Introduction

Diabetes mellitus is a huge public health problem in the United States.  

Diabetes prevalence estimates:   34.2M Americans have diabetes   7.3M are undiagnosed   88M have pre-diabetes   Among those aged 65 and older, 26.8% have diabetes ~5% have type 1 ~90% have type 2 ~5% have other types

Statistics from 2018 show that approximately 34.2 million (10.5%) Americans have diabetes mellitus, 7.3 million have the disease but are undiagnosed, and 88 million (33.9%) U.S. adults have pre-diabetes, most being unaware of their condition.1 In addition, the prevalence of diabetes mellitus has been steadily increasing since the late 1950s.2 Despite improvements in the number of people who have attained the recommended A1C level,3 there are still millions of Americans who have not achieved glycemic control.3  The percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65 years or older

 

New diabetes cases were higher among non-Hispanic blacks and people of Hispanic origin than non-Hispanic Asians and non-Hispanic whites. For adults diagnosed with diabetes: 1) New cases significantly decreased from 2008 through 2018 except in people under 20 years old, 2) The percentage of existing cases was highest among American Indians/Alaska Natives, 3) 15% were smokers, 89% were overweight, and 38% were physically inactive, 4) 37% had chronic kidney disease (stages 1 through 4); and, it’s interesting to note, that among those with kidney disease fewer than 25% with moderate to severe chronic kidney disease (stage 3 or 4) were aware of their condition.

         

Among American youth, newly diagnosed cases of type 1 and type 2 diabetes have significantly increased. For ages 10 to 19 years, incidence of type 2 diabetes remained stable among non-Hispanic whites and increased for all others, especially non-Hispanic blacks.

 

What is Diabetes?

Diabetes is the when the body no longer produces insulin or has become resistant to the insulin it does produce. Diabetes is a complex disease that can be accompanied by multiple complications if not controlled properly . Because of this, there is an abnormal metabolism of carbohydrates which, if left untreated, causes elevated glucose levels in the blood and urine. In turn, high levels of blood glucose can cause damage to the body. It is vital that diabetes is managed properly so that this damage does not occur.

Inability to produce or respond to the insulin hormone Results in abnormal metabolism of carbohydrates and elevated glucose levels in the blood and urine

Type 1 diabetes is an autoimmune disorder in which the immune system attacks the beta cells in the pancreas causing a loss of insulin production.  A person with type 1 diabetes relies on insulin injections to survive.

Type 2 diabetes is a form of insulin resistance where the body still produces insulin but does not use it efficiently. A person with type 2 diabetes will manage with medications, carb counting and physical activity. In some instances they will also take insulin.

Another common type of diabetes is gestational diabetes. This occurs during pregnancy when the woman’s body becomes resistant to the insulin she is producing--and usually resolves after the baby is born.

 

Diabetes is a complex disease. And there are many factors that lead are a part of the management of the disease. Following a diagnosis, the person with diabetes should spend time with a Certified Diabetes Care and Education Specialist (CDCES) to learn self-management skills tailored to their own specific needs. There are many nutrition-related influences that will greatly improve outcomes. There is also a need for adequate supplies such as medications and devices which can be crucial for survival. It is important that the healthcare professional have a basic understanding of these complexities in order to provide optimal care for the patient.