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Diabetes Mellitus Type II has been a failure to treat.

Type II diabetes (Adult Onset Diabetes) counts for over 90% of all cases. The epidemic keeps growing as the number of obese Americans reaches an all time high. We should all be deeply concerned about the onslaught of disease prevalence associated with Type II Diabetes and obesity. They are likely to bankrupt our healthcare system. Drug companies and bariatric surgeons see great PROFITS in diabetes and obesity respectively.

The diagnosis of Diabetes can be established if the fasting plasma glucose is 126 mg/dl or greater on two different occasions. The diagnosis is likely if a patient has specific symptoms, extreme thirst (polydipsia), excessive urination (polyuria), weight loss, overwhelming vaginal yeast infection or yeast balanitis and a random glucose that is over 200 mg/dl. A simple screening can be done by checking the urine glucose via a Diastix which is available over-the-counter. There are infrequently some false positives with Diastix, and patients must have public access so that they can check their plasma glucose with the aid of a readily available professional (Pharmacist) or nurse. If the urine shows glucose, it means that the blood level exceeded the renal threshold of 180 mg/dl and the body dumped excess glucose, a protective mechanism, into the urine. Our immune system does not function well when the glucose is over 180 mg/dl.

For Type I Diabetics (Insulin Dependent) diabetics are thin, young and have excessive eating (polyphagia) and dramatic weight loss and many of the same symptoms described above for Type II Diabetes.

What are the best approaches to reign in Diabetes and Obesity and thus reduce morbidity, and mortality? We must address the various factors that contribute to excess in caloric intake. It may be very difficult for patients with anxiety, stress or depression to follow specific caloric restrictions or guidelines. The provider must meet with the family and encourage certain nutritional changes at home. Instead of investing more on of the same or "Me Too Drugs," we must focus on new horizons.

We must consider expanding the dietitian's role and make them readily available for home visits. Psychologists must be recruited in other to help "bad habits" become "healthy habits." The psychological aspects cannot be underestimated. I do recommend that we begin to prescribe a specific diet for our diabetics, be it through Jenny Craig or new private companies rather than "new" and toxic drugs. We as physicians must be able to prescribe a specific diet or intake per day that is managed by allied healthcare professionals who report to the primary care provider.

For instance, if an adult's daily requirement is 2,000 Calories/24 hours, and we reduce his intake to 1,800 Calories/24 hours, then this patient would lose, on average, 3.8 pounds per month or more if an exercise regimen is added. There is a euphoria associated with weight loss and a dysphoria associated with obesity.

The time has come for us to re-invent our approach to Obesity and Diabetes. The drug companies are poised to develop profitable new drugs. We must view this with fear since many of these drugs are toxic as was Rezulin (troglitazone), which was taken off the market because of liver toxicity. Two similar drugs, Avandia (rosiglitazone) and Actos (pioglitazone), should be studied by the clinician before prescribing them. For instance, Avandia may be less hepatotoxic, but it has potentially serious side effects that include "cardiac events," edema, fluid retention (which may exacerbate hypertension).

Clinicians must encourage their patients to become fiscally responsible, comply with treatment and find ways to modify the environment that has made the consumption of food socially acceptable. The best treatment for Type II Diabetes is through diet and exercise. If drugs are to be used, we already have many generics available, the Sulfonylureas like Glipizide, Glyburide and the Biguanides, Metformin (Glucophage).

It has become evident that our private (and public) companies can no longer afford retiree health care, i.e., General Motors. At present, only 33% of companies with more than 200 employees offer retiree health benefits compared to 66% in 1988. The business community, especially small employers, cannot afford to provide health care coverage as envisioned by Senator Clinton.

"The evolving public morality seems to be turning away from the concept of health care as a right, toward treatment of health as a private matter," NEJM, September 20, 2007. Before we let health care become a private matter, we must educate consumers on how to get the most value out of health care. We must all get involved.

Luis Lomeli MD/Beta