Introduction
In recent decades, chronic diseases, particularly diabetes, have become a public health priority worldwide. The reason for this is that more people die from chronic diseases than from any other cause. In addition, diabetes negatively affects patients’ quality of life, complicates the already challenging work of healthcare professionals, creates an increased burden on the healthcare system and society, and incurs enormous costs. For all these reasons, it is essential to pay more attention to the problem of diabetes, conduct research, and realize and convey to patients and society the importance and seriousness of the problem of diabetes.
Causes of and Risk Factors for Diabetes
The exact causes of diabetes have not been established, but risk factors that influence the onset of the disease are well known. Diabetes is a chronic metabolic condition defined by high blood glucose levels, which over time, causes significant damage to the blood vessels, heart, nerves, eyes, and kidneys (Kumar & Kumar, 2020). Diabetes is classified into three types: type 1, type 2, gestational diabetes, and prediabetes. Type 1 diabetes is a chronic condition in which the pancreas produces little or no insulin. This type of diabetes is most likely caused by an immune response in which the body attacks itself by mistake. The risk factors for it are not as straightforward as for other types. Various risk factors might increase the chances of developing type 1 diabetes. Family history is one of them: if a person’s close family member has type 1 diabetes, the patient may also have a genetic marker that renders them prone to diabetes. This genetic marker is an HLA (human leukocyte antigen) complex found on chromosome 6. Viral infections, race and ethnicity, location, early diet, and other autoimmune diseases are all risk factors for type 1 diabetes. Access to affordable therapy, particularly insulin, is crucial for individuals with this form of diabetes.
The causes and risk factors for type 2 diabetes are more understood, studied, and specific. They include many different factors such as prediabetes, age over 45 years, family history, physical inactivity, and being overweight. Type 2 diabetes may also develop in those patients who have ever had gestational diabetes (diabetes during pregnancy). Ethnic and Racial factors also affect the likelihood of developing this type of diabetes, as do non-alcoholic fatty liver disease. A feature of this type of diabetes is that it can be prevented or delayed with proven lifestyle changes, such as losing weight in case of overweight or obesity, eating a healthy diet, and getting regular physical activity.
As for gestational diabetes, scientists don’t fully understand why some women get gestational diabetes, and others don’t. Presumably, one of the factors is the excess weight before pregnancy. Various hormones work to keep blood sugar levels in check. During pregnancy, hormone levels change, making it harder for the body to process blood sugar efficiently. Risk factors for gestational diabetes are similar to those for other types of diabetes and include overweight or obese, prediabetes, having an immediate family member with diabetes, physical inactivity, gestational diabetes during a previous pregnancy, polycystic ovary syndrome, and having previously delivered a baby weighing more than 9 pounds (Forouhi & Wareham, 2019). Some certain races or ethnicity, such as Black, Hispanic, American Indian, and Asian American, are more predisposed to gestational diabetes.
Diabetes is one of the fastest-rising illnesses in the world. The most common are type 1 and type 2 diabetes. Patients with this diagnosis have devastating macrovascular consequences, such as cardiovascular disease and microvascular problems, including diabetic nephropathy, diabetic retinopathy, and neuropathy. (Cole & Florez, 2020). All these factors lead to decreased quality of life, kidney failure, and increased mortality.
The Magnitude of the Diabetes
The global diabetes issue is much quieter than COVID-19 but no less dangerous to human life and burdens the healthcare system and financial resources even more. According to International Diabetes Federation (2021), 537 million adults in age 20 to 79 years are living with diabetes in 2021, which means that 1 out of 10 people has this disease. In comparison, only 108 million people had diabetes in 1980 (Kumar & Kumar, 2020). Diabetes is responsible for 6.7 million deaths in 2021 – 1 every 5 seconds, and almost 43% of this number were people younger than 70 years old (International Diabetes Federation, 2021). One of every four people with diabetes doesn’t know they have it.
An endocrine condition characterized by unusually high blood glucose levels is one of the world’s most frequent and fastest-increasing diseases. About 693 million individuals are expected to be affected by 2030, a more than 50% rise from 2017 (Cole & Florez, 2020). Type 2 diabetes accounts for the vast majority (>85%) of all diabetes mellitus cases (Forouhi & Wareham, 2019). Both prevalent types of diabetes can result in multisystem consequences such as retinopathy, nephropathy, and neuropathy, as well as macrovascular problems such as coronary heart disease, stroke, and peripheral vascular disease (Khan et al., 2018). The global trend of diabetes deterioration is heavily influenced by lifestyle and environmental variables. Type 2 diabetes is caused by either extended insulin resistance, the inability of insulin to act on target tissues, reduced insulin production, or a combination of these factors. The feedback loop between insulin production and insulin action is disrupted, resulting in protracted and persistent hyperglycemia. Prolonged insulin resistance increases hepatic glucose production.
One of the most severe problems is the high frequency of undiagnosed diabetes. According to estimates, undiagnosed or newly diagnosed diabetes accounts for around half of all adult diabetes cases globally (International Diabetes Federation. (2021). It has a substantially greater incidence of complications than in persons with normoglycemia. In the United States, roughly 23 million people have diabetes, with at least 7.2 million suffering from undiagnosed one (International Diabetes Federation, 2021). Every year, roughly 1.5 million new instances are diagnosed, with 84.1 million people having pre-diabetes (International Diabetes Federation, 2021). The scale and seriousness of the diabetes problem are enormous, and the dynamics of the number of cases is worsening yearly, with devastating consequences for health and the economy.
Ethnic, Racial, and Economic Class Variations
Ethnic, racial, and economic class variations are important factors influencing the onset of the disease. Moreover, these factors affect different types of diabetes in different ways. White people are more likely than African Americans, Hispanic, or Latino persons to have type 1 diabetes in the United States, while Chinese and South Americans have a decreased likelihood of having type 1 (Forouhi & Wareham, 2019). Together with that, African American, Hispanic or Latino, American Indian, or Alaska Native people are at higher risk of type 2 diabetes. Some Pacific Islanders and Asian American people are also at higher risk of this type. Geography and the area’s climate are also important factors that influence diabetes (Forouhi & Wareham, 2019). For example, people living in northern regions have a greater chance of getting type 1 diabetes. People living in southern regions, such as South America, are less prone to acquire it. Similarly, studies have discovered that more instances are identified in northern regions throughout the winter, whereas the prevalence falls during the summer.
Another factor influencing the prevalence of diabetes mellitus is economic conditions. The researchers suggest that the rising prevalence of diabetes in developed countries is primarily due to the rising percentage of obesity. It is recognized as one of the most significant risk factors for type 2 diabetes. At the same time, low- and middle-income nations account for 84% of undiagnosed cases (Kumar & Kumar, 2020). This is because the asymptomatic phase of type 2 diabetes can linger for years, progressively damaging organs and causing consequences such as cardiomyopathy, nephropathy, neuropathy, and retinopathy, among others.
Cost of the Chronic Disease Diabetes
Aside from health concerns, diabetes has a significant worldwide economic impact. Diabetes resulted in at least 966 billion USD in healthcare costs, which is 316% more than fifteen years (International Diabetes Federation, 2021). This covers direct medical costs for treatment, the impact on a professional job, and premature death. Diabetes also has an indirect impact on the national economy (GDP). According to International Diabetes Federation (2021), global GDP losses from diabetes are expected to reach roughly 1.7 trillion USD between 2011 and 2030. Diabetes is predicted to cost the US economy $379.5 billion in direct and indirect economic costs. Globally, 45.8% of the total adult population with diabetes remains undiagnosed, putting them at a higher risk of acquiring diabetes-related complications (International Diabetes Federation, 2021). Despite the high number of undetected diabetes cases, the worldwide economic impact is enormous. Vascular complications, such as cardiovascular disease, diabetic renal disease, diabetic retinopathy, and neuropathy, are the primary causes of morbidity and death in type 2 diabetes patients, imposing a significant financial burden on the healthcare system and society.
Current Treatments of Diabetes
Diabetes is a serious chronic disease that, unfortunately, cannot be cured. But often, it can be prevented or its effects reduced by specific treatments and changes in habits and lifestyle. Modern treatments significantly improve the quality of life of patients with diabetes, increase life expectancy, and significantly alleviate patient consequences. Diabetes therapy aims to maintain blood glucose levels as near to normal as possible.
The first step in this process is the correct diagnosis of the type of diabetes in order to select the optimal treatment model. This requires specific tests to determine the type of diabetes. These tests may include a glycated hemoglobin test, random blood sugar test, fasting blood sugar test, and oral glucose tolerance test (Kumar & Kumar, 2020). Type 1 diabetes can be diagnosed by testing urine for ketones, which are a by-product produced when muscles and fat are used for energy. They may also test for the presence of an autoantibody, the destructive cells of the immune system associated with type 1 diabetes.
After the type of diabetes and the level of severity of the disease is established, the optimal treatment is selected. Insulin injections, regular blood sugar tests, and carbohydrate counting are part of type 1 diabetes treatment. An islet cell or pancreas transplant may be a chance for some persons with type 1 diabetes. Type 2 diabetes treatment primarily consists of lifestyle adjustments, blood sugar monitoring, oral diabetic medicines, insulin, or both.
The American Diabetes Association Standards of Medical Care in Diabetes is one of the most regarded and up-to-date diabetes care standards. The recommendations are updated yearly and designed to offer healthcare professionals, patients, and researchers diabetes care components, general treatment goals, tools to evaluate the quality of care, and guidelines for medical, pharmacological, and lifestyle management (American Diabetes Association, 2020). These recommendations are based on many years of treatment experience. They include suggestions such as offering real-time continuous glucose monitoring (RT CGM) or intermittently scanned continuous glucose monitoring for diabetes management in adults with diabetes who are receiving daily injections or continuous subcutaneous insulin infusion (CSII). Diabetes management methods for kids and adults with type 1 diabetes should be available. For maximum effectiveness, RT-CGM devices should be used nearly daily as feasible in patients with multiple daily insulin injections (MDI) and CSII. CGM devices should be scanned regularly, at least once every 8 hours. Some people may benefit from systems that integrate technology and online coaching in treating pre-diabetes and diabetes.
Maintaining a healthy weight with a good diet and activity regimen is an essential part of managing any type of diabetes. Comprehensive clinical trials and observations reveal that lifestyle changes can reduce the incidence of diabetes by over 58%, which is far superior to pharmaceutical therapies (Khan et al., 2018). Dietary habits also revealed that high-quality fat and carbs are far more helpful than low-quality fat and carbohydrates in treating diabetes and associated issues. The researchers conclude that consuming processed red meat and sugary drinks raises the risk of type 2 diabetes, but eating fruits, vegetables, and whole grains lowers the risk.
Barriers to Treatment
Despite significant advances in diagnosis and treatment, diabetes, regardless of its type, also comes with some barriers and limitations. First of all, the limitation in solving the problem of diabetes is related to the fact that it implies self-management, with which some patients have difficulties. In most patients, these difficulties are related to a lack of resources, inadequate knowledge and behavioral beliefs, negative emotions, health problems, and lack of support (Kumar & Kumar, 2020). In addition, diabetes does not occur in isolation and has a shared etiology common to many other diseases and disorders (Khan et al., 2018). This complicates the treatment process and places even greater responsibility on the patient to monitor their own health and the dynamics of the course of the disease. Given the magnitude of this problem, no healthcare system in the world is able to monitor the health of every diabetic patient continuously.
Diabetes care is also influenced by the clinician’s attitude, beliefs, and understanding of diabetes. Clinicians may influence patients’ perceptions further by using good communication skills and having a well-integrated healthcare system. To successfully communicate the self-care message to patients, clinicians should grasp the patient’s psychological variables as well as other financial obstacles by examining the cause of this lack of adherence. Furthermore, it is critical to recognize collaborative connections in the management of chronic disorders such as diabetes. For example, instead of telling patients what to do, providing a rationale for the recommended treatment can facilitate the patient’s involvement as the primary decision maker for the treatment, which can lead to success in adherence by eliminating patient misunderstanding and negative attitudes toward diabetes treatment.
Conclusion
The importance of such a serious problem as diabetes is obvious. This disease is the fastest growing in the world at the moment, taking a significant burden on healthcare professionals, the medical system, and even the economy. Its solution should be an ongoing process that considers the interests and involves patients, clinicians, and researchers in the solution. Society needs to focus on diabetes control programs by developing people’s knowledge of the disease, its causes, effects, and treatment. Building sustainable and effective diabetes programs will reduce the enormous burden on society as a whole.
References
American Diabetes Association. (2020). Diabetes technology: standards of medical care in diabetes—2020. Diabetes Care, 43(1), 77-88.
Cole, J. B., & Florez, J. C. (2020). Genetics of diabetes mellitus and diabetes complications. Nature reviews nephrology, 16(7), 377-390.
Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22-27.
International Diabetes Federation. (2021). Diabetes around the world in 2021. International Diabetes Federation Diabetes Atlas.
Khan, A., Uddin, S., & Srinivasan, U. (2018). Comorbidity network for chronic disease: A novel approach to understand type 2 diabetes progression. International journal of medical informatics, 115, 1-9.
Kumar, A. & Kumar, A. (2020). Diabetes: Epidemiology, pathophysiology and clinical management. CRC Press.