Appalachian Health and Well-Being

6. Diabetes and Its Management

131 6 Diabetes and Its Management Sharon A. Denham According to the Centers for Disease Control and Prevention,1 25.8 million children and adults in the United States, or 8.3 percent of the nation’s population, have been diagnosed with diabetes, a figure that has more than doubled since 1980. In addition, an estimated 7 million people are unaware that they have the disease, and as many as 79 million people may have prediabetes . It is important to note, however, that these estimates may understate diabetes’ prevalence. For example, death certificates are likely to state the immediate cause of death and ignore diabetes, which may be a contributing factor. Diabetes is now the seventh leading cause of death in the United States1 and imposes a substantial cost burden on society, on those with diabetes, and on their families. Rates of work loss due to diabetesrelated complications are higher than for other disease groups.2 This chapter discusses diabetes and its risk factors, as well as the prevalence of diabetes in the Appalachian region and specifically in Appalachian Ohio. The management of diabetes is examined from the medical, self, and family perspectives, and models for diabetes interventions are presented. The chapter concludes with recommendations for future research and policies that address diabetes in Appalachia. Diabetes Diabetes mellitus, or diabetes, is a group of diseases characterized by uncontrolled blood glucose levels. This metabolic syndrome results when the body fails to produce or use insulin effectively. Insulin, a hormone manufactured by the pancreas, is essential for glucose uptake into body cells. Under current guidelines, the diagnosis of diabetes is dependent on an 132 Sharon A. Denham elevated glycosylated hemoglobin (HbA1c) level of 6.5 percent or higher. Levels from 5.7 to 6.4 percent point to a high risk of developing both diabetes and cardiovascular disease.3 Diabetes is widely known to be a major contributor to amputations, vision loss, and kidney disease. Types of Diabetes. The two major classifications of diabetes are type 1 and type 2. Type 1 diabetes is an autoimmune disease caused by the immune system attacking and destroying the insulin-producing beta cells in the pancreas, resulting in little or no insulin production in the body.4 This form of diabetes accounts for 5 to 10 percent of all diabetes cases.5 Symptoms are usually severe and occur rapidly. It is a lifelong condition that is treated with insulin. If not diagnosed and properly treated, a person with type 1 diabetes can lapse into a life-threatening diabetic coma. The most common form of diabetes is type 2 diabetes, accounting for 90 to 95 percent of all diagnosed cases.5 With type 2 diabetes, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively—a condition called insulin resistance. After several years, insulin production decreases. In contrast to type 1 diabetes , the symptoms of type 2 diabetes develop gradually. Type 2 diabetes can be prevented and is potentially reversible unless permanent beta cell failure has occurred. Diabetes Risk Factors. Type 1 diabetes, referred to as juvenile-onset diabetes, can occur at any age but is usually diagnosed in people younger than 30 years.Type 2 diabetes is generally associated with people older than 45, although it is increasingly being diagnosed in children and adolescents. Because genetic makeup plays a large role in type 2 diabetes,a family history of the disease is a risk factor, but lifestyle and social determinants have become increasingly important concerns. Other major risk factors for type 2 diabetes include inadequate physical activity, poor diet, excess body weight (body mass index greater than 30), race or ethnicity (African Americans, Hispanic Americans, and Native Americans all have high rates of diabetes), high blood pressure, high-density lipoprotein (HDL) cholesterol levels less than 35 or triglyceride levels greater than 250, and, for women, a history of diabetes during pregnancy. Another concern is pre-diabetes, a condition in which individuals have elevated blood glucose or HbA1c levels that are not high enough to be classified as diabetes.1 People with pre-diabetes have an increased risk of developing type 2 diabetes, heart disease, and stroke. Diabetes and Its Management 133 Diabetes Prevalence in Appalachia Appalachian Region Overall. Diabetes is more prevalent in Appalachia than in other parts of the United States.6 Combined data from the National Health and Nutrition...