Why a Spike in diabetes hospitalizations?

A recently published study in the journal Diabetes Care documents a 38% increase in the rate of hospitalization for diabetes among children and young adults, defined as ages 0 to 29, over the period from 1994 to 2003. The increased rate of hospitalization was almost entirely among young adults rather than children. The interpretation pitched by the mainstream media (Reuters Health for example) is that this is the result of the rising rate of diabetes. I think this is quite wrong. Follow me below the fold to see why.

I hope I don't bore people to death, but some details are in order. Diabetes mellitus is really two diseases that have essentially nothing to do with each other.

Type-1 diabetes, previously known as juvenile diabetes, results from the autoimmune destruction of the pancreatic islet cells that produce insulin, leading to absolute insulin deficiency and rapid onset of very high blood sugars. Patients typically present very sick, are immediately started on insulin, and remain insulin dependent for life.

Type-2 diabetes by contrast generally involves the insidious onset of resistance to insulin, followed by gradually rising blood sugars. It is strongly linked to obesity, consumption of large amounts of dietary sugar and starch, and sedentary lifestyle. This is the kind of diabetes that is becoming epidemic, and which threatens to engulf the upcoming generation of overweight kids. It's often treated with diet, exercise, pills and, eventually, insulin as well.

Here's the thing. Per-capita type-1 diabetes rates are essentially flat; they are not increasing. Type-2 diabetes rates by contrast are exploding, paralleling our obesity epidemic. This promises a calamity in the future with mushrooming rates of stroke and heart disease, kidney failure and amputations. But all these complications happen years, even decades, after the disease shows up. And type-2 diabetics very rarely require hospitalization for diabetes itself, especially in otherwise young and health patients- like those below age 30.

Type-1 diabetics, on the other hand, often require hospitalization when their diabetes gets wildly out of control. When blood sugar sails sky-high they get into a life-threatening condition called keto-acidosis. Or when their sugar gets way too low, they're in an insulin coma and unconscious. Both situations land them in the hospital.

So if type-1 diabetes rates are flat, and if type-1 diabetics make up essentially all patients younger than 30 requiring hospitalization, then why are hospitalization rates up 38%? Well, that's just the kind of intelligent question our brain-dead mainstream media never think to ask.

In fact this is the direct result of our deteriorating health care system and the rising tide of uninsured patients. It's one more canary in the coal mine. When kids and young adults lose health insurance, when they can't see a doctor, can't afford their test strips or insulin due to rising co-pays...their control deteriorates and they end up hospitalized. I suspect that this is happening more in young adults than in kids because more children are covered by some type of insurance (though Chimpy is trying to fix that by vetoing S-CHIP). Yes, there's an epidemic of type-2 diabetes exploding onto the scene; but that's not putting all those young diabetics in the hospital. It's the uninsured crisis and murder-by-spreadsheet that's doing that.