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Diabetes
Descriptive Epidemiology Project
Diabetes is a chronic metabolic disease that imposes a considerable burden on both
individual patients and healthcare system. An astounding 382 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
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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)
Rate of new cases of type 1 and type 2 diabetes among people
younger than 20 years, by age and race/ethnicity, 2008–2009
<10 years
10–19 years
Source: SEARCH for Diabetes in Youth Study. NHW =non-Hispanic whites; NHB=non-Hispanic blacks; H=Hispanics;
API=Asians/Pacific Islanders; AIAN=American Indians/Alaska Natives.
*The
American Indian/Alaska Native (AI/AN) youth who participated in the SEARCH study are not representative
of all AI/AN youth in the United States. Thus, these rates cannot be generalized to all AI/AN youth nationwide.
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
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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.
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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 diabetes this 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)
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Type 2 diabetes, this is the most common type of diabetes accounting for about
90% to 95 % of diagnosed diabetes in 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)
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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)
Obesity Is 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
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combined with longer life spans have increased the lifetime risk of developing
diabetes to about 40% in adults; 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 for type 1 diabetes are 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 developing gestational 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 longterm effects than non-Hispanic white women.” (Diabetes 2014 Report Card)
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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. During their
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
Age-adjusted* percentage of people aged 20 years or older
with diagnosed diabetes, by race/ethnicity,
United States, 2010–2012
*Based on the 2000 U.S. standard population.
Source: 2010–2012 National Health Interview Survey and
2012 Indian Health Service’s National Patient Information Reporting System.
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,
the incidence 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.
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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 all static 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)
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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 including poor 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
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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.
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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 new risk
factor for type 2 diabetes and obesity.
Works Cited
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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
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Epidemiol 2014, 24, p.460-468. Copyright 2014 by Yusuke Kabeya et al.
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Bertha (Lily) Gonzalez
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