One third of all adults in Minnesota either have diabetes or are pre-diabetic, and over the past 15 years the number of Minnesotans with diabetes has grown so fast that state health officials describe the disease as a juggernaut threatening to overwhelm the state's health care system.
Diabetes is measured in heart failure, amputations and loss of eyesight. It's also measured in dollars: $2.6 billion a year in Minnesota alone.
As bleak as the numbers are, there is hope. Researchers at the Mayo Clinic and the University of Minnesota have set out to conquer diabetes within 10 years.
Still a devastating disease
Diabetes strikes when the body stops producing or becomes resistant to insulin. Without insulin a person cannot convert food to energy. Blood sugars rise to dangerous levels while the body essentially starves.
The discovery of replacement insulin in 1921 transformed the most severe form of diabetes from a fatal disease to a chronic condition. People on their death bed were suddenly revived with an injection. The Canadians who discovered the treatment received a Nobel Prize.
But 91 years later, diabetes is still a devastating disease. Amputations, blindness, kidney failure, heart disease and strokes are all caused by repeated
exposure to excessive blood-sugar levels. Modern treatments can help patients drive down blood sugars to a normal
range. But it's still an enormous challenge to try to mimic daily the body's natural response to food over the course of a lifetime.
"It's just awful to watch someone walk in, have a little ulcer on their foot that you say, ‘Hmm, this doesn't look good. We're going to get you to see the surgeon right away,'" said Elizabeth Seaquist, a University of Minnesota diabetes specialist.
"And in three days they lose their leg."
Seaquist keeps close tabs on the health of her patients, among them Mary Miller, one of the longest-surviving diabetics in Minnesota.
Miller, of Minneapolis, has lived with the disease for 68 years. Her tight control of her blood sugar levels has likely added years to her life. Still, she's slowly losing her vision.
"I tend to be perfectionistic because I think if I could just do it perfectly then I wouldn't have some of the day-to-day hassles," she said of her blood-testing routine. "But there just isn't a way to do it perfectly."
A spike in diagnoses
Like all diabetics, defective genes made Miller susceptible. She was 7 when she was diagnosed with Type 1 diabetes in 1943. Her body makes no insulin and she depends on daily injections to survive.
People with Type 1 diabetes have an autoimmune disease that causes their bodies to mistakenly attack and kill their own beta cells, which produce insulin. This susceptibility can be passed down through families.
Genes also appear to play a role in Type 2 diabetes, which accounts for 90 percent of people who have the disease. In this form, insulin-producing cells malfunction but still produce insulin to varying degrees. Unlike Type 1, it is strongly linked to excess weight gain and inactivity. State health department officials say for every 10 Minnesotans with diabetes, five are obese.
Much of the growth in diabetes the last 15 years in Minnesota has been among Type 2 diabetics, said Jay Desai, a research fellow at HealthPartners Research Foundation and a former diabetes epidemiologist for the Minnesota Department of Health.
In 1994, about 3.8 percent of Minnesotans reported being diagnosed with diabetes, he said. As of 2010 6.7 percent had - a substantial increase that includes only those who know they have the disease. Desai said many others probably haven't been diagnosed yet.
"If you try to take into account those who are undiagnosed, I estimate it's closer to around 11 percent overall," Desai said.
That makes 446,000 Minnesotans who are either diagnosed or undiagnosed with diabetes. Add to that figure the 1.1 million Minnesotans believed to be pre-diabetic and it's a staggering number: More than one third of all adults in Minnesota are either diabetic or are pre-diabetic.
Decade of discovery
Diabetes threatens to overwhelm the state's healthcare system. A national study estimates the disease costs Minnesota more than $2.6 billion every year in health-care costs, premature death and lost productivity.
But there's hope.
A new partnership between Mayo Clinic and the University of Minnesota, called the Decade of Discovery, has the ultimate goal of curing diabetes. It also works on ways to make diabetes management more tolerable for patients so they stick with their treatment plan. It aims to improve patients' health and save money on avoidable complications.
Victor Montori, a Mayo diabetes specialist, said diabetics might fare better if they could reclaim time they lose to managing their disease.
"We've recognized that the average patient with Type 2 diabetes should spend 140 minutes a day doing things related to their diabetes," Montori said. "And 140 minutes a day is a part-time job."
Montori also believes doctors could do a much better job of coordinating care for diabetics, so they don't have to deal with multiple office visits, extra pharmacy trips or traveling long distances for treatment.
"The urgency of treating diabetes and getting it right is too huge for us to afford to have repetition, duplication and waste," he said.