The U.S. Centers for Disease Control and Prevention (CDC) calls diabetes "common, disabling, and deadly." That's why every year, the American Diabetes Association (ADA), in cooperation with communities and other organizations across the country, promotes November as American Diabetes Month. During November, the ADA strives to increase diabetes awareness and educate the public how to help those coping with the disease.
As a healthcare professional, you have the opportunity to be directly involved in that educational effort and may even be able to refer patients for assessment and treatment. A united vigilance among healthcare providers, individuals with diabetes, and those who care for them may go a long way toward lessening its effects.
Diabetes is the seventh leading cause of death in the United States. It strikes people of all ages, socioeconomic status, race, and gender. The impact of diabetes on both individuals and society is profound: Bodily functions may be greatly impaired falls among older adults may increase, and many lives are lost to the disease. In 2012, an estimated $176 billion was spent in direct costs for diabetes care, along with another $69 billion in disability payments and lost work, according to the CDC's National Diabetes Statistics Report, 2014.
Yet progress is being made against diabetes on a number of fronts. According to the CDC's report, the rate of those with diabetes having to be hospitalized for cardiovascular disease has declined. Diabetes-related hospital admissions have also diminished; the rates of new kidney failure diagnoses related to diabetes are decreasing; and the percentage of adults with diabetes-related visual impairment has also gone down.
Optimism is also found in ever-growing numbers of the public who learn from such efforts as American Diabetes Month, and it is also found in the aggressive research efforts that continually make new discoveries and breakthroughs in understanding, diagnosing, treating, and curing the disease. These and other efforts offer hope that someday the vision of the ADA and so many others — "a life free of diabetes" — may one day become a reality.
3 Types of Diabetes
A preventable disease for most, diabetes mellitus causes the body to have high levels of glucose in its bloodstream. The specific nature of this imbalance and its causes determine the type of diabetes. Ninety to 95 percent of people living with the disease have type 2 diabetes. Others have the type 1 and gestational forms of the disease. The remainder occur as a result of diseases or trauma to the pancreas, infections, medications, surgery, and other causes.
The CDC National Diabetes Statistics Report states that during 2008–2009, there were 18,436 new diagnoses of type 1 diabetes among people under 20 years of age. This form of the disease can strike at any age, but its onset is most common among young people who are white, especially between the ages of 10 and 20. An autoimmune disorder that can only be treated with insulin, type 1 diabetes cannot be prevented or cured.
Occurring during pregnancy and diagnosed during the second or third trimester, gestational diabetes is more common among American Indians, African Americans, and Hispanic Americans. For reasons that are not clear, nearly 10 percent of pregnant women develop gestational diabetes. Diet and exercise controls control the vast majority of gestational diabetes, but some women must also add insulin.
Type 2 diabetes is by far the most prevalent and destructive form of the disease. A progressive disease resulting primarily from lifestyle choices, type 2 diabetes is sometimes controlled with no more than making healthy dietary choices, stopping smoking, and increasing physical activity. In other cases — and in most eventually — insulin must be added, either orally or by injection. Obesity, age, a diet high in fat and sugar, and a sedentary lifestyle are all risk factors for type 2 diabetes.
Extent of the Disease
The CDC reports that 29.1 million Americans have diagnosed diabetes. Nearly 28 percent of people who have the disease — an additional 8.1 million people — live with undiagnosed diabetes. Diabetes is more common in men, and more than a quarter of people over age 65 have the disease. Although it is primarily suffered by older adults, type 2 diabetes is diagnosed in an estimated 5,000 people under age 20 every year due to increases in childhood obesity.
At 15.9 percent, diabetes is highest among American Indians, followed by 13.2 percent of African Americans, 12.8 percent of Hispanic Americans, 9 percent of Asian Americans, and 7.6 percent of white Americans. In 2012, 1.7 million new cases of diabetes were diagnosed among people over age 20. In addition, approximately 86 million American adults have prediabetes, a condition where physical changes and lifestyle choices indicate a predisposition toward the disease — and more than half of those aged 65 and older have prediabetes.
Consequences of Diabetes
Many people with diabetes live normal lives, while others must rely on daily insulin injections and must monitor their blood sugars routinely, at least once a day. Although diabetes may worsen with age, its rate and severity of progression can be limited and managed.
If diabetes is not managed properly, however, it can result in comorbidities and poor quality of life. In addition to peripheral nerve damage — such as in the hands and feet — nerve damage can occur in other parts of the body. Automatic neuropathy, for instance, involves such organs as the heart, bladder, eyes, and intestines. Diabetes may lead to blindness, dialysis for kidney failure, and amputation because of peripheral vascular disease in patients who do not manage their symptoms. Diabetes also contributes to cardiovascular disease, high blood pressure, stroke, poor healing, and a weakened immune system, among other complications. The risks are heightened for those who smoke, and onsets are earlier and healing is slower.
Barriers to Managing Diabetes
Beyond quitting nicotine, introducing or increasing exercise, and eating a wholesome diet, monitoring blood sugars is the most effective way to keep diabetes in check. Inconvenience, problems with medication management, fear of the test, and the cost of testing make lack of blood sugar monitoring the main culprit in patient noncompliance. Fortunately, Medicare, Medicaid, and most private insurance companies cover tests, though there is a lingering perception among some that they are expensive. For the uninsured, access to testing materials may be more difficult.
Poor patient compliance is a major (and perhaps the most challenging) obstacle to managing diabetes. Major dietary changes are often not necessary, but giving up sweets, second helpings, large portions, and fatty foods can be a struggle for many patients. As with other chronic diseases, the harm from diabetes and activities associated with exacerbating the disease are difficult to understand until the symptoms arrive — and by then it is often too late. Relentless education, health initiatives encouraging the outright removal of unhealthy foods, and research into ways to substitute unhealthy foods are the only realistic means available to overcome these barriers.
Research Offers Hope
Beyond substitutions for certain foods, overcoming barriers to compliance, treatment, prevention, and detection and control of diabetes are the important directions in research. New technologies have been developed for gathering blood specimens, remotely monitoring glucose levels, dispensing medications, and summoning help if a senior falls as a result of peripheral neuropathy. Other advocates seek ways to make diabetes control more feasible among especially vulnerable populations. Among these are the National Diabetes Prevention Program and the Native Diabetes Wellness Program.
Help Raise Public Awareness
Education remains a powerful tool that can be used — some teachers are in fact already deployed — to raise awareness among afflicted populations. These educators include healthcare professionals like you. Whether you are a nurse on an orthopedic floor, work in the hospital laboratory, or are a physician, pharmacist, or EMT, you are in a uniquely close position to encourage your senior patients to get involved in American Diabetes Month. Your profession automatically lends you credibility, and the ADA's website lists a number of activities and provides teaching resources to help you and your patients. The ADA invites volunteers, donations, and public efforts. To help in these efforts, they provide:
- Posters and banners
- Newsletter tips
- Social media messages
- PowerPoint presentations
- Fact sheets
Given the expected growth of the geriatric population, targeting seniors can help focus your efforts. Understanding and being able to explain to this population the relationship between mental and physical fitness, diet, and one of their fears — falling — is an excellent and very specific contribution.
One of the greatest problems with diabetes is that the most effective weapon, prevention, is the one least supported by culture and habit. American Diabetes Month, accompanied by information on the personal and social consequences of the disease must compete with a multibillion dollar advertising campaign for thousands of unhealthy products. Grocery stores are filled with foods that people, especially diabetics, should try to avoid eating. That's where you as a healthcare provider can play an important role. Your personal interaction with your patients and clients is more meaningful than advertising. You can even model a healthy lifestyle yourself. Beyond that, it comes down to choice. And with enough determined effort, more people may opt for the scourge of diabetes — healthy living.
For patients with diabetes (and other conditions that can contribute to increased fall risk), a medical alert device can improve safety and quality of life. Learn more about how to refer your patients for Lifeline medical alert devices.