Diabetes

 

Abstract

Diabetes is a condition that results from problems with the insulin hormone. This essay seeks to investigate the various details about Diabetes. To achieve this objective, the essay has been structured into several sections including an introduction, epidemiology, financial costs, etiology, and diagnosis, treatment, and prognosis. The result of the investigation shows that indeed diabetes is a severe condition that is responsible for millions of death per year globally. Although at present diabetes has no cure, there is hope as more research is being done into finding this cure. More studies need to be done in pancreas transplantation which could be the best hope of curing diabetes.

Introduction

Diabetes is a chronic set of diseases which arise from issues with the insulin, a hormone secreted by the pancreas and whose role is to adjust the blood sugar level. Insulin, therefore, prevents the conditions of hyperglycemia and hypoglycemia which refer to high and low blood sugars respectively (American Diabetes Association, 2015). Problems with this hormone give rise to Diabetes. Hence it can be referred to as a disorder of metabolism. The diseases that constitute diabetes include type 1 diabetes, type 2 diabetes, Gestational Diabetes Mellitus (GBM), and diabetes that may result from causes such as drugs. For the case of type 1, the pancreas stops making insulin, and it usually occurs from one’s childhood. Type 2 is characterized by the inability of the body to use the insulin it produces, also called insulin resistance, and it may begin at any age. Gestational diabetes occurs in expectant mothers due to factors such as deficient insulin. Diabetes poses severe adverse effects on the body including heart diseases, high blood pressure, stroke, blindness, kidney failure, and even causes nerve damage. The condition has no cure. However, there are means to manage the disease to avoid the long-term complications.

History of Diabetes

The history of diabetes places it as one of the oldest diseases to be known with records tracing it back to 400 BC (Leutholtz and Ripoll, 2011: 25). Although limited in their knowledge, the physicians of those times were able to observe various symptoms of diabetes such as a sweet taste of urine. Other evidence is found in the historical Egyptian Ebers Papyrus written around 1500 BC describing a condition of too much urine (Poretsky, 2010: 3). Other ancient evidence is also found in India. The disease was fatal until the early twentieth century when effective treatment was developed, following the isolation of insulin.

Epidemiology of Diabetes

Statistical prevalence    

According to the World Health Organization (WHO), the global prevalence of diabetes among adults who are aged above 18 years was 8.5% in 2014. In the same year 2014, the total number of people who have diabetes was found to be 422 million. Also according to the National Diabetes Statistical Report, 2017 which is a publication of the Centers for Disease Control and Prevention (CDC), diabetes is quite prevalent in the US. 7.2% of the US population is diagnosed with diabetes. For ages below 18 years, 0.18% of the younger US population has diabetes. For US adults aged 18 years and above, diabetes prevalence was found to be higher among the Indian/Alaskan natives at 15.1%, the non-Hispanic blacks at 12.7% and the Hispanics at 12.1%. These figures are higher compared to the lower figures among the non-Hispanic whites at 7.4% and Asians at 8%. The prevalence of diabetes in both men and women is almost equal with only a slight difference. Diabetes is more common in the developed countries; however, according to WHO, there is an increase in the prevalence in the low and middle-income countries following urbanization and lifestyle changes.

Risk Factors for Diabetes

As mentioned earlier, diabetes is as a consequence of the body’s incapacity to secrete insulin or utilize it. The risk factors for diabetes differ according to the type, i.e., type 1, 2, and gestational. Type 1 diabetes starts during childhood and is, therefore, for life. Its risk factors include a family history of diabetes, illnesses, and diseases of the pancreas (Pociot and Lernmark, 2016). Type 2 diabetes, caused by insulin resistance also has several risk factors including being obese or overweight, the ethnic background, gestational diabetes, living a sedentary lifestyle, impaired glucose tolerance, age, and the family history (Martin-Timon et al., 2014). For gestational diabetes caused by too little insulin or by the hormones made by the placenta during expectancy, the risk factors include glucose intolerance, age, family history, the ethnic background, and obesity.

Financial Costs

According to the American Diabetes Association (2013), the cost of diabetes was estimated at $ 245 billion in the year 2012. This amount included a total of $176 billion in the direct medical costs as well as $69 billion in reduced productivity. The medical expenditure can be broken down into various components including the hospital inpatient care which accounts for the highest spending. It is followed by the cost of the prescription medications, anti-diabetic agents, the cost of visits to the physician office and also the cost of providing residential as well as nursing facilities (American Diabetes Association, 2013).

 

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Costs to the individual and family

People with diabetes have been found to spend approximately $7900. They have also been found to incur over twice the medical expenditure, compared to a situation where the diabetes condition was absent (American Diabetes Association, 2013).

Possible costs to society

Some of the intangible costs of diabetes to the society include a lower quality of life as well as the pain and suffering that diabetic people undergo together with their families and friends.

Loss of productivity

Loss of productivity is an indirect cost of diabetes which results from factors such as increased absenteeism, the inability to work due to a disease related disability, lower productivity at work, and lost productive capacity due to high mortality of diabetic patients.

Anatomy & Physiology/Etiology:

The normal and abnormal structure & function behind Diabetes

Type 1 diabetes is as a result of the destruction of the β – cell destruction. These are the cells in the pancreas whose function is to make insulin. The cells are destroyed by the immune system in the process of T-cell mediated immunity (Rother, 2007). The result is insulin deficiency. Although in most cases, type 1 diabetes is immune-mediated, it is also idiopathic at times. This type of diabetes is mostly inherited with the Human Leukocyte Antigen (HLA) genotypes being a leading risk factor. Environmental factors including viral infections and dietary habits may also act as a trigger for type 1 diabetes. Type 2 diabetes is as a result of a metabolic abnormality resulting in insulin resistance. This resistance results in the body cells inability to use insulin hence high levels of glucose in the blood. Gestational diabetes is a result of the placenta producing various hormones which impair the functioning of insulin thus leading to high levels of blood sugar (Rother, 2007).

Diagnosis, Treatments, and Prognosis:

How diabetes is diagnosed

There are various ways to diagnose diabetes. Some of the symptoms to look out for include frequent urination and hence excessive thirst. There is also hunger and fatigue due to the body’s inability to utilize glucose. Blurred vision due to changing the level of fluids in the eye and dry mouth and itchy skin also due to loss of fluids can occur. Other common symptoms include skin yeast infections, taking long to heal bruises and cuts, and aching and numbness in the feet due to nerve damage. The symptoms are common to all types of diabetes (American Diabetes Association, 2015).

Lab tests include the Glycated hemoglobin (AIC) test which is a blood test that shows the average level of blood sugar in the blood for the previous three months. The blood sugar attached to the hemoglobin is measured to determine its percentage. A result of 6.5% and above indicates one has diabetes. Between 5.7% and 6.4% indicates pre-diabetes while levels below 5.7 are normal (Luethi et al., 2016). Other tests include a random blood sugar test taken at a random time, fasting blood sugar test taken after an overnight fast, and an oral glucose tolerance test (OGTT). The urine may also be tested. In the case, the presence of byproducts of muscle and fat metabolism is investigated.  In the case of gestational diabetes, initial glucose tests and follow up glucose tolerance testing is administered to monitor any case of diabetes arising.

 

Diabetes Treatment

Diabetes has no cure. The goal is to manage it and avoid any complications that may arise through a close follow-up of the blood sugars. Type 1 diabetes management requires insulin injections, exercise, and dietary changes while type 2 diabetes non-insulin medications, weight reduction or dietary changes as well as insulin. When it comes to diet, a diabetic patient has to work closely with a nutritionist and doctor to establish the most appropriate diet. When it comes to delivering insulin to the body, various methods are variable are available including insulin pumps, syringes, and pre-filled pens. The various medications that are prescribed for type 2 diabetes work by increasing glucose excretion, increasing insulin sensitivity, and also by decreasing the absorption of carbohydrates from the digestive tract. Regarding the prediction of the disease outcome, no proper methods have been developed yet (Rother, 2007).

Conclusion

Diabetes is a chronic condition that emerges as a result of problems with insulin. This can either be the lack of insulin production from the kidney or an abnormality referred to as insulin resistance. There are, therefore, different types of diabetes including type 1, type 2, and gestational, depending on the source of the issue. The prevalence shows that there is an increase in diabetic patients, which keeps raising the financial cost associated with the condition. Although diabetes has no cure, it can be managed through proper treatment and the right diet.

References

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association33(2), 97.

American Diabetes Association. (2013). Economic costs of diabetes in the US in 2012. Diabetes care36(4), 1033-1046.

Leutholtz, B. C., & Ripoll, I. (2011). Exercise and disease management. CRC Press.

Luethi, N., Cioccari, L., Tanaka, A., Kar, P., Giersch, E., Deane, A. M., … & Bellomo, R. (2016). Glycated hemoglobin A1c levels are not affected by critical illness. Critical care medicine44(9), 1692-1694.

Martín-Timón, I., Sevillano-Collantes, C., Segura-Galindo, A., & del Cañizo-Gómez, F. J. (2014). Type 2 diabetes and cardiovascular disease: have all risk factors the same strength?. World journal of diabetes5(4), 444.

Pociot, F., & Lernmark, Å. (2016). Genetic risk factors for type 1 diabetes. The Lancet387(10035), 2331-2339.

Poretsky, L. (Ed.). (2010). Principles of diabetes mellitus. New York: Springer.

Rother, K. I. (2007). Diabetes treatment—bridging the divide. The New England journal of medicine356(15), 1499.

 

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