There has been a decline in new cases of diabetes in US adults at a time when most despaired of the relentless upward trend. According to the US Centers for Disease Control and Prevention, new cases fell from 1.7 million in 2008 to 1.4 million in 2014 – the first consistent drop since 1990, although there is still thought to be at least one undiagnosed case for each known one in the US. This despite the migration into the US of people of Hispanic origin, who tend to have a higher risk of diabetes, with genetics suspected to play a role.
So what is behind the US trend? First, there have been changes in the way diabetes is diagnosed. The use of blood sugar levels is gradually being replaced by measuring glycated haemoglobin. (called the A1C blood test. It measures blood sugar levels over a three month period, not just that of the day of the test).
The most hopeful explanation for the trend is that public health messages aimed at tackling obesity and diabetes are beginning to hit home. There is increased recognition that obesity has been driving the diabetes epidemic and that prevention is possible through healthier eating and more exercise. If so, it would be a triumph for the government and the US public health movement, and would be a milestone in the prevention of a condition with huge personal and national costs. (Adapted from an article in New Scientist by Paul Zimmet, professor at Monash University and director emeritus of Australia’s Baker IDI Heart & Diabetes Institute, Melbourne).
The relevance to Epicureanism is that diabetes is sucking up a disproportionate amount of money and resources, which could be spent on, for instance, cancer. Where it is avoidable (by self- control, eating well and exercise) it is a test of self- discipline.
Despite a good diet, skeletal (well, nearly!) thinness and plenty of exercise, I have to have regular A1C tests. This is because I have indulged a sweet tooth since childhood and unknowingly abused my system for ages. Now I am pre-diabetic and determined to stop at with the “pre”. No one knew about diabetes when I was young. Sweeties were cheap and plentiful; puddings loaded with sugar de riguer, no one checked the number of carbohydrates children were consuming. I am paying for it now. I make this point because you are not born with a sweet tooth; you acquire it. If carbohydrate and sugar intake is not policed by parents, health problems follow later in life.
The trouble is, America’s urban planners have encouraged low density development. This has increased car dependency, and made cities less walkable. Unlike European cities, which were built with pedestrians, horses and later trains in mind, American cities were built for the car. High periods of time spent behind the wheel is bound to increase chances of diabetes. All of this means that America may have to put up with the problem for quite some time.
The other issue is that in many poor and largely African American communities, parents don’t let their children play in the neighbourhoods because of high crime rates. Increased levels of inactivity at childhood are bound to increase levels of diabetes. The good news is that the fall in diabetes may be partly attributed to the fall in crime.
One measure I would love to see implemented is healthier school meals in America, and for them to be provided to everyone who wants one. This has multiple benefits: it guarantees every child at least one healthy meal a day, it makes people more discerning in their foods tastes by introducing them to healthier food, it reduces health issues like diabetes, it reduces food insecurity for low income families, it can serve as a social event and it creates jobs in the catering industry. Although it would be expensive for the state, it would serve as a universal welfare programme that helps society as a while. It also reduces the stress and burden on parents to provide for their children.