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The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.

That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.

At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.

One factor driving the soaring costs: the number of people living with diabetes for lengthy periods, the researchers said. Over time, the cost of caring for someone with diabetes tends to rise along with their risk for developing complications, such as end-stage renal disease, which requires dialysis.

“We believe our model provides a more precise estimate of what the population size will look like and what it will cost the country and government programs like Medicare,” said study author Dr. Elbert Huang, an assistant professor of medicine at the University of Chicago.

Prior forecasts, including the ones currently used by the federal government’s budget analysts, have underestimated the burden, the researchers said. A 1991 study, for example, predicted that 11.6 million people would have diabetes in 2030. In 2009, there were already more than twice that many living with diabetes.

“In a similar way, we may be underestimating what’s happening, which is actually very disturbing,” Huang said.

Among Medicare beneficiaries, the number with diabetes is expected to rise from 8.2 million to 14.6 million in 2034, with an accompanying rise in spending from $45 billion to $171 billion.

“That essentially means that in 2034, half of all direct spending on diabetes care will be coming from the Medicare population,” Huang said.

The study is published in the December issue of Diabetes Care.

The high cost of chronic disease is one of the most pressing issues facing the United States as legislators grapple with financial strains on Medicare and the larger issue of health-care reform, the researchers say.

Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don’t use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.

Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said the study is one of several recent papers predicting a dramatic rise in the incidence of diabetes. And though which methodology provides the most accurate predictions is open to debate, he said, the overarching message is that steps need to be taken to prevent diabetes from overwhelming an already overburdened health-care system.

“This is, in a sense, evidence of an iceberg,” Kendall said. “What we are seeing currently is only a fraction of the potential future risk.”

In making their estimates, the researchers used data on people 24 to 85 years old who took part in the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey and the National Health Interview Study.

“This is clearly a very pressing problem,” said study co-author Michael O’Grady, a senior fellow at the National Opinion Research Center at the University of Chicago. “It’s one of the few chronic illnesses we have that is growing, and the cost of doing nothing is going to be quite high.”

Matt Peterson, director of information resources at the American Diabetes Association, said that community-based intervention programs that include dietary counseling and exercise, such as walking for 30 minutes most days of the week, can help combat the trend.

“We’re not talking about massive weight loss or for everyone to become marathon runners,” Peterson said. “We are talking about modest weight loss of 10 to 15 pounds. It’s a challenge, but it’s an achievable goal.”

For those with diabetes, the American Diabetes Association recommends modest weight loss, increased physical activity, maintaining A1C (blood sugar) levels below 7, cholesterol control and blood pressure control to prevent complications.

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If you’ve been diagnosed with cancer, it’s a difficult task to inform friends and family.

The American Cancer Society suggests how to approach the subject:
Compose a list of people you want to tell yourself, and other people you want them to notify for you. Also, jot down thoughts about how you’d like to begin, and what you want to share.
Explain your type of cancer, and share as much about your diagnosis, prognosis and treatment options as you are comfortable with.
Encourage family and friends to do research on their own.
Think about any topics that are too difficult for you to discuss, and avoid those topics.
Compose responses to likely questions, and know when and how you’d like to end the conversation.

New research sheds light on the possible link between the genes you inherit and the size of your belly.

Participants in a French study doubled their risk of having fat around the abdomen if they had a certain genetic trait, and the more of these traits one had, the greater the risk for a pot belly.

The study was looking at metabolic syndrome, a condition in which abdominal obesity, high cholesterol and high blood pressure combine to raise the risk of several diseases such as stroke, heart disease and type 2 diabetes.

The findings are just one more piece of the obesity puzzle, a nutrition specialist said.

“Certainly it adds to the body of knowledge, but we need to look at what it means within the big picture and context of all the other obesity research,” said Lona Sandon, an assistant professor at University of Texas Southwestern Medical Center and spokeswoman for the American Dietetic Association.

Results of the study, which was designed to explore a possible link between genes and metabolic syndrome, are published in the November issue of the Journal of Nutrition.

The researchers followed 1,754 French people for seven and a half years, tracking what they ate. They found that having any one of five genetic traits doubled the risk that a person would have abdominal obesity, and that eating a lot of saturated fats boosted the risk even more. But they also found that having one of the genetic traits didn’t boost the risk of metabolic syndrome.

Sandon said the study doesn’t confirm that the genetic trait directly leads to obesity. The findings, she said, show “an association, not a cause-and-effect.”

Also, she pointed out that while the study found a relationship between the gene and abdominal obesity, some subjects were consuming more than 15.5 percent of their calories from saturated fat.

The current recommendation is 10 percent for most healthy people and 7 percent for those with high cholesterol and other metabolic risk factors for heart disease, she said.

In the larger picture, researchers are beginning to understand how genetics are connected to obesity and “how those genes are affected by environment and food components,” Sandon said.

“The mystery is how do we put this into real health recommendations, and how do multiple genes work together to promote or squelch obesity,” she said. “If there were just one gene related to obesity, the answer might be simple. But we know multiple genes are involved, so it is difficult to make hard and fast conclusions about what people should do with this information.”

When it comes to obesity, the factors of genetics, diet and exercise — or lack thereof — are indeed “highly entangled,” said study co-author Dr. Richard Planells, a professor of biochemistry at University of Aix-Marseille II in France.

What to do? At the moment, genetic tests to track these particular genes aren’t feasible. “Many other genes have to be analyzed before one can design a genetic map,” Planells explained.

Even if there was such a test, “the majority of control is always in your hands,” added Cynthia Sass, a registered dietitian and author in New York City. “Even if you have strong genetic predispositions to obesity or any disease, you are not guaranteed to develop that disease. Given the exact same lifestyle, yes, you will have a higher risk, but the bottom line is that the majority of the risk lies in how you treat your body, and that’s empowering.”

Autistic children are more likely to have handwriting problems, including trouble forming letters, than those without autism, researchers say.

The new study included 28 children, aged 8 to 13. Half of the study participants had autism spectrum disorder, but all of the children scored within the normal range for perceptual reasoning on an IQ test.

The children were asked to copy a scrambled sentence — “the brown jumped lazy fox quick dogs over” — to eliminate any speed advantage for children who were more fluent readers.

Five categories were used to score the participants’ handwriting: legibility, form, alignment, size and spacing. Half of the 14 children with autism earned less than 80 percent of the total possible points, compared with one of 14 children in the group without autism. Nine of the children with autism scored below 80 percent in the form category, compared with two of the children without autism, the researchers reported.

The overall handwriting quality was poorer in children with autism, but all of the children in both groups were able to align, space and size their letters equally well, the study authors noted in their report in the Nov. 10 issue of Neurology.

“Our results suggest that therapies targeting motor skills may help improve handwriting in children with autism, which is important for success in school and building self-esteem,” study author Amy Bastian, of the Kennedy Krieger Institute and Johns Hopkins School of Medicine in Baltimore, said in a news release from the American Academy of Neurology. “Such therapies could include training of letter formation and general training of fine motor control to help improve the quality of their writing.”

A new “atlas” of bacterial life on and within the human body has uncovered the fact that your palms, feet and forearms are a veritable United Nations of germs.

The scientists, using sophisticated gene-sequencing technologies, pinpointed specific bacterial types and where they like to thrive on and within the body. They found a wide variability of bacteria, depending on the spot on the body. They also found that bacterial colonies differed person to person, with each individual carrying his or her own “personalized” assortment of microorganisms.

“We’ve always known that there are microbes on us and in us,” said study author Noah Fierer, an assistant professor of microbial ecology at the University of Colorado at Boulder. “But we weren’t always able to isolate them and differentiate them from each other. With these new techniques, we can.”

“Each of us is really an archipelago of distinct habitats, at least as far as bacteria are concerned,” added senior study author Robert Knight, an assistant professor of chemistry and biochemistry and computer science at the University of Colorado. “It’s truly amazing how different the sites within the same body are, and how different the corresponding sites on different people are.”

The team’s work is being published Nov. 5 in the online version of Science. The study builds on earlier research, including a 2008 study that found that women had a greater diversity of bacteria on their palms than men.

The mapping project focused on seven to nine men and women, who were examined four times each over a three-month period. Researchers swabbed 27 different sites, searching for bacteria in virtually every nook and cranny, from hair to ear wax, mouth to nostril and trunk and legs.

So, where are the most popular places for bacteria to hang out? They seem to like the gut (no surprise there), forearms, palms, index fingers, the backs of the knees and soles of the feet, according to the study. At least that is where some of the most diverse and thriving colonies take root.

Some bacterial communities appeared to strongly prefer one body spot over another. For example, when the scientists transplanted microbial groupings from the forearm to the forehead, the germs failed to thrive. But doing the reverse — transplanting communities from forehead to forearm — didn’t seem to impede bacterial growth.

Researchers focused on bacterial diversity rather than bacterial quantity. There are thousands of bacterial types, but certain ones seemed prominent in the study, said Fierer. Four bacterial groups stood out — Actinobacteria, Firmicutes, Proteobacteria and Bacteroidetes — and they were relatively stable over time. Individual bacterial types included the Streptococcus and Staphylococcus bacteria.

In some ways, the mapping efforts spurs more questions than it answers. Researchers are not sure why the forearms and other body parts attract so much microbial diversity. Also, it is not clear whether the different strains compete with each other or live in a kind of bacterial harmony.

Researchers also want to know whether people are born with these bacterial colonies or develop them after birth, through external contact with their mothers and during the delivery process. Even more fascinating is why each person has his or her own blend of bacteria — much like a fingerprint. Perhaps diet, climate, locale or a combination of variables are responsible for each person’s unique bacterial make-up, said Fierer.

Most important, researchers want to know how the colonies impact health and whether they can be harnessed in some way to treat disease. In the future, for example, microbial mapping could lead to routine screening of patients as a way to record a baseline of their normal microbial communities. Any later deviation could be a sign of disease.

“Our ultimate goal is to devise strategies for personalized medicine, based not on the human genome, where we are all 99.9 percent identical, but on the human microbiome, where we are 80 to 90 percent different from one another,” added Knight.

Women with atrial fibrillation are significantly more likely to have a stroke or die than are men with the heart condition, a new study has found.

Despite this, the study suggests, women with the condition receive less medical attention than men.

Atrial fibrillation occurs when the two small upper chambers of the heart, the atria, quiver rather than beat effectively. This can lead to pooling and clotting of blood. If a clot travels from the atria to an artery in the brain, it can cause a stroke.

Rush University Medical Center researchers reviewed past studies and medical literature and found that women with atrial fibrillation are more likely than men to experience symptomatic attacks and have recurrences, and that women have significantly higher heart rates during atrial fibrillation, which increases the risk for stroke.

“Stroke is one of the most devastating results of cardiovascular disease, and atrial fibrillation increases the risk of stroke,” the lead investigator, Dr. Annabelle Volgman, medical director of the Heart Center for Women at Rush University Medical Center, said in a news release from the hospital. “Women are at higher risk of atrial fibrillation-related stroke than men and are more likely to live with stroke-related disability, which can significantly lower quality of life.”

Volgman and her fellow researchers reviewed 20 years of studies that examined gender differences in atrial fibrillation and “were able to determine the most rational, safe and effective gender-specific approach to therapy for women.”

For starters, prevention therapies should be emphasized, the researchers said, as should treatments to ensure safe management once the condition is diagnosed.

Their findings and recommendations related to gender differences included:
Women are not prescribed blood thinners as often as men, resulting in a higher incidence of the formation of clots that break loose and block other vessels. The risk/benefit ratio should be assessed individually for each woman.
Women have a greater risk of bleeding from anticoagulation therapy, so this treatment must be monitored carefully.
Closely monitor women being treated with antiarrhythmic drugs because they have a higher risk for life-threatening arrhythmias and slow heart rates requiring permanent pacing.
Women’s hormonal fluctuations can cause more life-threatening arrhythmias.
Monitor women’s potassium levels in the blood because they have a higher risk of low levels, which boost the risk for drug-related arrhythmias.
Because women have a higher sensitivity to such therapies as statins and vasodilators, liver and kidney function should be closely watched.
Women are referred less often or later for non-drug treatments such as pacemaker implantation or ablation. Ablative therapy should remain an option for symptomatic women because they have success rates similar to those of men.

The study also found that, in general, women with atrial fibrillation have a lower quality of life than men with the disease. But the researchers said that careful assessment and relief of symptoms, and adequate control of heart rate or rhythm can make things better.

“For women with atrial fibrillation, these gender differences should always be kept in mind to help prevent strokes and heart failure and improve their quality of life,” Volgman said.