ORWH seminar panelists (from l) Joan Bardsley, Dr. Peter Savage, Dr. Robert Ratner, Dr. Alka Kanaya and Dr. Griffin Rodgers answer questions from attendees.

“Twenty-one million Americans currently have diabetes and 9.7 million of them are women,” said Dr. Griffin Rodgers, acting director of the National Institute of Diabetes, Digestive and Kidney Diseases at a recent ORWH Women’s Health Seminar series, “Stopping the Clock on Diabetes in Women: Strategies for Prevention and Treatment Across the Lifespan.” As the country’s most common chronic illness, with an estimated 4,000 Americans diagnosed every day, diabetes poses a great challenge to the nation’s public health system. Rodgers said, “There have been remarkable medical advances and technologies involving many NIH institutes. Through our efforts we will continue to improve diagnosis and treatment, as well as cure this disease.”

Dr. Alka Kanaya of the University of California, San Francisco, explained that the current diabetes epidemic involves type-2 diabetes and that the increase “has been remarkable, particularly among African-American women.” She pointed out that the upswing in diabetes rates has affected other racial/ethnic groups as well. Kanaya said that multiple risk factors for diabetes—including racial/ethnic group, older age, family history, gestational diabetes and obesity—demonstrate that the disease is a “complex interaction of genes and environment.” She stressed that “because diabetes is rising in every subpopulation, we must focus on prevention.”

Dr. Robert Ratner of MedStar Research Institute in Washington, D.C., spoke about gestational diabetes. “Our entire health care system could be overwhelmed” if we do not take steps to identify and treat pregnant women with gestational diabetes, he said. He emphasized that prevention can start with “improving the way you live.” He cited the Finnish Diabetes Prevention Study that showed lifestyle changes cut the development of diabetes by 58 percent. Ratner’s summary of studies showed that “the very high conversion rate to diabetes [in women with gestational diabetes] requires long-term and continuous monitoring.”

Dr. Peter Savage, acting director of NHLBI’s Division of Prevention and Population Sciences, also emphasized that although progress has been made in treating diabetes, there are still many remaining challenges. “The leading cause of death in diabetic patients, particularly in women, is cardiovascular disease and there is a clear association with duration of diabetes and development of cardiovascular disease,” he explained. While the risk for developing CVD is the same for type 1 and type 2, preventing diabetes is still a key to reducing CVD. “Once you have diabetes,” Savage concluded, “the treatment must be aggressive to prevent CVD.”

Looking at diabetic care in the real world, Joan Bardsley of MedStar Research Institute said, “Diabetes care is primarily self-care and good communication with a health care provider is related to better outcomes.” She noted that “self-care is also a challenge to health care providers who need to know what their patients are doing.” Citing the Diabetes Attitude Wishes and Needs Study, the largest global study of diabetes patients and their health care providers, she said 33 percent of patients do not follow treatment recommendations. “We need collaborative self-management plans,” said Bardsley. “These must be plans that respect the individual’s strengths, needs and concerns. Health care providers and patients must identify sources of personal motivation. Look at the person behind the diabetes.”