Diabetes has become an immense challenge to the global public health systems with its burden approaching unbearable proportions. With an upward surge of diabetes rates, it is observed that diabetes has the highest disease burden compared to all the other non-communicable diseases (Kimuyu, 2016). Epidemiological studies reveal that hypertension and diabetes has contributed to the increase of cardiovascular disease, the world’s leading cause of death and morbidity (Tabish, 2007). One of the epidemiological concerns related to the upward trends of diabetes is the increase in incidence rates of Type 2 Diabetes (T2D) among children. Ordinarily, T2D has always been known as the ‘disease of retirement,’ implying that it occurs among adults but its trends have changed (Kimuyu, 2017). Therefore, this paper will give a comprehensive analysis of the development of T2D and suggest prudent steps to address the psychosocial proliferation of the disease.
The State of Type 2 Diabetes and the Underlying Social, Behavioral and Psychosocial Causes
Patrick Kimuyu
Introduction
Diabetes has become an immense challenge to the global public health systems with its burden approaching unbearable proportions. With an upward surge of diabetes rates, it is observed that diabetes has the highest disease burden compared to all the other non-communicable diseases (Kimuyu, 2016). Epidemiological studies reveal that hypertension and diabetes has contributed to the increase of cardiovascular disease, the world’s leading cause of death and morbidity (Tabish, 2007). One of the epidemiological concerns related to the upward trends of diabetes is the increase in incidence rates of Type 2 Diabetes (T2D) among children. Ordinarily, T2D has always been known as the ‘disease of retirement,’ implying that it occurs among adults but its trends have changed (Kimuyu, 2017). Therefore, this paper will give a comprehensive analysis of the development of T2D and suggest prudent steps to address the psychosocial proliferation of the disease.
Development of T2D in the U.S. Compared to Its Development in Developing Countries
In general, T2D has become a challenge worldwide. Populations in all regions of the world are affected in one way or the other, although its consequences are severe in some regions. Historically, T2D emerged in industrialized countries and its incidence was observed to increase over the past century. In the United States, T2D emerged as a condition for the adult population. In addition, it was associated to a wealthy lifestyle in which rich families experienced more cases of T2D than poor and middle income families. Currently, T2D is estimated to have reached epidemic proportions in disadvantaged minorities in the United States (Shaw, Zimmet, McCarty & Courten, 2000).
Compared to the United States, developing countries were not prone to T2D prior to European colonization. However, westernization is believed to have contributed to the emergence of T2D in the developing world. Foremost, the spread of industrialization combined with rapid urbanization in developing countries enticed people to adopt western culture. Epidemiological studies indicate that T2D occurs in populations with rapid and major lifestyle changes, implying that lifestyle factors are responsible for the growing incidence of the epidemic (Tabish, 2007).
Currently, developed countries, including the United States have a small global share of T2D population compared to developing countries. It is estimated that 80% of diabetics are living in developing countries. Countries in the Middle East, Western Pacific and Eastern Mediterranean are the most affected by T2D. In contrast to the trends in the United States where old populations are highly affected, T2D in developing countries is affecting people of middle ages. Most people with T2D in the United States are aged over 64 years, whereas those in developing countries are aged between 35 and 64 years (Tabish, 2007).
Comparison of T2D rates in the United States and New Jersey
It is apparent that the United States experiences a high prevalence of T2D. According to epidemiological records, there are 29.1 million diabetics in the United States with an estimation of 8.1 million undiagnosed diabetes cases. Overall, 2 in every 5 adults in the United States are expected to suffer from T2D in their lifetime. In order to unearth the underlying trends of diabetes, it is worth comparing the national diabetes incidence and prevalence rates with those of the federal states. An overview of this comparison can be provided by the diabetes trends in New Jersey. In 2010, New Jersey had diabetes prevalence rate of 9.0% in which T1D accounted for only 5% of the total diabetic population (Katzen Condra, 2014). Compared to the national prevalence rate of 6.4%, New Jersey has a higher prevalence. On the other hand, the state has a higher incidence rate of T2D compared to the United States in general. The 2010 data showed that the national incidence rate was 8.1 per 1,000 people, whereas that of New Jersey was 9.1 per 1,000 people (Katzen Condra, 2014).
Moreover, trends of T2D reflect demographic aspects in which its distribution varies across the New Jersey population. Clinical statistics show that 9.5% of Hispanics, 14.55 of blacks and 8.1% of whites in New Jersey have T2D (Katzen & Condra, 2014). On the other hand, national statistics indicate that 7.6 of whites, 12.8 of Hispanics and 13.25 of blacks in the United States have been diagnosed with T2D (CDC, 2014). According to this epidemiological data, it is evident that New Jersey has a low incidence rate T2D among Hispanics. However, T2D incidence rates among the blacks and whites remain higher than the national incidence rates.
Cost of Treating T2D in the Community
T2D imposes immense social and economic consequences to the local community. It is reported that T2D presents the greatest single economic burden on the affected communities in which individuals and their families incur both direct and indirect medical costs. At the national level, direct healthcare costs of diabetes treatment accounts for $116 billion, annually (Sinha, Rajan, Hoerger & Pogach, 2010). At the local community setting, people use their resources for the treatment and management of T2D. It is worth noting that T2D is not curable. As such, treatment takes a lifetime, and this consumes huge sums of money. On the other hand, the New Jersey community incurs indirect costs from T2D. These costs can be evaluated through the use of lost productivity. In most cases, loss of productivity is attributable to premature mortality, disability and morbidity related to T2D. There are also intangible costs involved in treating T2D, and these can be expressed by the reduced quality of life due to psychosocial consequences of the disease.
Prudent Steps to Address the Psychosocial Proliferation of T2D
In general, diabetes has been found to have a connection with a number of psychosocial aspects. Over the past decade, extensive scientific inquiry has been done in order to understand the comorbidity of psychological disorders and diabetes. This inquiry has revealed that depression exhibits a prevalence rate of about 15% in uncontrolled studies. Therefore, it is apparent that diabetics are more prone depression than the general adult population, worldwide. Moreover, epidemiological studies indicate that depression occurs at the highest prevalence rates among people with diabetes than any other population suffering from other chronic diseases. Therefore, there is need to address the psychosocial aspects of T2D as the key approach for controlling its proliferation. From an epidemiological perspective, there are prudent steps that need to be adopted in addressing the psychosocial proliferation of T2D. Some of the key prudent steps include:
1. Control of substance abuse among people with T2D.
2. Use of psychopharmacological therapies for treatment and management of psychological disorders, primarily depression and eating disorders.
3. Use of psychological therapies for treatment of psychiatric disorders.
4. Establishment of social support programs.
5. Establishment of work-life balance among diabetics in the workforce.
Ideally, the above steps are focused on reducing the psychological impact of T2D. For instance, substance abuse is known to escalate depression. Therefore, controlling substance abuse among diabetics will reduce the severity of the disease. On the other hand, the use of psychopharmacological therapies will address the pathophysiological aspects of T2D such as insulin resistance and glucose intolerance. For instance, the use of anti-depressants controls depression, thus enhancing glucose regulation. In addition, double-blind studies indicate that Sitagliptin is effective in reducing T2D (Nauck, Meininger, Sheng, Terranella & Stein, 2007). Similarly, psychological therapies enhance the management of psychological disorders among diabetics. Moreover, establishment of social support programs will promote the psychosocial wellbeing of people with T2D. An outstanding example of the benefits of social support to patients can be provided by the paradigm of the healing hospital. Finally, work-life balance will reduce anxiety in people with T2D who are in their productive ages.
Steps to Address T2D in Nursing Homes
In practice, different environments require different prevention approaches for T2D. For instance, workplace environment offers different opportunities and challenges for addressing the proliferation of T2D compared to nursing homes. Therefore, my previous experience in a nursing home is essential for proposing appropriate steps which are necessary for addressing T2D in such facilities. Some of the most key recommendations include:
1. Establishment of weight management programs.
2. Adoption of prudent dietary regime.
3. Development of physical fitness programs.
4. Regular diabetes screening.
5. Restructuring of psychological therapies to incorporate diabetics.
6. Regular blood pressure checks.
These recommendations are focused on controlling the modifiable risk factors for T2D. Studies show that lifestyle intervention reduces the incidence rate of T2D (Knowler, Barrett-Connor, Fowler, Hamman & Lachin, 2002). Weight management is meant to address obesity as one of the predisposing factors for T2D. On the other hand, appropriate nutrition and physical activity will address the problem of glucose regulation among people in nursing homes. However, I would recommend diabetes screening to be given the highest priority. The rationale for this recommendation is because most adults live with undiagnosed T2D. In addition, age is a risk factor for T2D.
References
CDC (2014). National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: Department of Health and Human Services.
Shaw, J., Zimmet, P., McCarty, D., & Courten, M. (2000). Type 2 Diabetes Worldwide According to the New Classification and Criteria. Diabetes Care,23(2), B5–B10.
Tabish, S. (2007).Is Diabetes Becoming the Biggest Epidemic of the Twenty-first Century?Int J Health Sci (Qassim),1(2), V–VIII.
Knowler, W., Barrett-Connor, E., Fowler, S. E., Hamman, R., & Lachin, J. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med.,346, 393–403.
Katzen, A., & Condra, A. (2014). 2014 New Jersey state report: an analysis of New Jersey’s opportunities to enhance prevention and management of type 2 diabetes. Cambridge, MA: Center for Health Law & Policy Innovation (Harvard Law School).
Kimuyu, P. (2016). Diet and disease in America. Munich, Germany: GRIN Verlag. Retrieved from https://www.grin.com/document/380826
Kimuyu, P. (2017). Diabetes as a chronic disease: causes and effects of diabetes on organ systems.Munich, Germany: GRIN Verlag. Retrieved from https://www.grin.com/document/384372
Sinha, A., Rajan, M., Hoerger, T., & Pogach, L., (2010). Costs and consequences associated with newer medications for glycemic control in type 2 diabetes. Diabetes Care,33(4), 695–700.
Nauck, M., Meininger, G., Sheng, D., Terranella, L., & Stein, P. (2007). Sitagliptin Study 024 Group Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab.,9, 194–205.
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- Patrick Kimuyu (Autor), 2018, The State of Type 2 Diabetes and the Underlying Social, Behavioral and Psychosocial Causes, Múnich, GRIN Verlag, https://www.grin.com/document/388759
