Assignment: Chronic Disease Epidemiology Diabetes Paper

Assignment: Chronic Disease Epidemiology Diabetes Paper

Diabetes and its complications are a major cause of morbidity and mortality in the United States and contribute substantially to health care costs. Although we have already seen an epidemic of diabetes in the United States over the past 2 decades, we can expect a continued rise in the incidence of diabetes as the population ages, a continued increase in adult obesity rates, and an increase in the population of minority groups that are at high risk for diabetes. In addition, rising childhood obesity rates and the increasing diagnosis of type 2 (formerly “adult-onset” diabetes) among children and young adults have become an increasingly serious health crisis, which will result in more people having and managing diabetes for most of their lives.

Although 90% to 95% of the diabetes burden in the United States is due to type 2 diabetes, an understanding of the different types of diabetes and their impact on health is warranted. This article reviews the literature on the epidemiology of diabetes in the United States and provides background on the complications associated with diabetes, especially those complications most frequently seen by physical therapists.

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Pathophysiology of Diabetes
Diabetes mellitus is a group of chronic metabolic conditions, all of which are characterized by elevated blood glucose levels resulting from the body’s inability to produce insulin or resistance to insulin action, or both.1 This group of conditions can be subdivided into 4 clinically distinct types:

type 1, which results from autoimmune beta-cell destruction in the pancreas and is characterized by a complete lack of insulin production;

type 2, which develops when there is an abnormal increased resistance to the action of insulin and the body cannot produce enough insulin to overcome the resistance;

gestational diabetes, which is a form of glucose intolerance that affects some women during pregnancy; and

a group of other types of diabetes caused by specific genetic defects of beta-cell function or insulin action, diseases of the pancreas, or drugs or chemicals.1

Type 1 diabetes accounts for 5% to 10% of all cases of diabetes. Its risk factors include autoimmune, genetic, and environmental factors. To date, there are no known ways to prevent type 1 diabetes. Type 2 diabetes accounts for 90% to 95% of all diagnosed diabetes cases. This form of diabetes generally begins as insulin resistance and, because the body is unable to produce enough insulin to address the resistance, the pancreas may reduce the production of insulin or eventually stop producing it. Minority women, women who are obese, women with a family history of diabetes, and women who have had gestational diabetes in a previous pregnancy are at higher risk than other women for developing gestational diabetes. Strict glycemic control and management of women with gestational diabetes is necessary to prevent birth complications in the developing infant. Women who have had gestational diabetes have a 20% to 50% increased risk for developing type 2 diabetes later in life.2

Prediabetes is a precursor condition to diabetes in which a person has elevated blood glucose levels but does not meet diagnostic criteria for diabetes. People with prediabetes can have impaired fasting glucose or impaired glucose tolerance, or both. From 1988 to 1994, approximately 25% of a cross-sectional sample of US adults 40 to 74 years of age were classified as having prediabetes.3 For the year 2000, this would mean that 12 million people in the United States had prediabetes. This finding clearly indicates that there is a large population that is at risk for developing diabetes within a relatively short time frame.