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MONDAY, March 22 (HealthDayNews) -- Emerging outbreaks such as SARS, Ebola and avian flu make the most dramatic headlines, but there's a more destructive epidemic that threatens far more lives in the United States and the rest of the world: Diabetes.

Diabetes is the sixth leading cause of death in the United States. It was directly or indirectly implicated in more than 213,000 deaths in 2000, according to the U.S. Centers for Disease Control and Prevention.

To focus attention on this growing epidemic, the American Diabetes Association has declared March 23 American Diabetes Alert Day.

Experts believe that 18.2 million Americans, or about 6 percent of the adult population, have diabetes, although only 13 million know it. Between 90 percent and 95 percent of diabetics have the type 2 form of the blood sugar disease, the version closely linked to excessive weight.

Unlike type 1 diabetes, in which insulin producing cells in the pancreas die off early in life, patients with type 2 diabetes gradually lose sensitivity to the hormone but continue to make it. Many of these patients require daily injections of insulin to make up for the reduced ability of their cells to respond to insulin.

In addition to people with full-blown diabetes, at least 20 million other Americans have a precursor condition called pre-diabetes. These people show signs of insulin trouble and abnormally high blood sugar that's alarming but not high enough to be called diabetes.

This simmering situation carries its own risks. Scientists have mounting evidence that even moderate blood sugar problems can seriously harm the heart, blood vessels, kidneys and other organs.

As bad as the picture appears, the future only looks worse.

"The worst case scenario is that we'll just get fatter and fatter and more sedentary until we look like Jabba the Hutt [the galactically obese crime kingpin from Star Wars] and everybody will have diabetes in their 40s and 50s," says Dr. John Buse, director of diabetes care at the University of North Carolina School of Medicine.

People who do develop diabetes in their 40s can expect 15 to 20 years fewer, on average, of quality life, Buse, president of the American Diabetes Association, says. "It's a pretty dismal picture." Unless trends change dramatically for the better, one in two Americans born today will be a middle-aged diabetic, he says.

The good news, however, is that pre-diabetes doesn't have to make the jump to the real thing. Taking steps to improve blood sugar, such as losing weight, quitting smoking and exercising regularly, can prevent pre-diabetes from evolving into diabetes.

"It looks like moderately vigorous physical activity, 30 to 60 minutes most days of the week is enough" to control blood sugar, Buse says.

Another tip: Watch the intake of junk foods, swapping them for fresh fruits and vegetables. Also, avoid high-calorie snacks. And be sure to get regular checkups. "Most of these things we can see coming for years, if not decades," Buse says. "Don't neglect yourself."

Dr. Christopher Saudek, a Johns Hopkins University diabetes expert and a past president of the American Diabetes Association, says keeping a close eye on blood sugar is especially important for people at high risk of diabetes and those with a family history of the disorder.

"People at risk are really well-defined," Saudek says. "They're overweight, they have a strong family history of diabetes, a history of diabetes during pregnancy, or they're members of certain minority groups" including blacks, Hispanics and American Indians.

People in these categories should have their blood sugar tested often, probably once a year, he says. Those who aren't at high risk can be tested every three years, starting at age 45, Saudek says.

If a test indicates pre-diabetes, Saudek says, it's time to take action. "Work on some healthy habits like losing weight and being active," he says. "Even by losing five to 10 pounds the blood sugar can improve and may go back to a perfectly normal level."

More information

To learn more about diabetes, visit the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases.

(SOURCES: John Buse, M.D., associate professor, medicine, University of North Carolina, Chapel Hill; Christopher Saudek, M.D., professor, medicine, Johns Hopkins University, Baltimore)

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