Journal 2-2

Journal 2-2

Problem: Diabetes

Program: Diabetes Prevention Lifestyle Change Programs

Diabetes is a chronic degenerative and metabolic disease which prevalence continues to increase year after year. In 2014 the estimated population living with diabetes was 9.4%. (CDC 2014). It is currently estimated that a total of 30.3 million Americans are diabetics, however, there is a significant amount of underdiagnosing and approximately 7.2 million people with living with diabetes have not been identified as such, that is, one out of every 4 patients with diabetes are undiagnosed.

The African American, Native Americans and Hispanics, who have a lower access to health services are the more affected. (Geiss 2014). Underdiagnosing brings significant problems to the table. These patients are not treated appropriately, spending years living with a condition that can have devastating consequences that if left untreated, may develop major complications, disability, lower productivity, organ failure, etc. which, can translate into major economical magnitude problems. The American Diabetes Association released new research in 2013 estimating the total costs of diagnosed diabetes have risen to $245 billion in 2012. (ADA 2012). This cost has been steadily rising and, between 2007 and 2012 there was a 41% increase. If we couple that, one of every 4 diabetics are not yet diagnosed, the cost is even of higher magnitude.

Disparity Facts:

Even though diabetes affects the entire population, there are indeed important differences when race, education level and socioeconomic level are taken into consideration. The cargo of diabetes is much higher for specific ethnic minorities than for the white population. This may have a genetic influence, however multiple social factors as well as economic factors are known to play a role. Furthermore, some minorities have higher rates of diabetes-associated complications and death. (AHRQ 2001). For example, African American are up to 4 times more likely to develop renal disease, blindness, amputations and death as compared to Whites. (Peek 2007). This is of major impact for the population well-being and in life in general.

Diabetes is more prevalent among American Indians, African American and Hispanics. (CDC 2017). Table 1 and Figure 1 show these statistics graphically.

Race/ethnic group	Age-adjusted prevalence (%)
Non-Hispanic Whites	7.1
Asian-Americans	8.4
Hispanic-Americans overall	11.8
Non-Hispanic Blacks	12.6
Alaska Natives	5.5
Native Americans	33

Table 1. Race/ethnicity and Diabetes prevalence.

Figure 1. Diabetes prevalence and race/ethnicity.

Another important disparity is education, diabetes prevalence varies markedly by education level. This is an indicator of socioeconomic status. Specifically, in people with less than high school education, the prevalence is 12.6%, whereas the incidence is 9.5% and 7.2% of those with high school education and more than a high school education respectively. (CDC 2017, Geiss 2014).

Figure 2. Education and death risk of diabetes among same economic group people. Importance of education level.

Figure 3. General health and education level. The effect education has in general health. Similar to diabetes, higher education is positively related to better health.

Poverty is a major hurdle for healthcare access, those families with yearly income below Ten thousand dollars make 35.7% of the uninsured people, in contrast with a 7.1 % of those earning more than seventy-five thousand each year. The poverty rate form American Indians is 26%, for African-Americans is 26%, for Hispanics 25%^ and 9% for Whites. If we look at these poverty rates among ethnic groups, we can see that they parallel the prevalence of diabetes in our country. This is a clear example that economy is a major determinant of health and an important health disparity factor.

Diabetes is a chronic disease, it takes years to develop into a full-blown disease. Most patients become prediabetic prior to developing diabetes.This prediabetic state is a metabolic derangement that has multiple health consequences. Prediabetes or metabolic syndrome is known to be the most common cause of heart disease and precedes diabetes in most cases. Approximately 34% of the population are prediabetic. (CDC 2017). Importantly, 97% of the people with metabolic syndrome are not aware of having the condition. We are failing to address a major epidemic in a proper manner. As a consequence, multiple years go by before adequate therapy is started. For those patients with less access to health services, is not uncommon to have their first encounter with a health provider in an advanced stage when end organ failure is already present.

As we can see, diabetes is a major public health problem, it has epidemic behavior and its prevalence has steadily been climbing through the years. There are clear disparities and efforts as well as funds should be directed towards education and programs to address this important health problem.

References

Agency for Healthcare Research and Quality (2001). Diabetes Disparities Among Racial and Ethnic Minorities. https://archive.ahrq.gov/research/findings/factsheets/diabetes/diabdisp/diabdisp.pdf. Extracted, February 24, 2018.

Alliance to Reduce Disparities in Diabetes. (2011). About Diabetes Disparities. http://ardd.sph.umich.edu/about_diabetes_disparities.html. Extracted February 24, 2018.

American Diabetes Association. (2012). The cost of Diabetes. http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html?referrer=https://www.google.com/. Extracted February 24, 2018.

Beckles, G. L., Chiu-Fang, C., & Chou, C. (2016). Disparities in the Prevalence of Diagnosed Diabetes - United States, 1999-2002 and 2011-2014. MMWR: Morbidity & Mortality Weekly Report, 65(45), 1265-1269. doi:10.15585/mmwr.mm6545a4

Bo S, Ciccone G, Pearce N, Merletti F, Gentile L, Cassader M, Pagano G. (2007). Prevalence of undiagnosed metabolic syndrome in a population of adult asymptomatic subjects. Diabetes Res Clin Pract.  2007 Mar;75(3):362-5. Epub 2006 Aug 22. https://www.ncbi.nlm.nih.gov/pubmed/16930757. Extracted on February 18, 2018.

CDC. National Diabetes Surveillance System. National diabetes statistics report, 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/ national-diabetes-report-web.pdf

CDC, (2017). National Diabetes Statistics Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Extracted February 18, 2018.

Ford E, Giles W, Dietz W. (2002). Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287: 356–359.

Geiss L, Wang J, Cheng Y, et al. (2014). Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980–2012. JAMA 2014;312:1218–26. http://dx.doi.org/10.1001/ jama.2014.11494

Peek, M, Cargill, A, Huang, E. (2007). Diabetes Health Disparities. Human Health Services. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367214/. Extracted February 24, 2018.