To understand the magnitude of the diabetes problem, consider its impact on a village of 1,000 adults with the same 9 percent adult diabetes rate as southwestern Pennsylvania.

This hypothetical example was compiled with help from Gretchen A. Piatt, an epidemiologist with the University of Pittsburgh Diabetes Institute, along with figures from the state, American Diabetes Association and the Centers for Disease Control and Prevention.

In the village, 90 people -- 42 males and 48 females -- would have type 1 or type 2 diabetes. Those numbers include eight African-Americans, with the remainder being Caucasian.

Treating these 90 people costs $1.19 million a year.

Of the 66 villagers who are 35 or older with diabetes, 15 have heart disease and six have had a stroke. But when all is told, as many as 59 of the 90 -- or 65 percent of all people with diabetes -- will die of heart disease or stroke.

That percentage represents two to four times the death rate from heart disease and stroke than occurs in the population without diabetes.

Of the 90 villagers with diabetes, 65 have high blood pressure, equal to or greater than 130/80, or are taking medication to treat hypertension.

One villager is suffering from end-stage renal disease. One has eye disease, impaired vision, and possibly blindness, due to diabetes.

Sixty three of the 90 with diabetes have mild to severe forms of nervous system damage, including impaired sensation or pain in the feet or hands, slowed digestion, carpal tunnel syndrome or other nerve problems. One or two villagers have had feet or legs amputated due to circulation problems combined with nerve damage that impairs sensation in one's limbs.

And 30 villagers with diabetes have severe gum disease with some loss of attachment to the teeth.

All 90 are more likely to die of pneumonia or influenza than people without diabetes, especially if they have not received vaccines.

On average in the village, the 42 males with diabetes will live 12 fewer years than men without diabetes, and the 48 females with diabetes will live 14 fewer years than women without the disease.

And if the epidemic burgeons at the same rate it has nationally, 34 additional villagers, and possibly more, will develop diabetes by 2011. That would push the village total to 124, or one in every 8 adults.

But it does not end there.

Villagers with prediabetes, or elevated blood-glucose levels yet to develop into full-fledged diabetes, number 180. So 270 people -- or more than a quarter of the village's adult population of 1,000 -- have diabetes or face prospects of developing it, if preventive measures are ignored.

One key reason for the type 2 epidemic is that 442 of the 1,000 villagers are overweight, and 220 are obese, which are risk factors for type 2. That means almost two-thirds of the village population, or 662 people, are carrying too much weight, some excessively so.

So diabetes takes a heavy toll on the village population.

Unfortunately, this grim scenario exists in every community statewide, with only slightly lower rates, on average, across the nation.