Endocrinologist Expert Witness

Endocrinologist from Pennsylvania

Diabetes is epidemic in the United States. Especially in Latinos and African Americans. Diabetes affects 21 million Americans- 7% of the population – and will grow to 22 million by 2025. A new diagnosis of diabetes is made 2200-3500 times each day, yet 25% of people with diabetes are undiagnosed! The estimated costs of managing people with diabetes approaches a staggering 132 billion dollars a year. Thus Type II diabetes represents a major health care crisis and continues to grow.

Diabetes vents its damaging effects on multiple organs. Each year 82,000 amputations, 18,000 cases of blindness, 41,000 new dialysis starts and 213,000 people die from diabetes and its complications. The vast majority of deaths come from cardiovascular disease. Strokes are also a devastating complication. Women are particularly prone to suffer from diabetes related deaths. Although great strides have been made in the treatment of diabetes and its complications the disease continues to wreck havoc with disability and shortened lifespan.

Type II diabetes represents over 90% of all the cases of diabetes. This is characterized by an adult onset although there is an increasing prevalence of this type of diabetes in teenagers! Type II diabetes is caused by a resistance to the action of insulin and eventual loss of insulin production. Resistance to insulin leads to inflammation and blockage of small and medium arteries. Organs such as the brain, heart, eye and kidney suffer the results of poor blood supply and the development of atherosclerotic plaques. There is progressive loss of organ function. This also includes nerve damage with neuropathy and loss of sensation with resultant foot ulcers and amputations.

Making an early diagnosis of diabetes and identifying complications as early as possible is critical. The modern approach to diabetes includes aggressive treatment to improve insulin sensitivity and replace the missing insulin. What we have also learned is that people with diabetes must be treated vigorously with normalization of blood pressure and correction of lipid abnormalities.

Diabetes is not caused by a single gene or metabolic problem. Multiple hormonal abnormalities have been identified. This makes treatment complex but also offers many opportunities for new drug intervention. The past 10-15 years has seen an explosion of new treatment modalities for diabetes and has opened up the possibility for new approaches to overcome the metabolic problems.

Many patients with Type II diabetes will require insulin treatment. The past several years has seen the emergence of new insulins with steady action levels and improved delivery systems. For the first time inhalable insulin is now available obviating the need for frequent insulin injections.

Despite these new innovations the hallmark of diabetes treatment remains proper diet, weight control and exercise. With appropriate lifestyle changes diabetes can be delayed or improved by modest weight control and regular exercise. Diabetes is a complex and potentially severe medical problem. However, the future does look bright. Early identification and forceful treatment with lifestyle changes and medication has delayed or prevented diabetes and its complications. New medications, insulins and delivery systems have made treatment easier and more effective. And new discoveries about the process of diabetes itself will open more doors to the understanding and treatment of this widespread disease.


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