Diabetes as a Chronic Disease - Literature review Example

Diabetes as a Chronic Disease Name of Student Name of instructor Module Institution Date of Submission Introduction Diabetes is definitely one of the most common diseases in the modern world. The disease is actually a group of ailments that is caused by the inability of the body, and in particular the pancreas, to regulate glucose levels in the body leading to severe body damage. The disease is thus managed by controlling the glucose levels in the blood stream by managing glucose levels and minimizing exposure to risks and averting complications arising from the disease. There are four strains of diabetes but two are two ones- type I (diabetes insipidus) and type II (diabetes mellitus). Type II diabetes is the most common accounting for over 90-95% of the cases in the developed world (CDC, 2012) and higher in developing countries (WHO, 2004). Type III diabetes is not that common and has been likened to Alzheimer’s disease. Another minor type of diabetes that exists is the Gestational diabetes mellitus (GDM). This usually occurs in pregnant women as a result of carbohydrate intolerance according to the Centre for Disease Control (CDC, 2012). This paper looks at type 2 diabetes in the world and specifically the US, by addressing key determinants and issues surrounding the development and significance of the disease, assessing, interpreting and synthesizing different types of data and relevant readings on the same to develop a vigorous discussion on the current situation, prevalence and management of diabetes in America. Discussion The global diabetes prevalence figures currently stand at 347 million people according to the world health organization (WHO, 2013). It is estimated that a large number of cases are still undiagnosed especially in the developing countries which means that the number could be higher. The incidence of the diseases has been on upward path thereby indicating that current lifestyles such as increased weight, smoking, excessive alcohol consumption and lack of physical exercise have created an enabling environment for the disease. The CDC (2013) notes that in the US alone, diabetes prevalence has increased six-fold in the last four decades. The disease is attributed to a wide range of complications including blindness, kidney failure, stroke and cardiovascular ailments. The disease is also one of the leading causes of death globally Merrill (2013). WHO (2013) predicts that by 2030, the disease shall be the seventh leading cause of death and the prevalence will have increased by a whopping 50%. On the other hand, the CDC says that diabetes is already the seventh leading cause of death in the US going by number of deaths registered in 2007. Individual countries have varying figures and incidence rates. For a long time, the developed world has reported higher cases of prevalence that the developing world largely due to lifestyles in the developed and increased diagnosis. The International Diabetes Federation (2013) survey on diabetes prevalence across continents showed that rural villages in Fiji and Tanzania had lower rates than rural villages of China, Colombia, Tunisia and Bangladesh. The US, as the world leading economy has some of the highest diabetes prevalence rates in the world. According to 2011 data from the American Diabetes Organization (2013), 25.8 million children and adults in the United States—8.3% of the population—have diabetes. Another 79 million have prediabetes. Prevalence by age group is highest in the over 65’s at 10.9 million people. This means that 26.9 percent of senior citizens have diabetes. By race and ethnicity, non-Hispanic whites account for 7.1%, Asian Americans for 8.4%, non-Hispanic blacks for 12.6%, and 11.8% for Hispanics. This shows that prevalence varies with age, ethnicity. Another study by Maty and Tippenst (2010) in a small population of Hispanic, Latino and Chinese communities in Portland Oregon also reveals that prevalence varies with age, family (socioeconomic background and genetics), lifestyle and ethnicity. In a sample of 165 individuals with an average age of 45.2 years, 43% of them were at high risk of diabetes regardless of ethnicity and age. However, the perception of risk/susceptibility and exposure to risks varied with ethnicity. For this reason, any diabetes management program rolled out by governments and hospitals should recognize these factors (Merill, 2013) Numerous studies have been conducted on the disease to understand it better. In the various studies, it is generally agreed that type II diabetes is a complex disease because, one can develop it if they are genetically predisposed and activated by individual behaviours and more importantly, it is increasingly being influenced by social, cultural, psychological and environmental factors (Hayes et al 2008; diabetes report card, 2012). The genetic composition of Europeans contributes to about 25% because of the high prevalence (98%) of the Pro allele gene (WHO, 2013). There are approximately 40 DNA variants that have shown close association with type 2 diabetes (Cho et al., 2012). The more prevalent diabetes in a given community, the more the community is affected by the disease in terms of developing diabetes complications. Some of these complications include stress and depression which at times leads to suicide. Although elderly people are susceptible to high rates of diabetes and diabetes- related complications, there is much these people can do to prevent and delay diabetes. This can effectively and efficiently be done through weight management, lifestyle changes that include diet modifications, increase in regular physical exercises and smoking cessation (National medical association, 10). In so doing, the vulnerable groups will reduce their potential to develop risks factors such as obesity, hypertension that lead to diabetes. The Diabetes Organization (2013) reports that the cost of treating diabetes in the US as of 2012 alone was US$245 billion with $176 billion going into direct costs and the rest in reduced productivity. Reduced productivity is most felt in complications such as heart failure, kidney ailments and others mentioned earlier. Amputations have been some of the most common of complications. In fact, 60% of non-traumatic lower limb amputations occur to people with diabetes (diabetes org, 2013). To cater such spiralling cost of diabetes ain the US, the governments has initiated a number of programs geared towards stemming the situation. Among the measures initiated globally is the observation of the world’s diabetes day on March 16th every year. The day was set to create awareness about the diseases, inform the people about the risk factors and the prevention measures including changes in lifestyles. Nonetheless, information and sensitization is carried through. One way of doing is through the Pre-diabetes Risk Test that the public can take by answering simples questions online (http://www.cdc.gov/diabetes/prevention/prediabetes.htm). Majority of diabetes management programs involve patients and their families. Hayes et al. (2008) indicate that training patients on self-management is the most effective way of managing the complexities of type 2 diabetes. Micklethwaite et al (2012) carried out a study to assess the efficiency of self-management later discussed in the paper. The burden of diseases associated with diabetes as aforementioned in high on national scales and on personal and household levels. The cost of diabetes treatment has been increasing ever since the disease was discovered. Furthermore, the prevalence rates have increased thereby increasing the national burden of disease. Although diabetes is largely viewed as a lifestyle disease, it is most prevalent in low income and middle income economies (WHO, 2013). However, the trend in the disease has been changing over time with developing countries/regions such as Africa reporting higher rates of new cases. This is despite the economic conditions and healthcare delivery in such countries improving and access being improvement through investment in healthcare facilities and health education programs. This trend can be applied on national level to argue that diabetes prevalence is higher in low to middle income earning households. Diaz-Apodaca et al. (2010) investigated cross border variations in diabetes prevalence and noted significant differences. The study carried out in US and Mexico border showed that diabetes prevalence in Mexico was slightly higher at 16.6% while in the US it was 14.7%. The authors noted that there significantly high cases on undiagnosed cases which the authors say can be addressed by increasing awareness in the public. New cases of diabetes in developing countries can be attributed to increased diagnosis as a result of increased access to healthcare services (Liburd, 2010). The CDC further indicates that the perception of risk and susceptibility is usually low among even the high risks group. Maty and Tippenst (2010) verified this through a research involving a purposive sample of 324 Chinese and Latinos aged 18-86 years and found out that 25-53% of those perceived themselves not to be at risk of diabetes had two or more risk factors which varied with ethnicity. This clearly captures the chronic element of diabetes since the risk factors are not clear to the people at risk and that they can go on over a prolonged period of time. WHO has also identified a number of social determinants in the name of social gradient, stress, early childhood development, social exclusion, unemployment, social support networks, availability of health food and availability of healthy transportation. These determinants are generally categorized into two groups namely living conditions and distribution of resources and power. The living conditions according to WHO include access to healthcare, physical environments and social protection. The power and resources category includes financial resources, health programs, government financing and political empowerment and gender equity. In the case of access to healthcare, a number of programs have been rolled out to ensure that societies an individual have a bigger role to play in the management of their diabetes. Micklethwaite et al. (2013) discuss the case one program that targeted 89 patients of Mercy Hospital Joplin in Southwest Missouri. The study revealed that facilitating patients’ self-management of diabetes reduced visits to the hospital and costs to the hospital by $551. This shows that health literacy should be improved and patients and family members empowered with basic health knowledge on the disease to facilitate self-management and also trigger behavioral changes to reduce risk factors. Hayes et al. (2008) names the social issues that make diabetes a chronic condition. The authors note that the diseases, especially in low income earning families, is a source of tribulations as it can lead to death, decreased income and other social costs such as depression and stress. The management measures that are used in the managed of the condition which include strict glycemic control, sometimes cannot be implemented fully and consistently due to family resources restraints. Berry (2006) among other authors cited by Hayes et al (2008) claim that health providers, who happen to be fully aware of the determinants of diabetes are willing to update delivery of care and public education programs but the outcomes are short-lived largely because there is performance feedback. The author therefore calls for wider government involvement to facilitate early detection of the diseases and facilitate altering of lifestyle to reduce the diseases burden. Chronic diseases by nature require lifetime management and full support from family and society. The Diabetes report Card indicates that the loss of productivity noted in the US attributed to diabetes includes both patients and family members who are dedicated to caring for patients who have been severely been incapacitated by diabetes and its complications such as blindness. Cory et al. (2010) note that complications arising from diabetes are very common making the diseases one of the most problematic chronic diseases and a leading cause of death. In fact, an analysis by the same author of 2006-2007 data reveals that individuals can be limited in functioning, health and activity and work. Merrill (2013) writes that seven out of ten deaths in America are caused by chronic diseases among theme diabetes. Furthermore, one person out of ten with a chronic disease experience daily activity limitations. Some of the most tragic limitations caused by diabetes include blindness, kidney failure, stroke, cardiovascular illnesses and amputations. Diabetes is highly associated with certain lifestyles that increase the risk to contracting the disease. Some of these conditions can be managed to lower the risk. One of the greatest risks that have been cited by a number of studies is obesity. Interestingly, the US has one of the highest obesity prevalence rates in the world with variations by ethnicity being common. Individuals of African American and Hispanic ethnicity are more likely to be obese compared to other ethnic groups at 51%, 28% and 21% respectively (CDC 2010). Crawford et al. (2010) reviewed electronic medical records data from Centricity Physician Office to assess the effects of obesity as a risk factor in contracting three chronic diseases comprising of type II diabetes mellitus, hyperlipidemia, and hypertension. The authors assessed obesity levels in the over 8.9million patients in the database using the body mass index (BMI). This study showed that BMI variations occurred across ethnicity and gender. African Americans have the highest cases of obesity and type 2 diabetes and hypertension. On the overall, Crawford found that association between obesity and chronic diseases was consistent across the different ethnicities and across the gender divide. This means that diabetes is not specific to a particular gender. While obesity may vary across the gender divide, obesity prevalence does not thereby implying that obesity is not the only contributing factor in prevalence of diabetes. A research by Diaz-Apodaca et al. (2010) in the US- Mexico border clearly revealed that diabetes prevalence is higher among the low income earning Mexicans compared to high income earning Mexicans despite sharing ethnicity. Conclusion Epidemiologically, diabetes affects the pancreases and the ability of the body to regulate glucose in the blood stream. From other perspectives as discussed above, diabetes is one of the greatest threat humanity’s wellbeing. The economic, social and emotional costs of the disease not only in the US but worldwide is immense. The disease has necessitated the launching of public awareness programs that educate the people of management of the diseases and promoting early diagnosis of the disease. Early diagnosis facilitates early treatment and increases the ability to avert serious complications such as blindness, amputations and organ failure. References American diabetes association. Diagnosis and classification of diabetes mellitus. Retrieved online on 18th Aug from, http://care.diabetesjournals.org/content/27/suppl_1/s5.full CDC (2012). National Diabetes Fact Sheet 5. Retrieved online on 18th Aug from, http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. CDC (2010). Compared with whites, Blacks had 51% higher and Hispanics had 21% higher obesity rates. 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