Bryant Stamford| Special to Courier Journal

Our health care system is amazing, the best the world has ever seen. Is it perfect? No, of course not, nothing ever is, which means it can be improved. How so?

For starters, we need to recognize the greatest challenges confronting our health care system that can be improved and take steps to improve them. Unfortunately,we continually depend on medical science to keep us a step ahead, but thats like trying to remove water from a boat with a hole in the bottom. Its time for us to wake up, acknowledge the problem, and take meaningful steps in the right direction.

Lets begin with recognizing that despite our wealth and prosperity, or perhaps because of it, we Americans live sicker and die quicker than virtually every other industrialized society.

Why? Our lifestyle seems to have been crafted to promote chronic diseases, and we keep getting better at it. Look at the American diet, loaded with processed foods high in saturated fat and sugar. In addition, because food is plentiful and readily accessible, we eat far too much. Combine our horrible diet with a sedentary lifestyle and the result is a fat society.

How fat are we? Recent data indicates that 32.5% of Americans are overweight, 37.7% are obese, and 7.7% are morbidly obese (100 or more pounds above ideal body weight). In total, 77.9% of Americans have a weight problem.

How sedentary are we? The latest data indicates that 77% of adult Americans are sedentary, and only 23% of Americans get sufficient regular exercise. Minimal guidelines suggest at least 150 minutes per week (about 20 minutes daily) of moderate aerobic exercise (brisk walking), or 75 minutes per week of vigorous workout exercise, plus twice a week resistance training to sustain muscle mass.

Too much body fat and too little exercise is the perfect formula for promoting prediabetes (also called metabolic syndrome). Prediabetes precedes Type 2 diabetes (T2d, and its important to understand what this means, and the distinction between Type 1 diabetes (T1d) versus T2d.

When it comes to diabetes, in general, it simply means that you are not regulating your blood glucose (sugar) concentration effectively, leading to an accumulation of glucose in the blood. Too much blood glucose causes all sorts of health problems, including the destruction of tiny blood vessels leading to blindness and amputations, plus its a key risk factor for heart disease, stroke, and kidney failure.

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The problem of too much glucose in the blood can be caused in two different ways.

In T1d, the pancreas gland is not working properly to release insulin. Insulin is necessary to escort glucose into the cells, and without insulin, glucose remains in the blood. T1d typically is detected early in life, and the cause is an autoimmune disorder that destroys pancreas cells that produce insulin. Of all the diagnosed diabetics in the U.S., only about 5% (1.25 million) are T1d.

The vast majority of diabetics are T2d, with an estimated incidence of 34.2 million (10.5% of the U.S. population). Of these 34.2 million, only 26.9 million have been diagnosed, which means 7.3 million Americans have T2d and dont know it. T2d is caused by insulin resistance. This means that unlike Type 1 diabetes, the pancreas gland is doing its job to release an adequate amount of insulin, but the cells of the body are not responding.

While the number of Type 2 diabetics is alarming, it pales in comparison with the estimated 88 million (34.5% of adults in the U.S.) with pre-diabetes. Both pre-diabetes and T2d are caused by insulin resistance. The difference is that in T2d there is a more extreme resistance to insulin, resulting in a higher glucose concentration in the blood. If pre-diabetes is left untreated, odds are good it will eventually morph into T2d.

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When there is too much glucose in the blood, an excessive amount attaches to proteins, making it harder for proteins to repair themselves, leading ultimately to cellular destruction in small blood vessels and elsewhere. A diagnostic test for both prediabetes and T2d is the hemoglobin A1c test which determines the amount of glucose attached to the proteins in hemoglobin (the main component of red blood cells). This offers an easy and convenient way to gauge how much glucose-to-protein binding is occurring throughout the body.

A normal A1c level is below 5.7% (the lower the better), whereas levels of 5.7% to 6.4% indicate pre-diabetes. When A1c levels exceed 6.4% (extreme insulin resistance), the diagnosis is T2d.

Is the future incidence of T2d a threat to bankrupt our health care system? Hard to say, but it certainly will impose major stress. Diabetes is a very expensive disease to treat, costing on average more than double the medical cost per patient without diabetes. Worse, when you project into the future and see the 88 million prediabetics progressing toward T2d, the magnitude of the problem is obvious. Add to this the scary fact that pre-diabetes and T2d are showing up in progressively younger Americans.

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So, what can we do about this? Lets start with understanding the problem. Prediabetes and T2d are caused by insulin resistance, and the main factor driving insulin resistance is excess abdominal fat, specifically the visceral fat that lies beneath the layer of abdominal muscles and surrounding body organs.

An effective overall strategy for reversing prediabetes entails a short-term and long-term approach. Starting immediately, a brisk 20-30 minute walk is effective because it counteracts insulin resistance, making the cells of the body more insulin sensitive. But like a pill, the effects of exercise are acute and short-lived and must be renewed daily. In the long-term, take steps to reduce body fat, especially belly fat, to overcome insulin resistance.

And when prediabetes progresses to T2d, its important to know that the effects can possibly be reversed with the same short and long-term approach. However, if you ignore the problem for too long, it may not be reversible, so take action today.

Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.

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Will diabetes cripple our health care system? Maybe. Here's how to prevent the disease - Courier Journal