Type-2 diabetes has become an increasingly prevalent health issue in the United States. Population health trends demonstrate earlier onset as early as adolescence and young adulthood and continue to adversely impact health throughout the adult lifespan. Evidence suggests that early-onset type-2 diabetes has an aggressive disease phenotype and leads to unfavorable long-term prognosis.
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As there are an estimated 30 million diabetes cases in the US, with 90-95% of them being type-2, it is vital to examine this health issue (Lascar et al., 2018). The disease has a wide variety of premature development of complications that has adverse health and societal effects for adults throughout their lifespan. Effects may be noticeable in various aspects of adulthood such as acquiring education, ability to work, familial, and sexual health. The patterns of early-onset in young adults is directly correlated to longer disease exposure and the risk of severe complications.
Epidemiology and Influences
Type-2 diabetes is characterized by a slow onset of symptoms and gradual metabolic disturbances. Due to the long detection period, up to one-half of cases are considered undiagnosed. An efficient diagnosis as advocated by the WHO is the use of an oral glucose tolerance test.
Type-2 diabetes is defined by a fasting glucose of 7.0 mmol/L and higher than 11.1 mmol/L two hours after the glucose test. The worldwide distribution of type-2 diabetes demonstrates a higher prevalence in developed countries or ethnic groups that adopted Western culture. The primary pathophysiological defects which are the cause of type-2 diabetes are insulin resistance and insulin secretory defect (Fourouhi & Wareham, 2014).
Certain ethnic and cultural groups are more susceptible to the disease, due to what is known as the “thrifty gene hypothesis” which suggests that at times of food abundance, these ethnicities are more likely to be affected. In the U.S., these are black, Hispanic, and American Indian populations. There is a direct link in populations with the highest rates of obesity and type-2 diabetes. The United States is seeing increased prevalence in all age groups, particularly a rapidly growing incidence in children and young adults.
There is little discrepancy between genders for this condition (Forouhi & Wareham, 2014). Culture plays a role as dietary habits and traditions begin to affect long-term health and prevalence of diabetes. For example, Hispanic and African-American cultures with traditionally high carb and fat diets are more likely to be affected by obesity and consequently type-2 diabetes.
Socioeconomic status and physical environment of populations are directly related to the prevalence of type-2 diabetes. Health behaviors are directly linked to risk factors for chronic diseases such as diabetes. Therefore, environmental features such as access to physical activity, healthy food, appropriate social interaction, and good ecology are some factors that influence the prevalence of the disease. The neighborhood of habitat directly affects personal behaviors and stress levels, as well as social influences on proper diet and exercises (Christine et al., 2015). Neighborhoods tend to be divided by socioeconomic status, as well as some divisions of race.
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Low-income areas often lack the infrastructure, safety, and ecology to maintain a healthy diet and lifestyle, which leads to higher incidences of diabetes. Furthermore, working-class populations tend to work longer hours, eat unhealthy foods due to limited time, and remain in a cycle of poverty. The role of these factors in the development of adult type-2 diabetes is evident, with minor correlations to the socioeconomic status of the individual (Kivimäki et al., 2015).
Studies indicate that religion and spirituality have some positive effects on diabetes. First, it serves as a coping mechanism for patients with the disease, allowing for lower stress levels. Furthermore, in older adults, spirituality has been noticeably helpful in glycemic control due to dietary restrictions and fasting in many faiths. Overall religion and spirituality impact lifestyle. In the long term, younger adults that incorporate spiritual values into daily activities improve the management of physical symptoms of type-2 diabetes as well as psychological factors such as depression that may arise. Consistently, spirituality has been correlated with improved clinical outcomes (Sridhar, 2013).
Risks and Interventions
Type-2 diabetes becomes a potential risk for various serious complications which creates the quality of life issues and affects long-term health. For young adults, the most common complications that may occur are heart disease and kidney disease. Obesity, which is commonly a causative factor, can worsen as well without proper management of lifestyle and insulin. Middle-aged adults may experience the appearance of multiple symptoms as the body is not able to deal with the condition as easily. Heart and blood vessel issues are common, which may lead to nerve damage. This is characterized by decreased vision, dry skin, and foot problems.
There are endocrinological failures that lead to complications with urination, sexual health, and pancreas malfunction. Overall, there is increased fatigue and lack of energy (Huo et al., 2018). For older adults, diabetes becomes critical due to the increased prevalence of other multiple comorbidities. Microvascular complications, hypertension, and nerve damage are among the complications that older adults experience with diabetes. Without management, it is possible that type-2 diabetes can create a risk of early death by as much as 10 years (Kirkman et al., 2012).
Interventions for type-2 diabetes include a multifactorial approach that combines medication therapy with lifestyle changes. Due to the long-term impact of diabetes, it is vital to design interventions that would focus on factors that have caused or worsen the condition. For example, studies have demonstrated that the reduction of excess weight is necessary to reduce the impact of type 2 diabetes mellitus.
This can be done through adequate dieting and physical exercise in an individual that is fitting for their medically approved needs and capabilities. Weight management reduces risks on the cardiovascular system affected by diabetes in all age categories, as well as potentially improving endocrinological function and insulin resistance on an individual basis. Therefore, behavioral and lifestyle interventions are generally considered more effective in the long-term by physicians and are promoted in any multifactorial treatments (Gæde et al., 2016).
Type-2 diabetes is a multifactorial complex condition that requires a multidisciplinary approach to treatment and management throughout the adult lifespan. These patients have biomedical, social, and psychological needs that must be addressed. Furthermore, individual care processes may require focus beyond traditional clinical protocols. Best results are achieved for patients working with more than one discipline.
Currently, the most common treatment for type-2 diabetes is through medication which is prescribed by a physician after appropriate diagnostic tests (Conca et al., 2018). A physician may choose to collaborate with a pharmacist on non-standard situations to select the correct dosages.
The patient may be redirected to an endocrinologist to address any endocrine system problems which arise often for patients with obesity and diabetes. A certified nurse may aid in providing information to the patient on diabetes management, further treatment, and explaining lifestyle changes that the physician may have recommended. The patient is referred to a dietician to create an individual diet plan that would competently control glucose levels and manage a healthy weight (Johnson & Carragher, 2018).
A combination of these specialists can address the condition at various stages of progress and complications depending on the stage of adulthood and appropriate factors that may impact the quality of life. Management of the disease differs with age as the body may respond differently to treatment and there are slight variations in critical indicators.
Christine, P. J., Auchincloss, A. H., Bertoni, A. G., Carnethon, M. R., Sánchez, B. N., Moore, K.,… Roux, A. V. (2015). Longitudinal associations between neighborhood physical and social environments and incident type 2 diabetes mellitus. JAMA Internal Medicine, 175(8), 1311-1320. Web.
Conca, T., Saint-Pierre, C., Herskovic, V., Sepúlveda, M., Capurro, D., Prieto, F., & Fernandez-Llatas, C. (2018). Multidisciplinary collaboration in the treatment of patients with type 2 diabetes in primary care: Analysis using process mining. Journal of Medical Internet Research, 20(4), e127. Web.
Forouhi, N. G., & Wareham, N. J. (2014). Epidemiology of diabetes. Medicine (Abingdon, England: UK ed.), 42(12), 698-702. Web.
Gæde, P., Oellgaard, J., Carstensen, B., Rossing, P., Lund-Andersen, H., Parving, H., & Pedersen, O. (2016). Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia, 59(11), 2298-2307. Web.
Huo, L., Magliano, D. J., Rancière, F., Harding, J. L., Nanayakkara, N., Shaw, J. E., & Carstensen, B. (2018). Impact of age at diagnosis and duration of type 2 diabetes on mortality in Australia 1997–2011. Diabetologia, 61(5), 1055-1063. Web.
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Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B.,… Swift, C. S. (2012). Diabetes in older adults. Diabetes Care, 35(12), 2650-2664. Web.
Kivimäki, M., Virtanen, M., Kawachi, I., Nyberg, S. T., Alfredsson, L., Batty, G. D.,… Jokela, M. (2015). Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: A meta-analysis of published and unpublished data from 222 120 individuals. The Lancet Diabetes & Endocrinology, 3(1), 27-34. Web.
Lascar, N., Brown, J., Pattison, H., Barnett, A. H., Bailey, C. J., & Bellary, S. (2018). Type 2 diabetes in adolescents and young adults. The Lancet Diabetes & Endocrinology, 6(1), 69-80. Web.
Sridhar, G.R. (2013). Diabetes, religion and spirituality. International Journal of Diabetes in Developing Countries, 33(1), 5-7. Web.