Recommendations to Delay The Onset of Diabetes and Control of Diabetes

Introduction

Diabetes is a chronic disease that affects the body's mechanism of converting food into energy. A substantial amount of food that we consume is metabolized into glucose and transported into the bloodstream. When the sugar content in the blood spikes up, the pancreas receives instruction to secrete insulin. Insulin mimics the role of a key which allows the blood glucose to be absorbed into the body's cells as an energy currency. Diabetes occurs due to insufficient insulin production or insulin resistance. When either one of the mentioned conditions persists, glucose stays in the blood longer than it should be, which is known as Hyperglycemia. Consequently, it brings about severe complications such as cardiovascular disease, retinopathy, and kidney disease. Unfortunately, there is no way to reverse diabetes, yet, shedding pounds, healthy eating habit and leading an active lifestyle could keep it under control. Plus, compliance with medication and keeping up with the medical appointments, considerably decrease the impact of this disease. (Diabetes, 2019).

Statistically speaking, a whopping 30.3 million adults in the US, that is 9.4% of the US population, are suffering from diabetes, where a quarter of the mentioned population, or 12.2% of US adults, are completely oblivious of this fact! Unsurprisingly, diabetes ranks seventh in the leading causes of death in the US, where, in 2015, 79,535 deaths were due to complications of diabetes. Even worse, in 2014, it was the No.1 reason for lower-extremity amputations with 108,000 cases and kidney failures with 52,159 cases. Over the last two decades, the population diagnosed with this disease has increased more than two folds! Especially, the chance to develop this disease has increased by 25.2% among those who are 65 or older! It has been estimated that the cost of interventions for diabetes was $245 billion in 2012. Annually, a patient with diabetes found to spend an average of $13,700 on medical expenditure. (Diabetes, 2019) (Estimates of diabetes and its burden in the United States, 2017).

There are three types of diabetes i.e. type 1, type 2 and gestational diabetes. Type 1 diabetes is an autoimmune condition occurs among children and teens, where the sufferer has to inject insulin daily. This type has afflicted 5% of the overall diabetic population and completely unpreventable. Whereas 90% of the diabetic population made up of type 2 diabetes patients. Type 2 happens when the body fails to utilize insulin effectively to keep the blood glucose level within the normal range. Type 2 diabetes thought to be diagnosed in adults only, but, recently, even youngsters are increasingly getting diagnosed with it (Diabetes, 2019). From 2011 to 2012, 5,300 children and teenagers diagnosed with type 2 diabetes (Estimates of diabetes and its burden in the United States, 2017)

During 2013-2015, the prevalence of diabetes was highest among the Native Americans, which was 15.1%, followed by the Mexicans, 13.8%, non-Hispanic Black, 12.7 %, Hispanic ethnicity, 12.1%, Puerto Ricans, 12.0% and Asian Indians, 11.2%. Prevalence differed notably by the socioeconomic background, especially the education level. (Estimates of diabetes and its burden in the United States, 2017)

Type 2 diabetes could be avoided or delayed by leading a healthy lifestyle. While gestational diabetes is a form of diabetes which occurs in conceived women without a prior diabetes record. Usually, this diabetes resolves after the delivery, yet, it increases the predisposition of the women to get diabetes type 2 in the future. Besides, the child tends to be obese and predisposed to type 2 diabetes as well. In the US adult population, in 2015, more than 1 out of 3, that is, 84.1 million or 33.9% of adults were pre-diabetics! Surprisingly enough, 90% of the pre-diabetics were not aware of it, as their blood glucose levels were above the normal level, but, still not high enough to be diagnosed. Smoking, obesity, sedentary lifestyle, high blood pressure, hyperlipidemia, and hyperglycemia were highlighted as the risk factors. Of all the data collected from diabetics from 2011 to 2014, 15.9% were smokers, 87.5% were obese, 40.8% were physically inactive, 73.6% had high blood pressure, 58.2% had hyperlipidemia and 15.6% had hyperglycemia. Since 90% of the diabetics have type 2 diabetes, almost all the data are typical of type 2 diabetes. (Diabetes, 2019) (Estimates of diabetes and its burden in the United States, 2017) In this paper, I have come up with recommendations to delay the onset and control of diabetes.

Recommendations

I strongly recommend for proper health education as a primary tool to delay, control or prevent diabetes, as during 2013-2015, the age-adjusted incidence of diabetes was roughly twice higher among patients who had never obtained high school education, or 10.4 per 1000 persons, compared to, 5.3 per 1000 persons, of whom have surpassed high school education (Estimates of diabetes and Its burden in the United States, 2017). Besides education, community engagement and ecological or multilevel approaches are necessary to ensure the success of the health promotion program (Kelley, 2005). The following are my recommendations for diabetes:-

Diabetes Self-Management Education and Support (DSME/S)

DSME lays the foundation for the diabetics to explore their decisions and programs to improve their health and quality of life. DSME/S entails the process of imparting the knowledge, abilities, and skills to the diabetics for self-care. It gives the necessary support for the diabetics to apply coping skills and behavior transformations continually to avoid complications due to diabetes. DSME/S comprises various members from the community and the health care practitioners. Nevertheless, they are required to abide by the systematic referral process that type 2 diabetics get proper education and support in the practice setting. Two hallmarks of the DSME/S are education and support. Because they recognize that educating the diabetics once in a blue moon alone will do no favor to them, as behavioral transformation is of utmost importance to practice whatever taught to them. That is why, DSME/S modules are tailored to address the diabetics' beliefs about health, culture, knowledge, physical and emotional challenges, family's response, financial background, and other often-overlooked dimensions which still may profoundly affect their motivation for self-care. The American Diabetes Association (ADA) recommends DSME/S to all diabetics regardless of the type of diabetes, as it uplifts the diabetics in terms of education and self-care experience. Also, it is focused on reducing diabetes-incurred costs. (Powers, 2015).

Furthermore, health organizations looking forward to offering DSME/S could apply for recognition from the American Diabetes Association (ADA) or American Association of Diabetes Educators (AADE) to be eligible for medical cost refunds from Medicare, Medicaid agencies and health insurance policies. Since the benefits covered may be different by the insurer, it is important to be cognizant of one's benefits from the insurer. Particularly, Part B beneficiaries of Medicare are entitled to diabetes self-care education for 10 hours for a whole year, upon referral from doctors, physician assistants, registered nurses, and nurse practitioners. Then, the education hours increase by two hours each subsequent year. Despite its cost-effectiveness and health benefits, in the US, only about 5% of Medicare beneficiaries who are diagnosed with diabetes have joined DSME/S. (Diabetes self-management education and support(DSMES) toolkit, 2018).

Since Medicare has authorized outpatient coverage for DSME/S, numerous randomized trials have been carried out to gauge the efficiency of DSME/S on health outcomes among the type 2 diabetics. Turns out, undeniable glycemic control was attributed to DSME/S. 61.9% of 118 interventions, reported notable changes in glycated hemoglobin or A1C. The total mean decline in the A1C level was 0.74 and the average absolute decline in A1C was 0.57. Even a greater reduction of 83.9%, was recorded in patients with consistently elevated hemoglobin glycemic values which were more than 9, in the A1C scale (Chrvala, 2016). Another study shows that each 1% decline in A1C could reduce the risk of deaths by 21%, myocardial infarction by 14% and microvascular complications by 37% (Stratton, 2000).

Apart from that, DSME/S also was associated with a lower rate of readmission within 30-days analysis of 2,069 patients. Those who received the diabetes education recorded readmission frequency of 11% compared to 16% of those who did not join the education. The study suggested that diabetes education indirectly affected the patients' overall health by promoting compliance with the medications and therapeutic diet, besides keeping up with the best self-care skills and behaviors (Healy, 2013). Reduced readmission resulted in lower hospitalization expenses and cost patterns among the diabetics (Duncan, 2011).

Native Diabetes Wellness Program

Alaska Natives and the American Indigenous people have a greater predisposition to get diabetes compared to any other racial group in the US. Furthermore, the Native Americans are at risk of getting diabetes two times of the whites. Diabetes has been identified as the cause of kidney failure in around 2 out of 3 Native Americans. That made the Native Americans the race which was prone to get kidney failure from diabetes more than any other race in the US. What's more, Native Americans were 5 times more at risk of kidney failures than any other race in 1996. Nevertheless, this has dropped drastically through the implementation of Indian Health Service, an intervention of the Native Diabetes Wellness Program. (Vital Signs, 2017).

Native Diabetes Wellness Program utilizes a population approach to study long term health consequences and health care facility disparities among the Native Americans. Also, they assess the poverty, availability of nutritious food, jobs and conducive spots for exercise. Furthermore, the program is focused on the entire Native American community and bridges the gap between the people and the local resources, such as healthy food, accommodation, mental health care, and transportation. Also, the program includes a coordinated team approach that consists of diabetes education, following up, outreach to link the people with volunteers, pharmacists, health educators, behavioral clinicians, and nutritionists. Besides, this program incorporates diabetic nephropathy prevention into regular diabetes care which helps the patients to control the blood pressure and glucose level. Plus, they provide medications and kidney lab test appointments routinely. (Vital Signs, 2017).

As a measure to fight the diabetes epidemic in the Native American community, Congress formed the Special Diabetes Program (SDPI) grant in 1997. This grant program, allocates $150 million annually, to reach out to the Native American community. The Tribal Leaders Diabetes Committee was formed to be entrusted with the annual fund, which will be channeled to the Indian Health Service to coordinate all the treatment and prevention interventions (Special diabetes program for Indians, n.d.). Also, the federal government funded the development of the Chronic Kidney Disease or CKD Surveillance System to keep track of the prevalence, incidence, and risk factors narrowed down to any particular race including the Native Americans (Vital Signs, 2017).

From 1996 to 2013, Diabetic nephropathy reduced by 54% among the Native Americans by the efforts of the Indian Health Service. Over 5 years, kidney medications use among the Native Americans, increased to 74% from 42%. The average blood pressure was kept under control among the hypertension patients i.e.(133/176mmHg). Blood glucose control increased by 10% and the kidney tests among those who were 65 and beyond were 50% higher than the diabetic population covered by Medicare. Then, in 2013, Native American ranked third in the list of races with kidney failure due to diabetes as opposed to their first place in 1996 (Vital Signs, 2017).

National Diabetes Prevention Program

It has been estimated that, currently, the population of the pre-diabetics has almost reached 86 million in the US and within 5 more years to come, 15-30% of the mentioned population will get type 2 diabetes. With that in mind, Congress has commissioned the CDC to form the National Diabetes Prevention Program or NDPP, a semi-government effort to provide cost-effective and evidence-based interventions across the nation to fight type 2 diabetes. It is aimed to unite community organizations, religious bodies, private insurance agencies, employers, health care providers, and government sectors, to achieve an optimum impact on decreasing type 2 diabetes. This effort was backed by a research finding which showed that structured lifestyle transformations can reduce the risk of developing type 2 diabetes by half (National diabetes prevention program, 2018).

Different members of the community join hands in this nationwide initiative to bring awareness about prediabetes, disseminate information about the NDPP, motivate participation in lifestyle transformation programs and promote the NDPP as one of the inclusive health benefits covered by the insurers. Consequently, a strong workforce could be established to run the lifestyle transformation program nationwide successfully, while ensuring topnotch standardized reporting of the progress. Besides, participation in the interventions could be maximized by increased referrals (National diabetes prevention program, 2018).

One of the key features of the NDPP is the CDC-Recognized Diabetes Prevention Lifestyle Change Program which is designed to meet the needs of the patients at intrapersonal, interpersonal and community levels. Anybody interested or perceived the risk of being a pre-diabetic could take an online risk test and if the person is at high risk, he or she could get a blood sugar test. The person could participate in a lifestyle change program if he or she has prediabetes. The program information in one's community is readily available on the CDC website and finding the program is just as easy as entering one's ZIP code and picking one from the resultant list (National diabetes prevention program, 2018).

The CDC-Recognized Lifestyle Change Program consists of both online and in-person classes. It is led by an accomplished lifestyle instructor to guide one to eat healthily, cope with stress and increase physical activities for year long. The impact of this program is fortified by the interpersonal support from others who share the same challenges and goals. The success of this program lies in the principle of creating a nonjudgmental and encouraging environment where the emphasis is placed on small steps to boost participants' confidence for long term transformations. Statistics show that the participants who lost up to 7% of their weight and managed to add 150 minutes into their weekly exercise routine have reduced their risk of getting type 2 diabetes by 58%. Even better, people who were 60 and beyond reduced the risk to 71%. Over a decade, one out of three of the participants were less likely to get type 2 diabetes compared to those who did not participate (National diabetes prevention program, 2018).

Conclusion

Diabetes should be controlled at once. Providentially, the awareness and knowledge about this disease are increasing in the community, thanks to the Federal government and the other joined private and public sectors. At the core, the behavior of the people should change to bring about long-lasting positive transformation and prevent diabetes in the future. Sadly, in spite of the existence of many diabetes prevention programs, only a small fraction of the population are coming forward to participate. This scenario must change to optimize the impact of the designed health programs.

However, it is not possible without addressing the problem at multiple levels and identifying the underlying factors. That is exactly why, I have recommended DSME/S, the Native Diabetes Wellness Program and the NDPP to delay the onset of diabetes and control diabetes. Because, the mentioned programs are multi-faceted, cost-effective and productive.

References

1. Chrvala, C. (2016, June). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient education and counseling, pp. volume 99,Issue 6, 926-943.
2. Diabetes. (2019, August 6). Retrieved from Centers for disease control and prevention: https://www.cdc.gov/diabetes/basics/diabetes.html
3. Diabetes self-management education and support (DSMES) toolkit. (2018, March 6). Retrieved from Centers for disease control and prevention: https://www.cdc.gov/diabetes/dsmes-toolkit/index.html
4. Duncan, L. (2011, August 30). Assessing the Value of the Diabetes Educator. The diabetes educator, pp. Volume: 37 issue: 5, page(s): 638-657.
5. Estimates of diabetes and its burden in the United States. (2017). National diabetes statistics report, pp. 1-20.
6. Healy, S. (2013, October). Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control. Diabetes care, pp. 36(10): 2960-2967.
7. Kelley, M. M. (2005). Capturing Change in a Community-University Partnership: The ¡Sí Se Puede! Project. Preventing chronic disease, Volume 2, 2.
8. National diabetes prevention program. (2018, November 15). Retrieved from Centers for disease control and prevention: https://www.cdc.gov/diabetes/prevention/pdf/NDPP_Infographic.pdf
9. National diabetes prevention program. (2018, October 29). Retrieved from Centers for disease control and prevention: https://www.cdc.gov/diabetes/prevention/why-participate.html
10. Powers, M. A. (2015). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes care, 38(7): 1372-1382.
11. Special diabetes program for Indians. (n.d.). Retrieved from Indian health service: https://www.ihs.gov/sdpi/
12. Stratton, I. R. (2000, August 12). Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): a prospective observational study. BMJ, p. 321:405.
13. Vital Signs. (2017, January 10). Retrieved from Centers for disease control and prevention: https://www.cdc.gov/vitalsigns/aian-diabetes/index.html