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Diabetes
Student Health Information Page compiled by: Jack Corliss

What is Diabetes?

Chronic disease in the United States has continued to rise among the population and has been classified as the leading cause of death in Americans. The majority of chronic diseases are expected to persist throughout an individual’s life. One of the most common chronic diseases in the United States is diabetes. Diabetes mellitus (DM) is a disease of the metabolic system in which an individuals high blood glucose (sugar) levels are not being properly degraded by insulin. This can occur for two reasons:
  • There may be low production of the insulin hormone and as a result there is not sufficient amount of insulin to degrade all the glucose produced by the body; this is classified as type 1 diabetes.
  • Type 2 diabetes results as a lack of response from insulin receptors, in which insulin receptors are not properly responding to insulin.
Type 1 diabetes, more commonly referenced to as juvenile diabetes typically develops most commonly in young adults. However, individuals with Type 2 diabetes (adult-onset diabetes) can be diagnosed at any age, adolescence or as an adult. According to the Center for Disease Control (CDC), approximately 29 million people were diagnosed with diabetes in 2010. This number continues to rise by a rate of 1.9 million new cases each year. Diabetes is the most common chronic disease amongst American children with an influx of 13,000 new cases per year. With these obscenely high numbers, the U.S. is the third largest country with diabetes in the world. (“Diabetes Facts and Statistics” 2014) The majority (90%) of diagnosed diabetics are affected by type 2 diabetes. (“Fast Facts 2013) Diabetes is increasingly becoming a collective public health concern throughout the country as it continues to rise and can result to compounding health risks.

What is at Risk?

Diabetes is a multifaceted chronic disease, most influenced by genetic and lifestyle factors and can be worsened by a combination of both. A few risk factors for T2D are high blood pressure, history of cardiovascular disease, family background and age. (“Your Guide to Diabetes”) Prediabetes is also an indicator of potential onset of diabetes. Prediabetes is defined as high blood glucose levels that are not yet high enough to be diagnosed as diabetes. It is in this stage where cells begin to become resistant to insulin. (“Your Guide to Diabetes”) An individual with prediabetes is still able to prevent diabetes by lowering blood glucose levels by modifying diet and physical activity.

Type 2 diabetes is more closely linked to genetics in where diabetes-causing genes are inherited. Carrying the genes for type 2 diabetes increases the risk of acquiring diabetes by almost three times the normal population risk. ("Genetics & Diabetes”) To determine the roles of genetic and environmental factors, studies have been conducted using identical twins. When one identical twin is diagnosed with the onset of diabetes in adulthood while the other is not confirms that environmental factors initiate and/or accelerate the disease (Genetics and Diabetes, WHO).

Genetic contributions have also been confirmed through studying identical twins and have shown a higher risk for monozygotic twins than dizygotic twins. (Genetics and Diabetes, WHO) Patients with preexisting genetic diseases such as cystic fibrosis, down syndrome and turner syndrome are more inclined to have diabetes than those without genetic disorders. Inheriting the traits for diabetes increases the risk but ultimately it is the influence of environmental factors that express these traits.

Lifestyle choices include eating habits, physical activity, and preexisting health conditions determine the severity of diabetes. Individuals leading a sedentary lifestyle with an imbalanced diet are at highest risk for diabetes. Obesity is one of the most common diseases that heighten the risk of diabetes. Approximately 80-90% of type 2 diabetics are also diagnosed with obesity. (“Type 2 Diabetes” 2014) In addition, research has shown enteroviruses such as polio and hepatitis A negatively affect the pancreas and therefore affect the production of insulin.

Enteroviruses occurring in utero can increase the risk of diabetes significantly for the fetus. A study conducted by Borch-Johnsen et al. determined a relationship between breast-feeding and risk of type 1 diabetes. Children who are breast-fed for a shorter amount of time have an increased risk for T1D. (“Genetics and Diabetes”, WHO) This conclusion is supported by the fact that breast milk contains important cytokines, antibodies and growth factors necessary for prevention of immunological infections such as enteroviruses. Research is being continued involving the focus of etiology for diabetes. Further understanding is required to provide more explanation regarding the molecular biology of insulin cells, insulin receptors and uncovering the specific genes responsible.

Diagnosis?

Although the number of diabetic cases in the U.S. is listed as 29 million, approximately 8 million of these cases are undiagnosed. One in every four individuals is unaware that they have the disease. Type 1 diabetes symptoms occur noticeably and suddenly while early type 2 diabetes symptoms can easily be overlooked and falsely thought to be harmless. The most common symptoms of diabetes include:
  • excessive thirst
  • increased urination
  • fatigue
  • weight loss
  • increased infections of the feet, bladder, skin and kidneys. (Mayo Clinic 2013)
diabetis chart
A more serious complication of diabetes occurs when early symptoms go unnoticed for long periods of time and result in coma.

Regular physician visits and monitoring blood glucose levels can allow for earlier diagnosis and therefore decrease harmful long-term effects. Diabetes can act as a precursor for additional health complications such as obesity, heart disease, stroke, nephropathy (kidney disease) and shorter lifespan. Diabetic nephropathy results in end stage renal failure in about 20-40% of diabetic patients. (“Type 2 Diabetes” 2014)

Another common result of diabetes is the presence of neuropathy in about half of T1D and T2D patients. Neuropathy reduces nerve sensation in both peripheral and autonomic systems, leading to amputation, loss of sense, digestive problems, heart problems and bladder infections. (“Type 2 Diabetes” 2014)

Less common results of diabetes are the psychosocial effects that take place amongst adolescents after initial diagnosis. Diagnosis increases the risk for development of psychiatric disorders in children. A study conducted determined approximately one-third of adolescent diabetics were also diagnosed with psychiatric disorders such as eating disorders, depression and anxiety. (Delamater 2001)

Treatment

Treatment of diabetes depends on a multitude of factors including the type of diabetes and the main cause for diabetic onset. Type 1 Diabetes has no known cure and no prevention till date but requires constant daily insulin injections, exercise and modifications to diet to maintain a healthy lifestyle. Individuals with type 2 diabetes are able to maintain glycemic levels without medication by solely improving their diet and increasing daily physical activity. Medication and insulin injections may be used in T2D if needed.

The most effective treatment for individuals with prediabetes is weight loss. A weight loss of 10-15 pounds can drastically reduce the risk of diabetes. (“Type 2 Diabetes” 2014) T2D treatment is more complex for the reason that it requires close monitoring of blood glucose levels as well as requires treatment for any other additional health complications caused by T2D. Anti-hyperglycemic drugs may be prescribed in conjunction with insulin. Metformin is one type of anti-hyperglycemic drug that is approved for administration to both adults and children. (“Type 2 Diabetes” 2014)

Global Health Problem

Diabetes is a global health problem and continues to affect a range of populations. When comparing statistical data regarding rates of diabetes in different racial populations, disparities are evident. As mentioned before, lifestyle factors directly impact risk of diabetes and are dependent on economic differences in communities, cultural differences and racial genetics. Racial groups share common genes that affect their insulin production and insulin resistances, one of the reasons why specific ethnic groups tend to be at higher risk for diabetes. (“Diabetes Center”) African-Americans with about 18.7% of the population diagnosed with diabetes are the most affected ethnic group with the Hispanic population following in second. (“The Diabetes Epidemic Among African Americans” 2011) The disparity is explained by correspondence of high rates of obesity and hypertension amongst African-Americans (both factors that double the risk of diabetes in African Americans). Poverty, lack of health care and communities with poor provision of exercise-inducing activities can determine the risk of diabetes for populations. In Michigan, diabetes is the sixth-leading cause of death with about 10% of the population diagnosed with either T1D or T2D. (Hooper 2013)
diabetis by weight

Health Vision 2020 is a global mission to improve quality of life, promote healthier lifestyles, increase public health awareness and attempts to create suitable healthy living environments. (“About Healthy People”) One of the most important details of health vision 2020’s mission is the intent to implement these missions on multiple levels. Diabetes is a disease that requires attention at personal, institutional (improvements in health care systems), environmental and global level. Increasing awareness and prevention strategies of diabetes will mitigate the prevalence of this disease not only throughout America but worldwide. Healthcare systems have improved in treating the disease directly but still require advancements in preventing the large influx of new cases. The missions of Health Vision 2020 are feasible due to the fact that the disease is largely preventable by increased awareness and diligent efforts of individuals to positively modify their lifestyle. One of the overarching goals of Health 2020, “Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death” can be achieved simply through proper education of prevention methods. The current national spending allotted to diabetes and diabetes-related health risks stands at $245 billion dollars. (Fast Facts. 2013) Mitigating the rates of diabetes will significantly reduce medical spending both on an individually and nationally.

As common as diabetes has become, the disease is still overlooked and disregarded. Implementing beneficial changes will prevent onset and reduce risk of diabetes. In addition, it will decrease the medical expenditure as well as reduce risk for diabetes-related health risks. The future for genetic research regarding diabetes hopes to soon be able to identify specific markers for the disease and allow for early detection. The most important and stressed suggestion from researchers and physicians alike is the fact that diabetes is a preventable disease and precautious steps should be taken to avoid being diagnosed with the disease.

References

“Statistics About Diabetes”. American Diabetes Association. 10 Jun. 2014.
http://www.diabetes.org/diabetes-basics/statistics/

"Your Guide to Diabetes: Type 1 and Type 2: Learn about Diabetes." NIDDK.
http://diabetes.niddk.nih.gov/dm/pubs/type1and2/#signs

Nordqvist, Christian. "What Is Diabetes?" Medical News Today. N.p., Apr. 2010
http://www.medicalnewstoday.com/info/diabetes/

“Diabetes Facts and Statistics”. Diabetes Research Center. Albert Einstein College of Medicine. 2014.
https://www.einstein.yu.edu/centers/diabetes-research/facts-statistics/

Delamater, Alan. "Psychosocial Therapies in Diabetes." Diabetes Care. American Diabetes Association, July 2001
http://care.diabetesjournals.org/content/24/7/1286.full

"Genetics & Diabetes : What's Your Risk?" Joslin Diabetes Center
http://www.joslin.org/info/genetics_and_diabetes.html

"About Healthy People." - Healthy People 2020.
http://www.healthypeople.gov/2020/about/

"Diabetes." Symptoms: When Diabetes Symptoms Are a Concern. Mayo Clinic, 25 June 2013
http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-symptoms/art-20044248

Hooper, Ryan. "The Sugar State." - Hour Detroit. N.p., Oct. 2013.
http://www.hourdetroit.com/Hour-Detroit/October-2013/The-Sugar-State/#.U8B60xbfbwJ

“The Diabetes Epidemic Among African Americans” NDEP. Jan. 2011.
http://ndep.nih.gov/media/FS_AfricanAm.pdf?redirect=true

“Type 2 Diabetes” Health Guide. The New York Times. 11 Jul. 2014.
http://www.nytimes.com/health/guides/disease/type-2-diabetes/complications.html

"Diabetes Center." Detroit Medical Center.
http://www.dmc.org/healthlibrary/newsdetail.aspx?ContentTypeId=85&ContentId=P00353

“Genetics and Diabetes” World Health Organization.
http://www.who.int/genomics/about/Diabetis-fin.pdf

“Fast Facts: Data and Statistics about Diabetes” American Diabetes Association. Mar. 2013