Community Approach for Diabetes Patients Essay
Community Approach for Diabetes
Diabetes is a burdensome chronic condition that manifests through alterations in the way the body turns food into energy. According to the Centers for Disease Control and Prevention [CDC] (2022), the body often breaks down food into glucose (sugar) and releases it into the bloodstream. The pancreas releases insulin that facilitates the conversion of blood sugar into energy. Based on the normal body metabolism and the mechanisms for converting glucose into energy, it is possible to perceive diabetes as a condition that affects the body’s ability to produce enough insulin or a disease that compromises the body’s ability to utilize insulin. The CDC (2022) contends that when the body does not produce adequate insulin (type 1 diabetes) or the cells stop responding to insulin (type 2 diabetes), the subsequent accumulation of glucose in the bloodstream results in multiple complications and health problems, including vision loss, kidney disease, and heart disease. Notably, type 1 diabetes emanates from an autoimmune reaction that prevents the body from producing insulin. As a result, it is primarily an unpreventable genetical condition. On the other hand, type 2 diabetes is overly a lifestyle condition exacerbated by modifiable risk factors like obesity, physical inactivity, unhealthy diet, and alcoholism (Mayo Clinic, 2022). When considering the plausibility of preventing type 2 diabetes by modifying lifestyles, it is crucial to implement community-based approaches that promote self-management, lifestyle modification, and increased awareness of diabetes.
The Burden of Diabetes
Besides cancer and cardiovascular diseases (CVDs) like heart disease and stroke, diabetes is the leading cause of premature deaths, disability-adjusted life years (DALYs), increased care costs, compromised quality of life, and lengthy hospitalization. The World Health Organization [WHO] (2022) contends that diabetes is the primary cause of blindness, kidney failure, stroke, limb amputation, and stroke. Globally, the number of people affected by diabetes rose from approximately 108 million in 1980 to about 422 million in 2014. In 2019, diabetes and its complications accounted for approximately 2 million deaths. Despite the calls for all-concerted efforts to address the risk factors for this disease, diabetes may affect over 592 million people by 2035 (Moucheraud et al., 2019). The expected upsurge in new cases of diabetes signifies loopholes and deficiencies in primary, secondary, and tertiary prevention strategies.
In the United States, diabetes remains a significant public health problem, considering its ramifications and impacts on the population’s health, economic landscapes, and sociocultural contexts. According to the Centers for Disease Control and Prevention [CDC] (2022), about 96 million adults are prediabetic, meaning they are at risk of type 2 diabetes, heart disease, and stroke. Surprisingly, more than 8 in 10 prediabetic adults are unaware of the condition and do not engage in lifestyle change programs. Unawareness of the underlying risk of diabetes among adults exacerbates the condition and exposes people to multiple diabetes-associated complications, including diabetic nephropathy, diabetic retinopathy, and cardiomyopathy.
Risk Factors for Diabetes
Type 2 Diabetes is a primarily lifestyle condition exacerbated by various modifiable, as well as non-modifiable factors. According to Mayo Clinic (2022), obesity and overweight, physical inactivity, fat distribution, age, race and ethnicity, pregnancy-related risks, such as polycystic ovary syndrome, and family history are among aspects that increase people’s susceptibility to type 2 diabetes. For instance, obesity and overweight, physical inactivity, and fat distribution have direct impacts on the body’s ability to convert blood sugar into energy. In this sense, unhealthy accumulation of body fat results in physiological and metabolic changes that hinder glucose utilization (Chen et al., 2020). On the other hand, age is an independent risk factor for type 2 diabetes, considering changes in metabolism associated with old age. Examples of these changes that accelerate the risk of diabetes are slow blood flow, insulin resistance, and impaired pancreatic islet functions. It is vital to note older adults are more likely to endure the massive burden of diabetes because of the complexities associated with responding to pharmacological interventions, limited involvement in physical activities due to frailty, and altered metabolism.
Although age, obesity and overweight, physical inactivity, unhealthy diet, and pregnancy-related complications contribute to a high prevalence of type 2 diabetes, the subsequent incidences and effects of the disease are disproportionate to people of specific ethnic and racial orientations. According to the National Institutes of Health [NIH] (2018), black adults in the United States are nearly twice as likely as white adults to develop type 2 diabetes. The racial disparity in diabetes is ever-upsurging since African Americans are more susceptible to various risk factors for the disease. The National Institutes of Health (2018) contends that biological risk factors and unhealthy lifestyles, including smoking, alcoholism, and unhealthy diets increase black adults’ propensity to type 2 diabetes. Based on the disproportionate effects and prevalence of diabetes, healthcare professionals should implement population-centered interventions that are consistent with and sensitive to social determinants of health (SDOH).
Social Determinants of Health and Diabetes Prevalence
Amidst all-concerted efforts to prevent, manage, and control type 2 diabetes, healthcare professionals cannot ignore the contribution of social determinants of health in exacerbating health inequalities and leading to the disproportionate effects and prevalence of the condition. Hill-Briggs et al. (2021) define social determinants of health (SDOH) as “the conditions in which people are born, grow, live, work, and age” (p. 259). These conditions are responsible for preventable health inequalities, and avoidable differences, and depend massively upon economic, political, and resource landscapes. In this sense, SDOH exposes people to conspicuous and complex obstacles based on their socioeconomic status, racial and ethnic identities, sexual and gender orientations, and geographical aspects, including remoteness, proximity to healthcare facilities, and built environment. In the context of diabetes prevalence, prevention, and management, people’s socioeconomic status, education attainment, and neighborhood and physical environment are core determinants of population health and well-being.
Socioeconomic Status and Diabetes
Socioeconomic contexts of the population encompass various aspects, including levels of income, employment/unemployment, occupational issues, and social resources, including political power, social engagement, and control. According to Hill-Briggs et al. (2021), low socio-economic status and its components like low income, unemployment, and poverty result in increased vulnerability to diabetes and its complications since they hinder access to timely, quality, and affordable care. Also, low socio-economic status denotes food insecurity, limited access to healthy lifestyle choices, and stress which is an independent factor for physical inactivity. Limited diet choices due to affordable issues result in an increased risk of diabetes among people grappling with poverty, unemployment, and low income. Equally, it is possible to link low socio-economic status with poor housing, low-level education attainment, and health illiteracy (Hill-Briggs et al., 2021). These issues affect people’s quality of life and awareness of self-management approaches essential for preventing and managing type 2 diabetes.
Education Attainment and Diabetes
Although education attainment falls under the socioeconomic determinants of health, it is vital to consider its independent contributions to a high prevalence of diabetes and the subsequent inappropriate preventive and management actions. Hill-Briggs et al. (2021) argue that diabetes incidence is highest among adults with less than a high school education (10.4 per 1000 persons). High-level education attainment and health literacy are correlated and interrelated concepts that strengthen people’s awareness and knowledge of health conditions, preventive approaches, and self-management interventions. Equally, people with a high level of education are likely to understand the intricacies and demands of diabetes prevention and management, including vital sign monitoring, timely blood sugar tests, HBA1C regulation, weight management, and physical exercises. Finally, literate people are willing to comply with pharmacological interventions, including medications for regulating blood sugar. As a result, they exhibit a reduced risk of diabetes complications compared to people with lower educational attainment.
Neighborhood, Built Environment, and Diabetes
Infrastructural aspects and housing instability are independent factors that increase people’s susceptibility to type 2 diabetes. The infrastructural context of the community entails various components, including proximity to accessible health facilities, physical exercise centers, and neighborhood recreational facilities. On the other hand, housing instability can lead difficulties to engage in self-care, following self-management routines, and affording self-education (Hill-Briggs et al., 2021). Equally, people grappling with poor housing are susceptible to indoor pollution and encounter challenges when storing diabetes medications. Finally, housing instability is an independent cause of stress and non-adherence to pharmacologic interventions.
Neighborhood and built environment factors are essential aspects in determining access to quality and timely diabetic care, including early blood sugar screening, glucose regulation, and progress tracking. It is essential to link neighborhood and built environment issues with geographical determinants of health, including remoteness, transport systems, and food environment. In the context of poorly developed physical environments and neighborhoods, issues like limited access to physical exercise opportunities, drug and substance abuse, poor street walkability, and limited street connectivity are common (Hill-Briggs et al., 2021, p. 263). These factors exacerbate diabetes prevalence by undermining opportunities for lifestyle modification, creating preventable health disparities, and compromising various dimensions of quality care, including care efficiency, timeliness, effectiveness, and population-centeredness. As a result, community-based approaches for preventing and managing type 2 diabetes should focus on addressing poor Sofia determinants of health that hinder self-management goals and access to timely, quality, and efficient preventive and responsive care services.
Community Approaches for Preventing and Managing Diabetes
The knowledge of social determinants of health (SDOH) that expose individuals and communities to the increased risk of type 2 diabetes forms the basis of preventive and management approaches. According to Glenn et al. (2021), diabetes prevalence and effects are substantially disproportionate to people in rural areas compared to urban populations. The primary causes of disproportionate diabetes prevalence and effects rest on poor social determinants of health, including poverty, geographical constraints, poor sociocultural contexts, poorly-developed built environment, and low socio-economic status. Equally, Glenn et al. (2021) argue that rural populations face multiple problems associated with flawed health policies. Examples of these challenges are limited access to resources, marginalization, and exclusion from mainstream healthcare systems. Therefore, effective community-based approaches must focus on improving individual and population knowledge, awareness, and participation in preventive care.
Community members should demonstrate awareness and knowledge of diabetes risk factors, causes, complications, and prevention strategies. Healthcare professionals should educate at-risk groups on various self-care interventions, including strategies for addressing overweight, the importance of smoking and alcohol cessation, healthy diets, and thresholds for physical exercise. According to Dutta et al. (2021), these strategies underpin lifestyle modification and primary prevention strategies for diabetes. Equally, diabetic education is essential in improving adherence to pharmacologic and non-pharmacologic interventions for managing and controlling type 2 diabetes.
Unhealthy diet plans, including increased consumption of carbs, fat, and sugar-rich foods are the primary causes of obesity and overweight which are risk factors for type 2 diabetes. Healthy eating habits are paramount in the prevention and management of type 2 diabetes since they entail maintaining an optimal eating pattern, avoiding unhealthy foods, and effective weight management (Forouhi et al., 2018). While maintaining healthy eating patterns is challenging due to problems associated with social determinants of health like food insecurity, healthcare professionals and policymaker should improve food environments, educate people on healthy eating, and avail opportunities for proper weight management.
Diabetes Self-management and Environmental Modifications
Self-management goals for type 2 diabetes encompass multiple individual initiatives for reducing diabetes risks. Glenn et al. (2021) identify physical activeness, healthy eating, medication adherence, vital sign monitoring, and healthy coping as essential components of self-management approaches. Healthcare professionals are responsible for implementing health promotion programs that increase people’s awareness of these self-care interventions and strengthen their involvement in taking an active initiative against type 2 diabetes.
Secondly, modifying the physical environment and neighborhoods emerges as a profound strategy for improving community health and reducing the prevalence of type 2 diabetes. According to den Braver et al. (2018), the built environment encompasses multiple aspects, including higher walkability, access to recreational parks, availability of healthy foods, walking and cycling transportation systems, and facilities for stress management. Improvements in these aspects of the built environment result in healthcare weight management, access to healthy foods, obesity prevention, and appropriate stress management practices.
Early Blood Sugar Screening and Regular Monitoring
Besides the notable pharmacological and non-pharmacologic interventions for preventing and managing diabetes, early blood sugar monitoring and regular monitoring present ideal approaches for primary and secondary prevention. Glenn et al. (2021) identify HgA1C testing within the past 6 months, foot exams from healthcare professionals, blood pressure checks, dilated eye exams, and attending a diabetes class as timely interventions for identifying prediabetic conditions and informing preventive measures. Healthcare organizations should have functional policies for supporting these interventions, alongside other health promotion programs.
Type 2 diabetes is a burdensome chronic condition emanating primarily from lifestyle-associated risk factors, including physical inactivity, alcoholism, unhealthy diet, obesity, and overweight. Although genetics, a family history, and pregnancy-related complications can perpetuate type 2 diabetes, the knowledge of modifiable risks provides opportunities for preventing, managing, and controlling diabetes. Healthcare professionals and policymakers should address social determinants of health (SDOH) that undermine people’s self-management goals and access to timely, convenient, and quality care. Examples of community-based approaches that are responsive to poor social determinants of health include involving people in diabetic education, modifying the built environment and neighborhoods, healthcare promotion, and promoting early screening and regular blood sugar monitoring activities.
Centers for Disease Control and Prevention. (2022). What is Diabetes? https://www.cdc.gov/diabetes/basics/diabetes.html#
Chen, Y., He, D., Yang, T., Zhou, H., Xiang, S., Shen, L., Wen, J., Chen, S., Peng, S., & Gan, Y. (2020). Relationship between body composition indicators and risk of type 2 diabetes mellitus in Chinese adults. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-08552-5
den Braver, N. R., Lakerveld, J., Rutters, F., Schoonmade, L. J., Brug, J., & Beulens, J. W. J. (2018). Built environmental characteristics and diabetes: A systematic review and meta-analysis. BMC Medicine, 16(1). https://doi.org/10.1186/s12916-017-0997-z
Dutta, D., Arora, V., Dhingra, A., Das, A. K., Fariduddin, M., Shaikh, K., Priya, G., Shah, P., Rehim, A. A., John, M., Shaikh, S., Orabi, A., Saraswati, M. R., Selim, S., Baruah, M. P., Gangopadhyay, K. K., Langi, Y. A., Nair, T., Dhanwal, D., & Thapa, S. D. (2021). Quinary prevention in diabetes care: Need for a multidisciplinary approach. Clinical Epidemiology and Global Health, 11, 100757. https://doi.org/10.1016/j.cegh.2021.100757
Forouhi, N. G., Misra, A., Mohan, V., Taylor, R., & Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ, 361(4), 1–9. https://doi.org/10.1136/bmj.k2234
Glenn, L. E., Nichols, M., Enriquez, M., & Jenkins, C. (2019). Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes. Public Health Nursing, 37(2), 178–187. https://doi.org/10.1111/phn.12693
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2020). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258–279. https://doi.org/10.2337/dci20-0053
Mayo Clinic. (2022). Type 2 Diabetes – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
Moucheraud, C., Lenz, C., Latkovic, M., & Wirtz, V. J. (2019). The costs of diabetes treatment in low- and middle-income countries: A systematic review. BMJ Global Health, 4(1), e001258. https://doi.org/10.1136/bmjgh-2018-001258
National Institutes of Health. (2018, January 8). Factors contributing to a higher incidence of diabetes for black Americans. https://nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans#
World Health Organization. (2022, September 16). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes
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