DIABETES MELLITUS AND COMMUNITY HEALTH

Diabetes Mellitus: Introduction

A major health issue facing the nation and individual communities is the epidemic of diabetes.

According to Healthy People 2020, Diabetes affects over 23.6 million people in the United States and is the 7th leading cause of death.

Diabetes affects individual communities by decreasing life expectancy by 15 years, increases the risk for heart disease 2 to 4 times and is the leading cause of kidney failure, limb amputation and adult onset blindness.

Diabetes Pathophysiology

Diabetes is due to either a relative or absolute deficiency of insulin which results in hyperglycemia and glucose intolerance.

Insulin is a hormone secreted by the pancreas and is necessary for glucose to enter into cells. Without insulin, cells go through glucose starvation.

There is a correlation between obesity and diabetes mellitus. Obesity causes cellular insulin resistance which causes cell starvation and hyperglycemia.

Insulin function in our body

Populations at greater risk

Minority populations and communities are at greater risk for diabetes. Minorities make up 25% percent of individuals who have diabetes.

African Americans, Hispanic/Latino Americans, Pacific islanders, Alaskan natives and Asian Americans are at high risk for type 2 diabetes.

Prevalence rates among certain minorities can be two times higher than caucasians.

Hispanic males are at a lifetime risk of developing diabetes of 54.5% for while it is 31% for white men.

At risk populations continued African Americans are 1.7 times as likely

as caucasians to develop diabetes. Nearly 18 percent of Alaskan natives

have diabetes.

Financial costs of Diabetes

In 2007, the financial cost of Diabetes was $174 million which includes medical care, disability and death costs.

By 2012, diabetes healthcare costs rose to $245 billion.

A newly diagnosed diabetic incurs an average annual medical bill of $13,000, 2.3 times the national average (American Diabetes Association).

Diabetes health costs continued

Diabetes Health Costs continued

Healthy people 2020 goals

The goal of Healthy People 2020 is to “reduce the disease and economic burden of diabetes mellitus and improve the quality of life for all persons who have or are at risk for diabetes mellitus.”

Specifically, healthy people 2020 seeks to reduce the number people with diabetes mellitus diagnoses, reduce lower extremity amputations, improve glycemic control, reduce deaths related to cardiovascular disease.

Increase the proportion of individuals who have an A1c value under seven and decrease the number of people with an A1c value over nine.

Diabetes Signs and Symptoms Polyphagia (frequent hunger). Polydipsia (frequent thirst). Polyuria (frequent urination). Sexual problems. Vaginal infections Poor wound healing. Numbing and/or tingling in hands and/or

feet. Sudden weight loss.

Diabetes Signs and Symptoms

Diabetes diagnosis

Diabetes Mellitus is diagnosed is in several ways:

A1C test which measures serum blood glucose levels over several months.

Fasting plasma glucose measures serum glucose while fasting.

Oral glucose tolerance test measures how fast glucose is cleansed from your blood.

Diabetes Management

The most efficient means of diabetes management is to control blood sugar. Eating a healthy diet is essential for diabetes control.

Exercise will also help diabetes control When a healthy diet and exercise are not

sufficient by themselves, insulin and other medications which are designed to lower blood sugar are utilized.

Diabetes often requires insulin management

Culture and politics

African Americans often consume “soul food” which often has meat that is deep fried. African Americans often fry their food due to the ease of cooking meat quickly during hot summers.

Amelia Montes, Professor of Ethnic studies at the University of Nebraska-Lincoln states 'Genes are passed from one generation to another, but basically it's our way of eating.  And how can populations of Mexican descent along the border or in working class neighborhoods take the time to exercise or have the means to maintain a healthy diet when a half dozen tacos or a hamburger with fries and a coke is half the price of a pound of organic spinach?” 

Diabetes and culture: Junk food

Diabetes and culture: Fried Twinkies

Diabetes complications

Diabetes is the number one cause of adult onset blindness.

Diabetes causes cellular damage to the vascular system resulting in neuropathy, kidney damage, diabetic ulcers, blindness.

Individuals with diabetes are at greater risk for stroke and heart disease.

Diabetes complications: foot ulcers

Diabetes and Politics continued

On a national level, legislation has been proposed to develop a committee composed of private and public individuals whom will make recommendations to improve diabetes healthcare.

Community Resources

In Alaska, most farmers markets accept food stamps in effort to get healthier food to the individuals at greatest risk for poor diabetes control and obesity.

In addition, Anchorage has the “Get out and Play Every Day” program which encourages kids to exercise daily and to eat healthy diets.

Alaska has the Indian Health Services (IHS) which has specific programs aimed at helping people lose weight and decrease diabetes risks and complications. The IHS has established the special diabetes program to teach people to minimize diabetes risks and then to control diabetes.

Get out and play everyday-Alaska style!

Get out and play everyday in Alaska

Alaska: Get out and play everyday-Play on glaciers!

Points for patients to understand Diabetes often can be controlled through a

healthy diet and exercise. When a healthy diet and exercise are not enough

to control serum glucose levels, medications such as metformin and insulin may be necessary.

Diabetes has serious complications that need to be taken seriously such as adult onset blindness, amputations, renal failure, diabetic ulcers.

Individuals with diabetes need to understand daily monitoring and healthy habits are necessary to maximize health.

References

http://www.ameliamontes.com/2011/08/how-mexicans-are-made-diabetic---.html

American Diabetes association Alaskan Department of Health and social

services