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Diabetes juggernaut threatens to overwhelm MN health care system

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Diabetes patient
Diabetes patient Dave Paul has a consultation with Dr. Victor Montori using the medication cards Montori developed. Montori, a Mayo Clinic researcher and clinician, created the cards to help patients and their doctors make informed decisions about the medications they use to treat their diabetes.
Photo by Alex Kolyer for MPR

The worldwide diabetes epidemic is taking a huge toll in Minnesota. One-third of all adults in the state either have diabetes or are pre-diabetic, with blood glucose levels that are higher than normal.

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.

In human terms, diabetes is measured in heart failure, amputations and loss of eyesight. Measured in dollars, the cost is enormous:  $2.6 billion a year in Minnesota alone.

As bleak as the numbers are, there is some hope. Researchers at the Mayo Clinic and the University of Minnesota have set out to conquer diabetes within 10 years. 

'A TERRIBLE DISEASE'

Diabetes strikes when the body stops producing insulin or becomes resistant to insulin. Without insulin in the digestive system, a person cannot convert food to energy. As a result, 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 who were on their death bed were suddenly revived after receiving an injection of insulin. The Canadians who discovered the new treatment received a Nobel Prize for their achievement.

Miller sees her doctor
Mary Miller, who has lived with diabetes for some 68 years, visits with Dr. Elizabeth Seaquist at the University of Minnesota in December 2011.
MPR Photo/Lorna Benson

But  91 years later, diabetes is still a devastating disease.

"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 Dr. Elizabeth Seaquist, a University of Minnesota diabetes specialist. "And in three days they lose their leg.

"These things happen with diabetes," she said. "It's a terrible disease."

Limb 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 their blood sugars to a normal range. But it's still an enormous challenge to try to mimic the body's natural response to food, day in and day out, over the course of a lifetime.

Avoiding such outcomes is a priority for any diabetic. That's why Seaquist keeps close tabs on the health of her patients. Among them is 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. Yet despite her diligence her eyes have been damaged, and 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." 

PREVALENCE RISING

Like all diabetics, defective genes made Miller  susceptible to her disease. She was 7 years old when she was diagnosed with type 1 diabetes in 1943. Her body makes no insulin and she depends on daily insulin 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.

It's an enormous challenge for diabetics to try to mimic the body's natural response to food, day in and day out, over the course of a lifetime.

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 of diabetes, insulin-producing cells malfunction while still producing 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.

Indeed, 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 that rate had increased substantially to 6.7 percent.   

That's an almost doubling of the diabetes rate in a little over a decade, and includes only diabetics 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. 

Diabetes threatens to overwhelm the state's health care system. A national study estimates that diabetes costs Minnesota more than $2.6 billion every year in health care costs, premature death and lost productivity. 

  DECADE OF DISCOVERY

But there's hope that the trajectory of diabetes in Minnesota can be reversed. 

  A new partnership between Mayo Clinic and the University of Minnesota, called the Decade of Discovery, is working on ways to make diabetes management more tolerable for patients so they can stick with their treatment plan. It aims to improve patients' health and likely save money on avoidable complications. 

Medication cards
Diabetes medication cards were developed by Dr. Victor Montori, a Mayo Clinic researcher and clinician, to help patients and their doctors make informed decisions about the medications they use to treat their diabetes.
Photo by Alex Kolyer for MPR

Dr. Victor Montori, a Mayo diabetes specialist, said diabetics might fare better if they could reclaim some of the 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. 

Patrick Minikon would welcome anything to make his diabetes easier to manage.

The father of two was diagnosed with diabetes about four years ago. At just 37, Minikon already takes a daily cholesterol drug, a high blood pressure pill, insulin, another diabetes medication and a multivitamin. Doctors will likely add more drugs to his treatment plan in the years ahead.

When Minikon lost his health insurance for a time this winter, his sister helped him pay for his medications.

It's a lot to juggle, but Minikon realizes that if he doesn't take care of his diabetes properly now, life will become far more difficult for him and his family.  

"The whole thing is really scary. I think about my kids. That scares me more -- that if I don't take care of myself I might not be in the capacity to actually affect their lives in a positive way," he said. "I don't want to be a burden to them or my wife. So I'm trying really hard to do everything I'm supposed to do: work out, eat right, don't drink, don't smoke -- because all of those things affect everything."

But even Minikon's best efforts can only do so much to keep him healthy for the next 40 years or more. The ultimate goal of Decade of Discovery is to find a cure for diabetes.