A Discussion of Diabetes: Background, Epidemiology, Cost and Management Strategies

Houston, with a population of 2.1 million people is the fourth largest city in the United States. Approximately, in every ten adults, one is diabetic (CCD, 2016). With obesity being one of the most prevalent chronic diseases here, the statistics become even scarier. 32 percent of the adult population is obese, these men and women have a 7 to 12 fold risk of developing diabetes. According to the 2010-11 statistics, without intervention, the number of people with diabetes would reach 1.1 million by 2040 with costs related to diabetes achieving the tunes of $11.4bn (Dart, 2016). The national diabetes statistics report done this year (2017), reported that a total of 30.3 million people are diabetic (9.4% of the population) (CDC, 2017). This figure has bypassed all the previously projections. For instance, in table 1 below,

Table 1: predicted diabetes burden. Done in 2001 by American diabetic association.

Year U.S.A population (%)

2000 3.99

2005 4.34

2010 4.72

2025 5.89

2050 7.21

Diabetes has wrecked immense damage to this community. An average adult who has lived here all along cannot count on one hand the number of relatives and friends who have lost limbs, developed complications or even lost their lives to diabetes-related tragedies. The economic effect of the disease is also burdening the community. With Houston having enjoyed a rapid growth as a result of the low cost of living and high job markets, the epidemic threatens to derail development and impoverish the community. The loss of labor, a lot of funds and time in the management of the condition is retrogressive to their economy. This disease has a considerable impact both economically and socially and requires thorough scrutiny to come up with strategies to beat it. This study focuses on this issue.

Diabetes Mellitus

Diabetes Mellitus is a disease that results from dysregulation of blood sugar levels. It is a metabolic disorder that results in abnormally high levels of blood sugar by various mechanisms which lead to the classification into types. In type 1, insulin, the hormone responsible for conversion of glucose to glycogen for storage is not produced in the body. In the second, which is more common, there is a disorder in insulin synthesis and utilization resulting in increased levels of sugar in the body. Another type of diabetes is gestational diabetes which occurs when blood glucose levels shoot in pregnancy. There are also situations where blood sugar is high but not high enough to be categorized as diabetes and is classified as prediabetes. In other cases, blood sugar rises temporarily during the course of a treatment, this is referred to as type 4 diabetes.

Symptoms of diabetes include increased thirst, increased frequency of micturition, extreme hunger, physical fatigue and weight loss. Other signs such as sores, that take too long to heal, tingling and loss of sensations in extremities, the presence of ketone bodies and loss of sight which results from diabetic retinopathy present with the progression of the disease.

Surveillance Methods

The U.S diabetes surveillance methods provide resources for recording the public burden of diabetes by use of questionnaires, surveys, and administrative data. These are sensitive and highly specific for both the primary infection and associated complications. However, the use of cause-of-death-data obtained from death certificates is insensitive. It also does not identify decedents, and therefore the research does not enable the researcher to be a position to predict or project values. Surveillance is key for projecting trends in the disease to have targeted prevention goals. The approaches employed should be able to provide valuable data which would enable the investigator to improve the general management of diabetes in the population, after putting into considerations the various limitations of the data that the surveillance methods produce.

Descriptive Epidemiology of Diabetes

The various types of diabetes affect different people based on various factors, for instance, gestational diabetes will only affect women during pregnancy. Type 1 diabetes is genetic; it occurs when pancreatic cells stop producing insulin. It can occur at any age but mostly occurs at early ages (early onset diabetes). This type of diabetes occurs in 10-20 per 100,000 people per year in the US and by the time they are 18 years old about 1 in 3,000 develop the disease. The predisposition to this type of diabetes is familial, but the inheritance pattern has not yet been fully understood. Type 2 diabetes, however, occurs when the body is unable to make or utilize insulin properly. It also occurs at any age, but mostly in middle ages or later (late onset diabetes). It is the most common and accounts for 90-95% of the cases with more than 23 million people in the US alone affected by 2015. Its prevalence increases with age and it now affects at least 20% of Americans more than 65 years old. The risk is also ethnically and geographically distributed with Native Americans, Alaska Natives, African Americans, Hispanics and Asians being more at risks in descending order. The prevalence also increases with increase in sedentary lifestyles and obesity (NIH, 2017). The disease may affect close family members due to shared genetic factors, similar lifestyle and eating habits, but the pattern is also not understood. The recently released statistics (2017) can be summarized as shown below.

Table 2: Epidemiology of diabetes

Statistic/Fact Significance

30.3 million diabetics 1 out of every ten people are diabetic, one out of 4 are unaware they are diabetic

84.1 million diabetics More than 1 out of 3 adults are prediabetic, nine out of 10 of these dont know they are prediabetic.

$245 billion lost to the epidemic Medication cost for diabetic patients is twice that of non-diabetics

Diabetes patients have a higher risk of comorbidities

This information is critical in formulating preventive measures that can help reduce the burden of the disease. For instance, losing weight, exercising and eating healthy among prediabetics reduces the risk of developing diabetes by half. The risk factors for diabetes include genetics, too much weight, race, sedentary lifestyles, and age. This information is useful in many ways; first, by maintaining healthy body weight level people reduce the risk of developing the disease. Same goes for other healthy lifestyles such as exercising and monitoring diet. Individuals who come from families with a history of diabetes should ensure they have regular medical check-ups to detect the disease early enough for better management and keep healthy lifestyles. This also applies to individuals who are at risk based on their race or geographical location.

The economic impact of diabetes is also overburdening. In the US, costs related to diabetes alone in 2012 were $245 billion (ADA, 2013). People with diabetes suffer from other comorbidities which have both social and economic implications such as hindering them from work, school, increased risk of death among the aged by 50% and other social events that impact their life negatively.

Diagnosis

Various strategies are employed in the diagnosis of diabetes. The most commonly used are the random blood sugar test and the fasting blood sugar test both done using a glucometer. The random blood sugar tests are done randomly regardless of when one last ate, a random blood glucose of 200mg/dl or 11.1mmol/L or higher is suggestive of diabetes. Fasting blood sugar tests are done after at least 12 hours of fasting. A blood sugar level of 126mg/dl (7mmol/L) or higher on two separate tests are diagnostic of diabetes. Other tests done include the glycated hemoglobin (A1C) test and oral glucose tolerance tests.

The oral glucose tolerance test is the standard for diagnosis of type 2 diabetes. In this experiment, the individual has to fast for at least eight hours but should not exceed 16 hours, after which they receive a dose of 75g oral glucose, preferably in a liquid, and then plasma glucose levels are measured in the blood four times at intervals between 0 and 2 hours. An individual is diagnosed to be diabetic if plasma glucose is higher than 200mg/dl after the 2 hours. If the value falls between 140 and 199, the individual is said to have impaired glucose tolerance. As studies have shown, the sensitivity and specificity of this method are at 95% confidence but have lower specificity in diagnosis of gestational diabetes mellitus. In pregnancy, therefore, this technique is thus used as an alternative (Lovrencic, Bijak, Bozicevic, & Ljubic, 2013). The cost implications of glucose tests are substantial in the community. With the prices ranging from $25 to $150 per test, a lot of money is being lost, which would better be used in growing the economy.

Management of the Disease Rates in Houston

The management of the disease in Houston, for instance, will require a joint approach. A lot of resources should be focused towards predicting the patterns of the disease. This way we can aim at preventing rather than curing the disease. As type 2 diabetes is the most common, this objective is very achievable. Support is necessary from the government, medical schools, the community and health institutions at large. Schools should be involved in community sensitization programs to ensure that people are well aware of the impacts of the disease. They also should help other stakeholders in gathering and relaying information that can help in identification of new risk factors and challenges in the fight against the epidemic. Such information would ensure that vulnerable individuals exposed to new risks are identified early enough and preventive measures initiated. The community should also join hands in supporting each other in endeavors such as losing weight, cutting off sugar and other diet adjustments programs. This war against diabetes can only be won by collective effort and staying steps ahead.

Conclusion

Diabetes is a metabolic disease which has a wide range of risk factors such as genetics, lifestyles, race, age, economic background, obesity and geographical location. It has been known to humanity since 1552 B.C, four thousand years ago, when it was described as a urinating disease that causes wasting. These risk factors vary for the various types of the disease. The disease is diagnosed in multiple ways. There are the use of oral glucose tolerance tests, random blood sugar tests, fasting blood sugar tests among others. These vary in specificity and accuracy, but oral glucose tolerance test has been shown to be more accurate and specific than the former two.

Currently, the 30.3 million individuals have diabetes in the U.S. with 84.1 million being prediabetic; this implies that 1 in every ten individuals are diabetic and 1 in every four citizens are prediabetic. The epidemic has cost the states a total of $245 billion a year, which is crippling and deteriorative to the economy. In Houston, one of the largest cities among the states, one in every ten people has diabetes. The most critical risk factor here is obesity as 32 percent of the adult population is obese. The epidemic has impacted the society very negatively, both socially and economically. To stay ahead of the outbreak, surveillance strategies have been laid in place. These help in collecting data that enables researchers to project the expected burden and also plan ways of overcoming the epidemic.

Overcoming this disease will, however, require a collective effort. Most importantly, we have to stay up to date with the changing patterns of the disease which result from the changes in lifestyles and environments wit...