Download Type II Diabetes – Final

Type II Diabetes: A Public Health Perspective
By
Rachel A. Franklin
Submitted to:
Dr. Jennifer Janousek
Concordia University of Nebraska
Type 2 Diabetes is a chronic condition in which sugar levels in the blood are elevated.
According to information gathered from the Centers for Disease Control, type 2 diabetes
accounts for 95% of cases of diabetes mellitus. Type 1 diabetes, formerly known as juvenile
diabetes, and gestational diabetes account for the other 5% of cases (Centers for Disease Control,
2011). Diabetes is basically an elevated level of blood glucose. Glucose is a big source of
energy for cells in the body. During digestion, glucose is taken from the food one eats and is
absorbed into the bloodstream. From there, with the help of insulin, glucose is moved to cells in
the body where it is used for energy. Insulin is secreted from the pancreas when one eats.
Insulin helps “open up” cells to allow glucose to enter them. By moving glucose from the
bloodstream to cells in the body, insulin helps to lower glucose levels in one’s blood. The liver
also helps create glucose. It stores and manufactures glucose and when a person hasn’t eaten in a
while and their blood levels of glucose become low, the liver will release glucose into the body’s
bloodstream to help keep one’s glucose levels normal. In diabetes, the body is resistant to
insulin and the pancreas cannot make enough insulin to combat this resistance. Therefore,
glucose derived through food is built up in the bloodstream overtime. Because blood sugar does
not get moved properly to the cells, it is built up in one’s blood. So, basically, having diabetes
means you have too much glucose, or blood sugar, in your blood. Having too much glucose can
lead to many different health problems (Mayo Clinic, 2012).
The symptoms of diabetes include excessive urination (polyuria), excessive thirst
(polydipsia), hunger, weight loss, vision changes, and fatigue (World Health Organization,
2012). In type 2 diabetes, these symptoms can sometimes not be as noticeable. Type 2 diabetes
was for years known as adult onset diabetes, as it was only seen and diagnosed in adults.
However, recently, more and more children worldwide are being diagnosed with type 2 diabetes,
so that nomenclature is no longer used in reference to type 2 diabetes. Over time, diabetes can
cause severe damage to many organs, including the heart, eyes, blood vessels, kidneys, and the
neurological system. The long term risks associated with type 2 diabetes are heart disease and
stroke, neuropathy due to poor blood flow, leading to ulcers and limb amputation, retinopathy,
kidney failure, and death (WHO, 2012).
If diabetes runs in one’s family, it raises one’s risk of developing type 2 diabetes. The
other risk factors include lifestyle behaviors such as poor diet, physical inactivity, and being
overweight. Many people are overweight or obese when diagnosed with diabetes. This is
because having a higher amount of fat makes it difficult for the body to use insulin correctly
(National Library of Medicine, 2011). The two main types of lab tests used in diagnosis of
diabetes are fasting blood glucose and a hemoglobin A1c level. Fasting blood glucose shows
how high one’s blood glucose is when fasting. Hemoglobin A1c level shows the average amount
of blood glucose over a period of 3 months. Lower than 5.6% is considered normal, while 6.5%
or higher is indicative of diabetes (NLM, 2011).
The statistics for diabetes in America are derived from several sources. These include the
Centers for Disease Control, Indian Health Services, the U.S. Renal Data System of the National
Institutes of Health, the U.S. Census Bureau, and the National Patient Information Reporting
System. The estimated numbers and percentages of those living with diabetes are derived from
the National Health and Nutrition Examination Survey (NHANES), Indian Health Services data,
the National Health Interview Survey and through the U.S. population estimates. As of last year,
2011, the statistics have begun to include hemoglobin A1c levels in addition to fasting blood
glucose levels to derive estimates for undiagnosed diabetes and prediabetes (National Diabetes
Information Clearinghouse, 2011).
The diabetes and prediabetes estimates are derived from the NHANES. This is a survey
that randomly selects a 5,000 sample of Americans. It includes an in-home interview, which
asks about health status, diet, and disease history, and a health examination, which is performed
by a mobile health center. The health examination includes health measurements, lab tests on
urine, blood, water, and a private health interview. Each person selected for the survey
represents approximately 65,000 other residents with similar vital statistics including age,
gender, and ethnicity (Centers for Disease Control, 2011). Indian Health Services collects data
among minority groups including Alaska Natives and Native Americans in the United States.
They perform annual progress reports to collect the current data of the prevalence of diabetes in
the population at risk as well as evaluating the quality of care available to the population. The
way this data is collected is through the submission of data among each IHS program that is
receiving money from the federal government or from the grants through IHS (Indian Health
Services, 2012).
The data collected through both the NHANES and from Indian Health Services is applied
to the U.S. Census’ population estimates in order to derive the estimated numbers and
percentages of U.S. residents who are both diagnosed and not diagnosed with diabetes. The
numbers for Type 1 and Type 2 are not separated out except through estimated percentages.
Meaning, because it is known that Type 1 accounts for approximately 5% of the population
diagnosed with diabetes, that means the remainder percentage is then calculated separately as
those diagnosed with type 2 diabetes.
Some populations are at higher risk of developing type II diabetes. These populations
include the elderly, African Americans, Latinos, Native Americans, and Asian Americans/Pacific
Islanders (American Diabetes Association, 2012). According to the Asian American Diabetes
Initiative (AADI), “Diabetes is a rapidly growing health challenge among Asians and Pacific
Islanders who have immigrated to the United States, affecting about 10 percent of Asian
Americans… The higher rate of type 2 diabetes in Asian descents results from a combination of
genetics and environmental influences (2010).”
Type 2 diabetes has a variety of risk factors including older age, obesity, physical
inactivity, family history of diabetes, impaired glucose metabolism, history of gestational
diabetes, and race/ethnicity (CDC, 2011). Because so many of these risk factors are
environmental like obesity and physical inactivity, a primary prevention focus is underway by
many channels including federal and state health agencies, local community groups, and lifestyle
management programs through employers or other groups. The focus is on diet, exercise, and
regular monitoring of blood glucose levels with a physician. A study was done through the
Diabetes Prevention Program that focused on prevention for people at high-risk of developing
diabetes. The study found that lifestyle changes to increase physical activity and lose weight
reduced the incidence of diabetes by 58% over a 3 year period and a 71% reduction among
adults aged 61 and older (CDC, 2011).
Many times, before people become diagnosed with type 2 diabetes, they often develop
prediabetes. Prediabetes is when a person’s glucose levels are high, but not high enough to be
considered diabetes. People who develop prediabetes are likely to develop diabetes within 10
years as well as being susceptible to having a heart attack or stroke (National Diabetes Education
Program, 2012). Type II Diabetes has been proven to be preventable. “Studies show that people
at high risk for diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of
their weight, if they are overweight – that’s 10 to 14 pounds for a 200-pound person (NDEP,
2012).” Interventions that delay or prevent the onset of type 2 diabetes in individuals with
prediabetes is cost-effective. Research shows that lifestyle changes are more cost-effective than
using medications (CDC, 2011).
There is a known association between type 2 diabetes and obesity, older age, physical
inactivity, family history of diabetes, impaired glucose metabolism, history of gestational
diabetes, and race/ethnicity. Type 2 diabetes has many social and behavioral factors involved.
Type II Diabetes is usually preventable or can be delayed greatly. According to the Centers for
Disease Control, “a large prevention study of people at high risk for diabetes, showed that
lifestyle intervention to lose weight and increase physical activity reduced the development of
type 2 diabetes by 58% during a 3-year period (2011).” Since, type 2 diabetes can be either
prevented or delayed, there should be a focus with public health efforts on behavior change and
lifestyle changes to help this occur, since research shows this is effective.
The Transtheoretical Model is an approach to behavior change based off of several stages
and the interventions are designed specifically depending on that individuals’ stage of behavior.
The stages are precontemplation, contemplation, preparation, action, and maintenance. The
precontemplation and contemplation stage involves the lack of willingness to take initiative to
change. This could be based off of their limited knowledge of the risky behaviors and/or the risk
factors they may be denying they have that make them at risk for type 2 diabetes. Preparation is
when the individual is ready to make a change and is planning what those changes will be.
Action is when they have begun making changes and are somewhat sustaining them.
Maintenance is when those changes have become habit and their new lifestyle. Interventions
using the Transtheoretical Model are typically different depending on the stage of change the
individual is in. As Dr. Laurie Ruggiero states, “Research has suggested that change is best
achieved by appropriate matching of processes with the stage of change (2000).” For example,
precontemplation and contemplation interventions might be more education or awareness
focused, compared to preparation, which would be setting real goals in terms of what they hope
to accomplish (ex. exercising 5 days a week for at least 30 minutes).
In contrast somewhat to the Transtheoretical Model, there is the Ecological Model. This
focus is more on the surrounding environment and how it may contribute to better behavior
patterns. For example, if a rural neighborhood were given closer and cheaper access to fresh
fruits and vegetables, people in that neighborhood will most likely begin to eat more fresh fruits
and vegetables as a part of their diet. There are five levels of influence in the Ecological Model:
intrapersonal factors, interpersonal factors, institutional factors, community factors, and public
policy. The second through fifth levels all impact the first level of intrapersonal factors, thus
affecting an individual’s knowledge, attitude, and skills. The interpersonal factors involve the
people around them including family, co-workers, peers, and friends. Institutional factors would
be schools and workplaces. The larger community is the neighborhood, town, city, or even state
the individual resides in. The public policy includes the regulations and limitations that will
affect an individual’s behavior. For example, a no smoking indoors policy would make it more
difficult for individuals to smoke in public places, therefore limiting their ability to engage in the
unhealthy behavior. These regulations should reduce unhealthy behaviors at the least and,
hopefully, increase healthy behaviors. As some research suggests, “Healthy eating patterns and
physical activity levels are not likely to occur or persist without convenient sources of healthy
foods and attractive and safe settings for exercise (Fisher et al., 2005).”
The government is working, using the Ecological Model, to improve the health of
communities. Through the CDC’s Healthy Communities efforts, grants are given to cities and
counties across the United States in the hope of improving the entire United States health status
by improving one community’s health at a time. These grants are giving communities the
opportunity to properly assess and evaluate the community and to make changes that will be
lasting and sustainable: primarily policy changes. According to the CDC’s Action Communities
for Health, Innovation, and EnVironmental change(ACHIEVE) initiative, “Specific activities
will be directed toward reducing tobacco use and exposure, promoting physical activity and
healthy eating, and improving access to consistent, high-quality preventive health services
(2012).” While this is a small start, it will be impactful as time goes by and the CDC will be able
to evaluate these programs’ effectiveness. The hope is to continue these efforts and expand these
types of programs so that more communities across the United States can benefit from these
efforts. In the future, hopefully, the government will fund more and more of these programs
overtime.
References
American Diabetes Assocation. (2012). Facts About Type 2. Retrieved September 15, 2012 from
http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html
Asian American Diabetes Initiative (2010). Diabetes in Asian Americans. Boston, MA: Joslin
Diabetes Center.
Centers for Disease Control. (2012). Health Communities Program. Retrieved October 18, 2012
from http://www.cdc.gov/healthycommunitiesprogram/
Centers for Disease Control. (2011). National Diabetes Fact Sheet, 2011. Atlanta, GA: U.S.
Department of Health and Human Services, Centers for Disease Control.
Centers for Disease Control (2011). National Health and Nutrition Examination Survey.
Retrieved September 23, 2012 from http://www.cdc.gov/nchs/nhanes/about_nhanes.htm
Fisher, E.B., Brownson, C.A., O’Toole, M.L., Shetty, G., Anwuri, V.V., and Glasgow, R.E.
(2005). Ecological Approaches to Self-Management: The Case of Diabetes. Retrieved
October 8, 2012 from http://journal.diabetes.org/diabetesspectrum/00v13n3/pg125.htm
Indian Health Services (2012). Division of Diabetes Treatment and Prevention. Retrieved
September 23, 2012 from http://www.ihs.gov/MedicalPrograms/Diabetes/
Mayo Clinic (2012). Diabetes. Retrieved September 30, 2012 from
http://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=causes
National Institute of Diabetes and Digestive and Kidney Diseases (2011). National Diabetes
Information Clearinghouse. Retrieved September 23, 2012 from
http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx
National Library of Medicine (2011). Type 2 Diabetes. Retrieved September 30, 2012 from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/
Ruggiero, L. (2000). Helping People With Diabetes Change Behavior: From Theory to
Practice. Retrieved October 8, 2012 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449392/
Schneider, M. J. (2011). Introduction to Public Health (3rd Ed.). Sudbury, MA: Jones and
Bartlett Publishers.
World Health Organization (2012). Diabetes. Retrieved September 30, 2012 from
http://www.who.int/mediacentre/factsheets/fs312/en/