found between telomere length and smoking.

Only the sugary, bubbly stuff showed this effect. Epel didn’t see any association between telomere length and diet soda intake. “The extremely high dose of sugar that we can put into our body within seconds by drinking sugared beverages is uniquely toxic to metabolism,” she says.

She also didn’t see a significant link between non-carbonated sugary beverages, like fruit juice, which Epel says surprised her. But she thinks the results might be different if the data were more modern. “We think that the jury’s still out on sugared beverages—theoretically they’re just as bad,” she says. “But 14 years ago people were drinking a lot less sugared beverages…they were mostly drinking soda.” At the time of the study, 21% of adults in the study reported consuming 20 ounces or more of sugar-sweetened soda each day, but soda consumption has been on the decline for years.

Telomere length dwindles naturally as we age, but it may not be an irreversible process. Previous research shows that it’s possible to increase telomere length by as much as 10% over 5 years by stressing less and eating a healthy diet—no soda included.

Read next: Here’s How to Stop Teens From Drinking Soda

TIME Obesity

How Jet Lag Can Contribute to Obesity

Woman sleeping in airplane
Getty Images

Changing your circadian clock messes with your microbes

Working the night shift has long been linked to an increased risk of obesity, heart attack and breast cancer. One 2011 study even showed that shift work lasting a decade or more boosts your risk for type-2 diabetes by 40%. And new study published in the journal Cell looked at why.

Researchers led by Eran Elinav, MD, PhD, senior scientist in the immunology department at the Weizmann Institute of Science in Israel, suspected the gut microbiome, which he calls “the neglected organ,” might be affected by a disrupted circadian rhythm. It wasn’t an obvious choice. Microbes hang out in the dark of our guts, so they’re never directly exposed to light and dark cycles, he says. That’s why it was surprising to find out that the microbiome is very much affected by disruptions to our bodies’ inner clocks.

Elinav started by making mice work the graveyard shift, subjecting them to a state that would be the equivalent of jet lag from an 8-hour time difference in humans. Mice are nocturnal, so in this case, they stayed awake during the day. “We saw that in the presence of jet lag, their microbes were completely messed up,” he says. The bugs changed in composition and function, losing their circadian rhythm and becoming far less efficient at tasks like cell growth, DNA repair and detoxification. Like humans, mice microbes perform housekeeping and repair functions while they sleep, and growth and energy-promoting functions when they’re awake. But in the study’s graph of these functions in jet-lagged mice, the tasks hardly vary throughout the day and are performed at much lower levels.

These mice were also more susceptible to obesity and diabetes, and when Elinav transferred their gut bacteria into sterile, germ-free mice, they also transferred the heightened risk for disease, “proving that it’s actually their microbes driving this susceptibility,” he says.

Such a theory is much harder to test in humans, of course, but Elinav studied two people traveling from the U.S. to Israel, which induced an 8-hour jet lag similar to the mice. He sampled their gut bacteria three times over two weeks, capturing the main stages of jet lag, and found that their microbes indeed changed in composition, and in ways that were startlingly similar. Elinav even transferred the humans’ jet-lagged bugs into germ-free mice. “We could very nicely see that transferring the gut microbes from the point where jet lag was at its highest induced much more obesity and glucose intolerance,” he says.

Thankfully, the gut microbes of the travelers had returned to normal two weeks after their flight, and transferring their bugs into mice no longer led to increased obesity and glucose intolerance. But the implications of the findings are troublesome for frequent travelers and especially shift workers, whose work demands a consistent disruption of circadian rhythms.

TIME diabetes

How Race Affects Diabetes Care—and Leads to Amputations

High Blood Sugar Test
Getty Images

Black diabetics are much more likely to face amputation

Black type-2 diabetes patients are three times more likely to lose a leg to amputation as non-black patients, finds a new report from the Dartmouth Atlas Project. That’s partly because they’re also far less likely to get preventative care like foot exams, cholesterol testing and blood sugar testing.

Researchers looked at Medicare claims from 2007-2011 from patients diagnosed with diabetes and peripheral arterial disease, a condition in which plaque builds up in the arteries and blocks blood flow, primarily in the legs. They found significant disparities, both racial and regional: black patients and the rural Southeast region of the U.S. both saw elevated amputation rates.

Diabetes-related amputation, a last resort, generally results from wounds on the feet and poor circulation. Foot exams and testing for blood sugar and cholesterol levels can help lower the risk of having to resort to extreme measures. But in 2010, 75% of diagnosed black diabetics received a a blood lipids test, while 82% of non-black patients had the test.

An average of 2.4 leg amputations for every 1,000 Medicare patients with diabetes and peripheral arterial disease happen nationally, but regionally, the situation is much more grim. Mississippi, which currently ties West Virginia for the most obese state, also has some of the highest amputation rates—6.2 per 1,000 patients in the city of Tupelo. It’s not just racial: For every 1,000 black Medicare beneficiaries with diabetes, 14.2 amputations occurred in the Mississippi city of Meridian, but only 2.1 occurred among black patients in San Diego.

“The resources needed to prevent amputation are currently severely misaligned,” says co-author Philip Goodney, MD, director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center. “While we must look for opportunities to expand education and preventive care for all patients at risk for amputation, it seems clear to us that we can make the greatest gains by focusing on African-American patients in the highest risk regions, typically in the poor rural regions of the Southern United States, where the highest amputation rates remain.”

TIME Research

Stem-Cell Researchers Make Breakthrough in Type 1 Diabetes Treatment

"We are now just one pre-clinical step away from the finish line"

Updated Oct. 13

Researchers have made a major breakthrough in finding a treatment for type 1 diabetes, Harvard University announced Thursday.

For the first time, scientists were able to create insulin-producing beta cells using human embryonic stem cells, at a volume required for cell transplantation and pharmaceutical use. Type 1 is the variety of the metabolic disease that can be inherited and which is likely due to an underlying autoimmune condition in which the body destroys the beta cells that produce insulin, a hormone that regulates glucose and helps the body process sugar. (Unlike type-2 diabetes, there is no way to prevent type-1.)

“We are now just one pre-clinical step away from the finish line,” said Doug Melton, who led the research and who has worked toward finding a cure for diabetes since his son was diagnosed as an infant 23 years ago.

That final step is finding a way to protect the 150 million beta cells needed to for transplant in the treatment of each patient from their immune systems, which automatically attack those cells. Melton is working with other researchers to develop a device for such protection. Tests of a device in mice have so far protected insulin-producing beta cells for several months.

TIME diabetes

Here’s Why Women Should Avoid Fried Food Before Pregnancy

Fried chicken
Getty Images

So much for those burger-and-fries cravings.

A new study published in Diabetologia found that women who eat more fried food before conceiving are at greater risk for developing gestational diabetes—the kind that starts or is first noticed during pregnancy. Researchers looked at diet questionnaires from about 15,000 women enrolled in the Nurses’ Health Study II.

Once they adjusted for BMI, researchers found that women who ate fried food seven or more times a week had an 88% greater risk for gestational diabetes than those who ate fried food less than once a week.

MORE: Mom’s Diabetes Linked To Autism and Developmental Delays

Interestingly, the association was particularly strong with fried foods eaten away from home compared to home-cooked fried food. Restaurants tend to reuse their oil for multiple fryings, a practice that deteriorates oils through oxidation and hydrogenation. “Refrying may produce more of those detrimental chemicals,” says co-author Cuilin Zhang, MD, an investigator at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Frying also creates inflammatory compounds that may contribute to cell damage and diabetes—which Zhang suspects are related to the fried food.

No one would argue that a chicken nugget is a health food, but that kind of dining may be more hazardous when you’re getting ready to eat for two.

TIME Diet/Nutrition

Grapefruit Juice May Be As Effective as Diabetes Drugs

grapefruit
Chris Turner/Getty Images

A new mice study suggests that grapefruit juice might be just as effective as the type 2 diabetes drug, metformin, at lowering blood glucose. The research, which was funded by the California Grapefruit Growers Cooperative, was published Wednesday in the journal PLOS ONE.

Regarding the funding, study co-author Joseph Napoli, PhD, professor and chair of nutritional sciences and toxicology at the University of California, Berkeley, said this: “I understand the skepticism.” But the funders had nothing to do with the experiment, he says, besides providing some money and grapefruits. “We were very clear in telling them, you’re going to get the data we get,” Napoli says. “We can’t guarantee you’re going to like what you see. It might be nothing.”

What they found was not nothing.

The researchers fed different groups of mice a range of liquids: sweetened diluted grapefruit juice, sweetened water, and water that contained metformin, a diabetes drug. The mice who were fed a high-fat diet typical of the average American and drank the grapefruit juice lost 18% more weight than those drinking sweetened water, and they had a 13-17% drop in blood glucose levels and threefold decrease in insulin levels. (Mice on a low-fat diet had far less dramatic effects.)

But one of the biggest findings was that mice drinking grapefruit juice had glucose-lowering effects that were just as potent as the mice who sipped on metformin. “It was very surprising,” says Napoli.

You might have to drink a lot to get those prescription-level effects, however. The amount of grapefruit juice used in mice equates about four cups a day in people, the study says. But the researchers were so encouraged by the results that they plan to next look at if lower doses have the same impact.

“When someone says a particular food has this magic quality of improving your health all by itself, we mostly take that kind of claim with a grain of salt,” Napoli says. But Napoli, an avid grapefruit juice drinker himself, who says he’s convinced a few colleagues of its health merit, thinks his results show that grapefruits might actually do something special when it comes to diabetes.

TIME diabetes

Type 1 Diabetes Treatment Gets Boost from Stem Cells

Human stem cell derived beta cells
Insulin-making cells grown from stem cells glow green two weeks after they are transplanted into mice (c) Douglas Melton 2014

Scientists started with stem cells and created the first insulin-making cells that respond to changes in glucose

Scientists are closer to a potential stem cell treatment for type 1 diabetes.

In a new article in the journal Cell, Douglas Melton, co-director of the Harvard Stem Cell Institute (and one of the 2009 TIME 100) and his colleagues describe how they made the first set of pancreatic cells that can sense and respond to changing levels of sugar in the blood and churn out the proper amounts of insulin.

It’s a critical first step toward a more permanent therapy for type 1 diabetics, who currently have to rely on insulin pumps that infuse insulin when needed or repeated injections of the hormone in order to keep their blood sugar levels under control. Because these patients have pancreatic beta cells that don’t make enough insulin, they need outside sources of the hormone to break down the sugars they eat.

MORE: Stem-Cell Research: The Quest Resumes

Melton started with two types of stem cells: those that come from excess embryos from IVF procedures, and those that can be made from skin or other cells of adults. The latter cells, known as iPS cells, have to be manipulated to erase their developmental history and returned back to an embryonic state. They then can turn into any cell in the body, including the pancreatic beta cells that produce insulin. While the embryonic stem cells from IVF don’t require this step, they aren’t genetically matched to patients, so any beta cells made from them may cause immune reactions when they are transplanted into diabetic patients.

Both techniques, however, produced similar amounts of insulin-making beta cells—something that would have surprised Melton a few years ago. But advances in stem cell technology have made even the iPS cells pretty amenable to reprogramming into beta cells. Melton’s group tested more than 150 different combinations of more than 70 different compounds, including growth factors, hormones and other signaling proteins that direct cells to develop into specific cell types, and narrowed the field down to 11 factors that efficiently turned the stem cells into functioning beta cells.

MORE: Woman Receives First Stem Cell Therapy Using Her Own Skin Cells

The two populations of stem cells churned out hundreds of millions of insulin-making cells, which is the volume of cells that a patient with type 1 diabetes would need to cure them and free them from their dependence on insulin. An average patient, says Melton, would need one or two “large coffee cups” worth of cells’, each containing about 300 million cells. Melton and his team then conducted a series of tests in a lab dish to confirm that the cells were functioning just like normal beta cells by producing more insulin when they were doused with glucose, and less when glucose levels dropped. That was a huge advance over previous efforts to make beta cells from stem cells—those cells could produce insulin, but they didn’t respond to changing levels of glucose and continuously pumped out insulin at will.

Next, the scientists transplanted about five million of the stem cell derived beta cells into healthy mice, and two weeks later, gave them an injection of glucose. About 73% of the mice produced enough insulin to successfully break down the sugar. What’s more, that was similar to the proportion of mice responding to glucose after getting a transplant of beta cells from human cadavers. That was especially encouraging since some type 1 diabetics currently receive such transplants to keep their diabetes under control. “We’ve now shown that we can produce an inexhaustible source of beta cells without having to do to cadavers,” he says.

MORE: First Stem Cells Cloned From Diabetes Patient, Thanks to Egg Donors

Taking the tests even further, the group showed that even mice that were already diabetic showed improved blood sugar levels after receiving a transplant of the stem cell beta cells—in other words, the transplanted cells effectively cured their diabetes. “We showed you can give three sequential challenges of glucose—similar to breakfast, lunch and dinner—and the cells responded properly,” says Melton.

But he acknowledges that as exciting as the advance is, it only solves half the problem for those with type 1 diabetes. The reason their beta cells aren’t able to make enough insulin may be due to the fact that they are attacked by the body’s own immune system for reasons that scientists still don’t understand. So the next step in turning these findings into a potential therapy is to find ways to protect the beta cells from destruction, either by encapsulating them in a mesh-like device similar to a molecular tea bag, or finding ways to genetically modify them to carry ‘don’t attack me’ proteins, the same way that fetal cells do so that an expectant mother’s immune cells don’t attack the growing baby.

MORE: Stem Cell Miracle? New Therapies May Cure Chronic Conditions like Alzheimer’s

“It’s taken me 10 to 15 years to get to this point, and I consider this a major step forward,” says Melton, who began researching ways to treat type 1 diabetes when first his son, then his daughter were diagnosed with the condition more than two decades ago. “But the longer term plan includes finding ways to protect these cells, and we haven’t solved that problem yet.”

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