Type 2 Diabetes

Fundamentals of Public HealthConcordia University NebraskaViveth Bucknor

What is diabetes?

The inability of the body to produce or respond properly to the hormone insulin Results in a malfunction of carbohydrate, protein, and fat metabolism A chronic disease that requires lifelong behavioral changes

Diabetes means:

2 x the risk of high blood pressure 2 to 4 x the risk of heart disease 2 to 4 x the risk of stroke #1 cause of adult blindness #1 cause of kidney failure Causes more than 60% of non-traumatic lower-limb

amputations each yearNIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2010.

Cost of Diabetes

Diabetes, a serious life-threatening disease, has reached epidemic proportions in the U.S. As the number of people with diabetes grow so does the financial burden of this county.

“The total costs of diagnosed diabetes have risen to $245 billion in 2012 from $174 billion in 2007, when the cost was last examined.

This figure represents a 41 percent increase over a five year period.” (American Diabetes Association, 2013)

Type 2 Diabetes Was previously called non-insulin-dependent diabetes mellitus

(NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all

diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the

cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.

Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.

African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes.

Type 2 diabetes is increasingly being diagnosed in children and adolescents.

Symptoms

Frequent urination Excessive thirst Extreme hunger or

constant eating Unexplained weight loss Presence of glucose in

the urine

Tiredness or fatigue Changes in vision Numbness or tingling in

the extremities Slow-healing wounds or

sores Abnormally high

frequency of infection Many people have no

symptoms

Risk Factors

Weight-If you are overweight you are at a greater risk Inactivity- Lack of exercise increases the chance of

getting type 2 diabetes Family history-If a parent or sibling has diabetes the

chance of getting it increases. Race-The risk of getting diabetes is greater in African

American, Hispanics and Native Americans Age- The chance of getting diabetes increase with age.

(Mayo Clinic, 2013)

Distribution of Disease in Population CDC scientists have identified a diabetes belt located mostly in the southern portion of the United States. The diabetes belt consists of 644 counties in 15 states. The diabetes belt spans counties in most of the Southern states and reaches up through Appalachia. They are Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia. The entire state of Mississippi is included in the belt.(CDC, 2011)

Distribution of Disease in Population Cont.

Within the diabetes belt, 11.7% of the people have diagnosed diabetes. Outside the belt, 8.5% have diagnosed diabetes. People living in the diabetes belt counties were more likely to be black (23.8 percent in diabetes belt counties versus 8.6 percent in the rest of the country), and were more likely to be obese Sedentary lifestyle was more common in the diabetes belt areas than

nationally (30.6 percent versus 24.8 percent, respectively).

Biomedical Basis

Regular exercise and restricted diet control are the keys for the type 2 diabetes self-management. An ability to maintain one's blood glucose at a relatively even level, not fluctuating wildly with meals and hypoglycemic medical intervention, would be the goal for self-management. The average normal person should have a glucose level of around 4.5 to 7.0 mmol/L (80 to 125 mg/dL). (Diabetes Daily, 2013) Levels greater than 13-15 mmol/L (230–270 mg/dL) is considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high.(Diabetes Daily, 2013)

Environmental Factors Smoking and secondhand smoke affects diabetics

negatively by creating additional insulin resistance and inflammation of the cells lining the arteries contributing to damage of the cardiovascular system.

Pollution can affect the symptoms of diabetes by increasing inflammation and contributing to weight gain.

Stress can be caused by a reaction to the environment. Diet high in animal fats, refined carbohydrates, and sodium

will contribute to diabetes related symptoms and weight-gain.

Inactivity increases weight gain, a risk factor for the onset of Type 2 Diabetes.

Social and Behavioral Factors

Social factors which may influence type 2 diabetes include low income, employment insecurity, low educational attainment, and poor living conditions, on health outcomes.

Behavioral influences include factors such as physical inactivity and inadequate sleep.

Biostatistics

Biostatistics is the branch of statistics responsible for the proper interpretation of scientific data generated in the biology, public health and other health sciences (i.e., the biomedical sciences).

Diabetes costs $116 billion annually in direct medical costs.

Diabetes costs $58 billion annually in indirect costs like loss of work, disability and loss of life.”

(The Ohio State University, n.d)

Biostatistics Cont.

Total cost of DiabetesNet Wellness (2013)

Governmental Agencies that support diabetes research

Center for Disease and Control and Prevention, The Indian Health Service, The Health Resources and Services Administration, The Department of Veterans Affairs, and The Department of Defense.

Control the ABCS

A1c: Glucose control Blood Pressure control Cholesterol (lipid) control Smoking Cessation

Eat more fruits and vegetables

Fresh Frozen dried

Eat more balancing meal

Exercise Daily

References Barker, LE, Kirtland, KA, Gregg, EW, Geiss, LS, Thompson, TJ, (2011)

Geographic distribution of diagnosed diabetes in the USA diabetes belt, CDC, Atlanta, Georgia Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21406277

CDC, (2011) CDC Identifies Diabetes Belt, Retrieved from http://www.cdc.gov/diabetes/news/docs/diabetes_belt.htm

Mayo Clinic Staff (2013) Risk Factors Retrieved July 8, 2013 from http://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=risk-factors

Net Wellness, (2013) Diabetes and African Americans, Retrieved from http://www.netwellness.org/healthtopics/aahealth/highblood.cfm

Healthy Eating (2009) The Eatwell Plate http://www.doyoufeelgood.org/healthyeating/the-eatwell-plate.aspx