New York is in the midst of a diabetes epidemic with more than one in eight of the city's population developing the condition, according to a report in the New York Times.
The problem, which affects an estimated 800,000 New Yorkers, has become so acute that doctors are warning diabetes could overwhelm the city's health service, leaving schools struggling to cope with more diabetic children and increasing the number of people with disabilities.
"Either we fall apart or we stop this," Thomas Frieden, commissioner of the New York City department of health and mental hygiene, told the New York Times.
The paper has conducted a year-long investigation into the disease and claims that the city harbours all the ingredients for a continued epidemic: large numbers of poor citizens and a growing number of Latinos, who get the disease in disproportionate numbers, and of Asian people, who can develop diabetes at much lower weights than other races.
New York has a diabetes rate one-third higher than the rest of the country. Overall, nearly 21 million Americans are believed to be diabetic, and one in three children born in the US five years ago is expected to develop the disease at some point. Children are becoming increasingly affected by type 2 diabetes - the predominant form of the disease linked to being overweight or obese - something the newspaper said was almost unheard of 20 years ago. According to the American Diabetes Association, the disease could lower American life expectancy for the first time in more than a century.
People with diabetes are up to four times more likely to develop heart disease or have a stroke, while many suffer nervous system and circulation problems that can lead to amputations.
New York is also prone to the disease because of high levels of poverty, with as many as 20.3% of the city's population living below the poverty line compared with 12.7% nationwide.
African Americans and Latinos - particularly Mexicans and Puerto Ricans - get diabetes at almost twice the rate of whites, according to the paper. The disease is particularly prevalent in the Bronx and Brooklyn, and much lower in mainly white areas such as the Upper East Side.
Some scientists believe that a higher proportion of people in these groups have a "thrifty gene" that enabled ancestors who farmed and hunted to stockpile fat during times of plenty. The American predilection for jumbo meals, burgers and pizza means the gene is now working against them, hoarding unhealthy levels of fat.
Where New York leads, the rest of the world is following. The UK's obesity epidemic, the precursor of a diabetes epidemic, is thought to be a couple of decades behind the US, but few experts have any doubt that the pattern will be the same without serious action.
In 1996, 1.4 million people were diagnosed with diabetes, according to the charity Diabetes UK. People with type 2 diabetes may not realise the cause of their tiredness, but if it is not spotted in time, it can lead to complications that include blindness and amputations.
Diabetes UK says that around 3% to 5% of the UK population has diabetes, but the incidence is higher in areas where there are large black or Asian communities. In Brent, the incidence is 6%, in Leicester 5.9%, in Wolverhampton 5.79% and in Newham in London, it is 5.64%. Type 2 diabetes has also started to appear in children in the UK for the first time.
At a glance
· Diabetes is caused by a deficiency of insulin, which makes the body unable to use glucose to produce energy
· Type 1 is genetic, often diagnosed young. Type 2 is more common and can be triggered by obesity
· Diabetes increases risk of heart disease, stroke and kidney failure
· The NHS spends an estimated £5.2bn a year on diabetes and associated complications
