Instructions
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Learning Objectives Upon completion of this course the participant will be able to: 1. List three risk factors for developing type 2 diabetes 2. List three treatment goals in type 2 diabetes 3. Describe three treatment strategies for the management of type 2 diabetes Background Information
Let’s start with some background, which will illustrate why understanding more about diabetes is important in health care today. An estimated 30.3 million people or about 9.4% of the United States population has diabetes.(1,2,3,5) There are 1.5 million newly diagnosed cases of diabetes every year. While nearly 23.1 million have been formally diagnosed, many cases, an estimated 7.2 million go undiagnosed.
There are approximately 23.1 million people over 18 years of age diagnosed with diabetes and about 12.2 million (25.2%) of 65+ year olds with diabetes.
Diabetes was directly listed as the underlying cause of death in nearly 80,000 death certificates in 2015. Diabetes may have contributed to far more deaths and was listed in a total of more than 252,806 death certificates in 2015. The risk factor for death is approximately twice that of people without diabetes.(2,5) There are several types of diabetes, including: Type 1, Type 2, Gestational, and others. Type 1 diabetes was previously referred to as insulin-dependent diabetes mellitus or juvenile-onset diabetes.(3) This type of diabetes accounts for about 5-10% of diabetes cases in the United States and is usually diagnosed during childhood or young adulthood. Type 1 diabetes is an autoimmune disease in which the body’s immune system mistakenly attacks and destroys pancreatic beta cells, which are responsible for producing insulin. While the exact causes are unknown, heredity may play a role in Type 1 diabetes. In addition, this type of diabetes can occur as a result of pancreatic damage from alcohol, disease, or surgery. People with this type of diabetes take insulin daily to mimic natural insulin release. As we will see, blood monitoring and multiple insulin injections are typical in managing Type 1 diabetes. Type 2 diabetes was previously referred to as non-insulin-dependent diabetes mellitus or adult-onset diabetes. However, younger people may be diagnosed with this type of diabetes, and some people with type 2 diabetes are treated with insulin. Between 90-95% of diabetes cases fall into this category.(2,5) It can be progressive, starting with insulin resistance which means that the targeted body cells don’t use insulin properly. Eventually the pancreas may not be able to produce an adequate amount of insulin, called secondary beta cell failure. Because this is the most common type of diabetes, we will review this type in more detail. Gestational diabetes is diagnosed during pregnancy and occurs more commonly in obesity, those with family histories, and people of African, Hispanic/Latino, and American Indian descent. Treatment is geared to control maternal blood glucose levels to reduce the risk for health complications for the infant. Progression to type 2 diabetes is common, with 5-10% of women with diabetes immediately after pregnancy and a 40-60% chance of developing diabetes within 5-10 years. Other types of diabetes account for 1-5% of all diabetes and are generally related to genetic predisposition, surgery, medication interactions, infections, pancreatic disease, or other conditions that affect the pancreas. We should take a moment to mention pre-diabetes, which is a condition where the blood sugar level may be higher than normal, but not high enough to qualify for a diagnosis of diabetes. This condition is estimated to occur in more than 84 million people in the U.S.(2,5) or more than three times the number of people living with diabetes. While pre-diabetes increases risks for developing type 2 diabetes and its associated health problems, it may be reversed through weight loss, increased physical activity, and other therapies. Rick Fields-Gardner |
