Descriptive Epidemiology Project

Diabetes

Diabetes is a chronic metabolic disease that imposes a considerable burden on both individual patients and healthcare system. An astounding382 million people estimated to have diabetes around the world.(International Diabetes Federation IDF 2014) Socially and economically disadvantaged people are the most affected by diabetes. Four out of five people with diabetes live in countries with less financial resources (International Diabetes Federation IDF 2014). The number of people with diabetes is increasing due to the population growth, aging, urbanization, increasing prevalence of obesity and physical inactivity. (Global Prevalence of diabetes 2014)

“Younger people are developing diabetes now, a trend that is very worrisome for future generations. If these patterns continue,more than 592 million people will be affected with diabetes within a generation. This figure takes into account changes only in the population and patterns of urbanization;Estimates of type 1 diabetes in young people also show unexplained and rapid increases in several regions along with the rise in type 2 diabetes in older populations.” (IDF)

The burden is also seeing in the growing number of premature deaths due to diabetes. In 2013,roughly half of all deaths due to diabetes in adults were in people under the age of 60, and in less-developed regions like sub-Saharan Africa, that proportion climbs to 75%.

Nationally every 19 seconds, someone is diagnosed with diabetes.That’s more than 32,000 friends, neighbors, co-workers and family members in the next 7 days. (American Diabetes Association 2014)

According to the CDC, more than 29 million people or 9.3 of the population of United States are estimated to have diagnosed or undiagnosed diabetes, this is about one out of 11 people. One out of 4 of them don’t know they have diabetes and one out of 9 healthcare dollars is spend in diabetes care. In 2013 diabetes was the 7th leading cause of death, but the fifth cause of death among black, Hispanic and Asians and fourth cause of death among American Indians. (Mary Jane Schneider 2014).

“Diabetes contributes to premature death more often than reported by death certificates, examination of death certificates of people known to have diabetes have found that only 35 to 40 percent of them had diabetes listed anywhere on the certificate.” Many death listed as cause by heart disease may be linked with diabetes and people with diabetes have 2 to 4 times more risk of dying of heart disease. En general the risk of death in people with diabetes is double compare to the risk of people of the same age without diabetes. (Schneider 2014) “Diabetes kills more Americans each year from breast cancer and AIDS combined” (ADA 2015).

In addition of those who already have diabetes The CDC estimates that 86 million adults more than 1 in 3 have prediabetes, which can increase the risk of developing type 2 diabetes, heart disease and stroke.

Among adults, about 1.7 million new cases of diabetes are diagnosed each year. If this trend continues, as many as 1 out of every 3 adults in the United States could have diabetes by 2050.

What is Diabetes?

“Diabetes is a group of diseases marked by high levels of blood glucose resulting from problems in how insulin is produced, how insulin works, or both. If blood sugar builds up in the body and its levels are not controlled, it can cause serious complications, such as heart disease, stroke, kidney failure, and blindness, amputations of the legs and feet and premature death.” (National Diabetes Statistics Report CDC 2014)

There are three main types of diabetes

Type 1 diabetesthis form of diabetes develops when the cells in the pancreas that produce insulin, know as beta cells, are destroyed. This destruction is initiated or mediated by the body’s immune system and limits or completely eliminates the production and secretion of insulin, the hormone that is required to lower blood glucose levels, The onset of type 1 diabetes is sudden and dramatic.The peak age for diagnosis is in the mid-teens. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. In adults, type 1 diabetes accounts for approximately 5% of all diagnosed cases of diabetes. There is no known way to prevent type 1 diabetes. (CDC 2014)

Type 2 diabetes, this is the most common type of diabetes accounting for about 90% to 95 % of diagnosed diabetesin adults. The development of type 2 diabetes is gradual and silence and usually begins as insulin resistance, a disorder in which cells. Primarily within the muscle, liver and fat tissue, do not use insulin properly. As the need for insulin rises, the beta cells in the pancreas gradually lose the ability to produce sufficient quantities of the hormone. The role of insulin resistance as opposed to beta cell dysfunction differs among individuals, with some having primarily insulin resistance and only a minor defect in insulin secretion, and others with slight insulin resistance and primarily a lack of insulin secretion. (CDC 2014)

Gestational diabetes is a form of glucose intolerance, diagnosed during the second or third trimester of pregnancy. During pregnancy high blood glucose levels increase the risk for both mother and fetus and require treatment to reduce problems for the mother and infant. 5% to 10% of women with gestational diabetes continue to have high blood glucose levels and are diagnosed as having diabetes, usually type 2. The occurrence of gestational diabetes itself is a risk factor for developing recurrent gestational diabetes with future pregnancies and subsequent development of type 2 diabetes. Also, the children of women who had gestational diabetes during pregnancies may be at risk of developing obesity and diabetes.Other complications include preeclampsia, high birth weight, birth related trauma, jaundice, low blood sugar (hypoglycemia, and birth defects

In 2009 the prevalence of gestational diabetes among all pregnant women who delivered in a hospital was 5.6% per 100 deliveries (CDC 2014)

Who’s at Risk?

About 8.1 million people with diabetes do not know they have the disease, because both type 2 diabetes and prediabetes have few physical symptoms. For the same reason some do not realize how serious the disease is. People can decrease their chances of getting the disease by knowing their risk factors. (CDC2014)

ObesityIs one of the main factors related to type 2 diabetes. The CDC stated that diabetes and obesity are the twin epidemics because obesity greatly increases the risk of diabetes (Schneider 2014). Unhealthy eating habits, lack of physical activity, and socioeconomic factors contribute to both obesity and type 2 diabetes. Increasing age, race and ethnicity, high blood pressure, history of gestational diabetes, poor nutrition during pregnancy and impaired glucose tolerance (IGT)which is a category of higher than normal blood glucose but below the threshold for diagnosing diabetes are also risk factors for type 2 diabetes.

People with type 2 diabetes and obesity are more susceptible to have uncontrolled blood sugar, blood pressure and high cholesterol levels. Complications of diabetes can be more serious when the person is overweight or obese. Diabetes and obesity combined with longer life spans have increased the lifetime risk of developing diabetes to about 40% inadults; the risk is the same for both men and women.

“Changes in eating habits and physical activity related to rapid development and urbanization have led to sharp increases in the numbers of people developing diabetes type 2.” (CDC 2014)

Risk factors fortype 1 diabetesare still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes.

Nearly 167, 000 youth younger than 20 had type 1 diabetes in 2009. Non Hispanic white children and adolescents have the highest rates of new cases of type 1 diabetes.

Pregnant women who are overweight, have been diagnosed with IGT, or have a family history of diabetes are at increased risk of developinggestational diabetes (GDM). In addition being of certain ethnic groups puts women at increased risk of developing GDM “Asian-American, Native Hawaiian, Pacific Islander, Hispanic, and African-American women are at a disparately higher risk for GDM or its long-term effects than non-Hispanic white women.” (Diabetes 2014 Report Card)

Race and Ethnicity

En general,“Compared with Non Hispanic whites, members of racial and ethnic minority groups are more likely to be diagnosed with diabetes. Duringtheir lifetime, half of all Hispanic men and women and non –Hispanic black women are predicted to develop the disease” (Diabetes 2014 Report Card)

Racial and ethnic differences in diagnosed diabetes among people aged 20 years or older, United States, 2010–2012

Influence of social determinant of health

Social determinants (such as income, education, housing, and access to nutritious food) are central to the development and progression of type 2 diabetes.Moreover,theincidence and prevalence of type 2 diabetes appear to be socially graded, as individuals with lower income and less education are 2 to 4 times more likely to develop diabetes than more advantaged individuals.

The sociobiologic cycle of diabetes.

Social determinants of health encompass factors such as income, education, housing, and access to nutritious food.

Lifestyle factors incorporate dietary choices, physical activity levels, and access to primary health care services.

Biologic responses refer to increased allstatic load, cortisol, blood pressure, and blood glucose levels, while psychological responses connote increased depression and anxiety, as well as decreased self-esteem, energy, and motivation.

Managed condition implies individuals are able to ensure their diabetes is approximately controlled by clinical standards.

Social consequences include increased health care costs and employment complications, as well as decreased productivity and educational attainment potential.

(Hill, Nielsen and Fox 2013)

Summary

Diabetes is a major health problem in our nation. Millions of people around the world have been impacted by diabetes. The burden of this disease is more significant in low and middle income countries. Socially and economically disadvantage people in every country have the higher risk of diabetes.

Every year younger people are developing type 2 diabetes. If these patterns continue 592 million people will be affected with diabetes within a generation.

The cases of type 1 diabetes in young people are growing as well as type two diabetes in older people.

We also have more cases of gestational diabetes.High blood glucose during pregnancy can lead to an increased risk of type 2 diabetes later in life for the child and mother.

In addition of those who already have diabetes the CDC estimates that 86 million adults; more than 1 in 3 has prediabetes, which can increase the risk of developing type 2 diabetes.

Many factors are contributing to this public health issue includingpoor nutrition, lack of physical activity, family history of diabetes, lack of access to medical care, racial background and other social determinants of health, like poverty, low level of education, housing, and lack of access to nutritious food.

Diabetes is a chronic condition and is critical for the patient to have long term medical supervision. This is challenging because lack of medical coverage and lack of access to medical care are common problems in this country (one out of three Latinos are lack of medical coverage and some of them have no access to medical care). Lack of legal status is directly related to the lack of medical services and medical coverage.

Diabetes is silent, this is the reason why some patients don’t take diabetes seriously and delay attention. There is an urgent need of a diabetes education awareness campaign in different languages.

There is also a need to develop culturally and linguistically diabetes classes sensitive to the need of the people e.g., Latinos vs. African American and Native American (The eating habits and diabetes care expectations of these three ethnicities are different).

There is an urgent need to provide diabetes self-management classes and diabetes care at no cost. Patients prefer to pay the rent of the house and to buy food for the family instead of paying for diabetes education.

At the community and institutional level the hospitals and public health clinics has to collaborate together to overcome barriers like lack of transportation, lack of money to pay for medication, mental health issues like depression, literacy and numeracy. The main goal of this collaboration is the prevention of diabetes complications and hospitalization.

Grocery stores, schools, warehouses, the YMCA , leaders of the county and other organization has to be involve in the development of a healthier and happier community e.g. Healthier menus in the school, development of safest places to do physical activity outdoors, implementation of wellness programs in warehouses, early diabetes screening and the promotion of a culture of health to change human behaviors one person at the time.

At the legislation level, Public health clinics have to provide long term diabetes care, medication and self management education at no cost for those patients who need this service. This will save a lot of money to the long term, because will decrease the visits to the emergency department and best of all will prevent complication and improve the quality of life of many diabetic patients.

Finally there is a need of more research and more public awareness about the chemicals and other pesticides within the food and the environment and their relationship to diabetes.

According to the American Diabetes association persistent organic pollutants POPs exist in our everyday environment (we are eating within our food and inhaling them within our air), and they are contributing to the diabetes and obesity epidemic. Exposure to POPs should be considered a newrisk factorfor type 2 diabetes and obesity.

Works Cited

Schneider, Mary Jane. (2014). Introduction to Public Health, Jones and Bartlett Learning.

Friss and Sellers. (2014). Epidemiology for Public Health Practice,

“Global Prevalence of Diabetes “ by S. Wild, G. Roglic, A. Green, R. Sicree and H. King (2004), Diabetes Care, 27, number 5. Copyright 2014 by the American Diabetes Association.
“Understanding the Social Factors that Contribute to Diabetes: A mean to Informing Health Care and Social Policies for the Chronically Ill.” By J. Hill, M. Nielsen, and M. Fox, (2013), the Permanente Journal, 17, p. 62-67. Copyright 2013 by the Permanente Journal
“Descriptive Epidemiology of Diabetes Prevalence and HbA1c Distribution Based on a Self –Reported Questionnaire and a Health Checkup in the JPHC Diabetes Study. By Y. Kabala, M. Kato, A. Isogawa, Y. Takahashi, Y. Matsushita, A. Goto, H. Iso, M. Inoue, T. Mizoue, S. Tsugane, T. Kadowaki, and M. Noda. (2014), J Epidemiol 2014, 24, p.460-468. Copyright 2014 by Yusuke Kabeya et al.
American Diabetes Association., (2015) retrieved from
International Diabetes Federation., (2015) retrieved from :
Center for Disease Control and Prevention (2015) retrieved from
Fast Facts Data and Statistics about Diabetes ., (2014) retrieved from
Welcome to the Purdue Owl., (1995-2015) retrieved from june2014_final3.pdf
Center for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Center for Disease Control and Prevention, Us Dept o Health and Human Services.
American Diabetes Association. (2014). Can Pollution Cause Diabetes and Obesity (2014) retrieved from
American Diabetes Association.(2014). Stop Diabetes (2014) retrieved from
National Diabetes Education Program. (2011) a Program of the National Institute of Health and the Center for Disease Control and Prevention.

Ohio Gestational Diabetes Mellitus. (2013)
Diabetes Risk Factors. (2015) Retrieved from

Bertha (Lily) Gonzalez