Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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/