Why Study Diabetes?
There are two kinds of diabetes, Type I and type II, and they both tend to be a problem for many people throughout the world today, but for Americans it is especially alarming. The major concern with the American people is that Type II diabetes tends to occur at a very young age (Gilliland, Carter, Skipper, & Acton, 2002). Traditionally, Type II diabetes was assumed to be an adult onset disease. However, research shows that the development of Type II diabetes in Americans tends to decrease as population ages, therefore it is especially important to educate young Americans about the risks (Gilliland, Carter, Skipper, & Acton, 2002).
Since American youths are getting Type II diabetes at a high rate, the mortality rates for Americans from this disease have been on the rise. Type I diabetes typically appears in children or younger people and has never been specifically linked to aging, nor have the number for individuals acquiring this disease been rising (Gilliland, Carter, Skipper, & Acton, 2002). It is important to address not only the prevalence of diabetes in society today, but what can be done to help lessen it, especially in the younger population.
Further research shows that not only are young Americans getting Type II diabetes at a faster rate, but having Native American blood affects the likelihood of developing the condition. In older Native Americans, for example those aged between 45 and 74, the Type II diabetes incident rate is several times higher than that of the general United States population. Research shows a Type II diabetes rate between 38% and 72% in the Native Americans that were studied (Gilliland, Carter, Skipper, & Acton, 2002). Clearly this research shows the need for further investigation and informational programs for Native Americans. For those who are not of this genetic makeup, however, there is no call for complacency. Diabetes and insulin resistance is rising in America no matter what the heritage of the person.
Type I or Type II – What Are the Differences?
Type II diabetes, also called adult onset diabetes, differs from type I diabetes in significant ways. In type I diabetes, the body does not produce enough insulin and therefore the sugar in the blood of the afflicted individual is raised to a level that is deemed unsafe (Studies, 2002). In Type II diabetes however, whether or not the body produces enough insulin is not really the issue. The body makes the proper amount of insulin, but the insulin does not work the way it should, and therefore the sugar in the blood still rises to an unsafe level, which can harm many different organs (Studies, 2002).
Because of the differences between the two types, Type II diabetes is sometimes considered much easier to treat. Although both kinds can be dangerous, Type II diabetes often requires dietary changes, weight loss, and pills which have to be taken once a day. Type I diabetes often requires insulin shots every day, and sometimes more than once a day. Both types of diabetes must be monitored, as excessive amounts of sugar in the blood can lead to severe complications such as stroke, blindness, and heart disease (Studies, 2002). For people with Type I diabetes, however, controlling their disease can become a constant battle, where individuals with Type II diabetes usually do not have as serious of an issue to deal with, provided they follow their doctors’ orders and make some changes to their diet and lifestyle, along with taking their medication.
Both Type I and Type II diabetes have many complications. Hundreds of thousands of people die every year as the result of diabetes. In addition to those that are killed by the disease, many others suffer through uncomfortable, painful, and debilitating conditions that are related to diabetes. Kidney disease is one of the complications of diabetes. As it progresses, it often requires kidney transplants or dialysis for the patient to survive. Blindness is another complication of diabetes. Over 10,000 people every year between the ages of 20 and 74 lose their sight to diabetic complications. Other complications such as heart disease, nerve disease, stroke, amputation, and impotence can all be attributed to diabetes (Studies, 2002).
While it is true that many people who do not have diabetes have heart disease, stroke, and other problems, the rates are much higher for those who have diabetes than for those who do not. Because they are greater risk, people who have diabetes must be more careful of their health in general so as to avoid serious problems.
The Spread of Type II Diabetes – Research Studies
Through the use of medical reviews, the prevalence of Type II diabetes in the American population has been studied. According to research, the onset of Type II diabetes, which is typically see only in adults, has been found to be occurring at younger ages. This was determined by studying blood glucose readings from medical charts in many communities across the United States. Through this it was discovered that many young Americans had blood glucose readings that should have been lower. While many diabetics in these communities were seeking treatment, there was a large segment of people who were going untreated.
Those who did research into this topic found that many Americans were dying of diabetes or diabetes related complications (Lee, Welty, Cowan, Wang, Rhoades, Devereux, Go, Fabsitz, & Howard, 2002). Many of these steps could be prevented by proper treatment, health assessments, and information as to the causes of diabetes. Intervention programs were found to be desirable, especially for the younger population.
Another study confirmed a correlation between Type II diabetes and periodontal disease (Gilliland, Azen, Perez & Carter, 2002). According to this research, adult diabetes is more easily controlled when good oral health regimens are followed. During the study it was discovered that giving antibiotics to Americans with gum or periodontal disease helped with the control of blood sugar (Gilliland, Azen, Perez & Carter, 2002). Some who participated in the study are of the opinion that periodontal disease and oral health is the most important risk factor when looking at the causes of diabetes.
It would take precedence, in the opinion of those researchers, over such factors as obesity, age, and smoking. Researchers believe that glycated hemoglobin, a marker of blood sugar control, becomes elevated during gum or periodontal disease (Gilliland, Azen, Perez & Carter, 2002). Therefore, treating the disease with antibiotics also helps to control blood sugar, and can work independently of, and just as well as, standard diabetic medications. In doing the study, researchers noted that the American population needed to be taught the importance of good oral health, and more needed to be done to treat periodontal infections in this population (Gilliland, Azen, Perez & Carter, 2002).
Participants in one study were examined for both their rates of diabetes and also for their risk factors (Jacobson, Booton-Hiser, Moore, Edwards, Pryor, & Campbell, 1998). Risk factors included such things as obesity and smoking. While these were largely expected by the researchers, an unexpected development was that an additional risk factor appears to be having Native American blood. Researchers were quite alarmed by the prevalence of diabetes in those with this blood.
This single risk factor appeared to be more significant than smoking, obesity, and many other factors which were traditionally associated with diabetes (Jacobson, Booton-Hiser, Moore, Edwards, Pryor, & Campbell, 1998). After viewing the result of the study, researchers recommended that prevention programs and information programs be implemented immediately in the Native American population to reduce the risk of further cases of diabetes (Jacobson, Booton-Hiser, Moore, Edwards, Pryor, & Campbell, 1998).
While researchers were careful to note that this would not stop Americans from getting diabetes, they also help believe that, through proper understanding of the causes of the disease, Native Americans could lessen their chances of becoming diabetic in their lifetime. Also discovered during the study was that many Native Americans who did not already have diabetes did have an impaired level of glucose tolerance (Jacobson, Booton-Hiser, Moore, Edwards, Pryor, & Campbell, 1998). Through close monitoring of their health, weight control, and other helpful measures these Native Americans would have the potential to avoid becoming diabetic (Jacobson, Booton-Hiser, Moore, Edwards, Pryor, & Campbell, 1998).
In order to help the American population avoid diabetes, researchers are finding that intervention programs are becoming very necessary (Acton, Shields, Rith-Najarian, Tolbert, Kelly, Moore, Valdez, Skipper, & Gohdes, 2001). In order for these intervention programs to work, researchers have also discovered that the programs need to meet the cultural needs of the American society. Intervention programs that are not culturally acceptable to Americans will not be as beneficial to them as intervention programs that fit in with the culture and lifestyle that this population is accustomed to. In response to their growing concerns, researchers created an intervention program that was designed specifically for the Native American population, as well. This intervention program focused on many of the things that would be expected in a diabetes intervention program, such as more exercise, less fat, and less sugar (Acton, Shields, Rith-Najarian, Tolbert, Kelly, Moore, Valdez, Skipper, & Gohdes, 2001).
Researchers used this information, and designed it in such a way that it fit in with the lifestyle that this population was accustomed to (Acton, Shields, Rith-Najarian, Tolbert, Kelly, Moore, Valdez, Skipper, & Gohdes, 2001). This allowed the researchers not only to study the population more closely, but also to achieve a major degree of success that might not have been possible in a standard intervention program. The study found that many of those who completed the intervention program had lowered blood pressure, lowered weight, and lowered blood sugar levels (Acton, Shields, Rith-Najarian, Tolbert, Kelly, Moore, Valdez, Skipper, & Gohdes, 2001). While this was encouraging, the researchers were also careful to note that the only way the Native American population will actually decrease in their levels of diabetes is to continue the changes made during the intervention program over the course of their lives.
Another study detailing the importance of intervention programs was performed by nurses who realized the significance of remaining in a culture for some time before a true understanding of that culture’s ideals was apparent (Costacou, Levin, & Mayer-Davis, 2000). These nurses found that, while there was a lot of literature and information on diabetes and the American population, it was not really sufficient for the work that they wanted to perform. They note in their research that spending an extended period of time immersed in the culture that they were studying was extremely useful in furthering their research.
Among some of the desires of the nurses were training some of the Native Americans to be caregivers, respecting the ideals of the culture, and conducting research that met the needs of the Native Americans while being careful not to make them feel as though they were being experimented on (Costacou, Levin, & Mayer-Davis, 2000). The project was funded for three years, and during that time the researchers note that they were able to learn a great deal by spending time with the Native Americans and learning about their values. Researchers found that when they respected of the values of the people and made a sincere effort to be accepted, they learned much that was of value and were able to do much more toward helping them avoid diabetes (Costacou, Levin, & Mayer-Davis, 2000).
The Diabetes Quality Improvement Project, which has been around for several years, was modified slightly for use with the Native American population, but it can be used with any population that is found to be at risk. Primarily, glucose control and blood pressure were examined. Since the original project had such small ranges of measurement for these items, many of these were omitted or changed because they were simply not practical. Even though the original project was modified slightly, and therefore this also affected the results, it was still a very useful tool in determining the prevalence of diabetes in the Native American population. Since there was no original, established baseline, it took several years of study before the data could really be compared against previous data. Even though this was a complication, the researchers still found the original project to be a useful tool that, when modified, greatly assisted their examination into the causes and complications of Type II diabetes.
Diabetes and Diet
One of the main concerns for Americans when it comes to diabetes is diet (Kramer, 1992). More and more Americans are overweight or obese, and this is a large contributing factor to the prevalence of diabetes in the population. In order for Americans to lessen the frequency with which diabetes occurs, the need to be informed about correct dietary choices and implementation of the correct dietary choices must also be established (Kramer, 1992). The United States Department of Agriculture, as well as the American Diabetes Association, have set out guidelines dealing with proper nutrition and weight management that are instrumental in helping those with diabetes.
In addition, other countries are also seeing their citizens gain weight at an alarming rate because of the western influence that a lot of them are getting. With that being the case, the prevalence of diabetes is beginning to rise in those countries, as well, and steps must be taken to educate these individuals about the foods that they are eating and how this could be causing much of the problem.
Living With Diabetes – Medication and Treatment
Because so many people are living with diabetes (either Type I or Type II) today, treating it has become something of a problem for some doctors. It is not that the disease cannot be treated, but simply that there are so many people to treat (Gilliland, Azen, Perez, & Carter, 2002). For Type I diabetes, insulin shots are the standard treatment. How much insulin must be injected into the body and how often depend on the person’s resistance to insulin, what they eat, and how well-controlled their diabetes is. For some people, there is little problem other than some inconvenience.
For other people, controlling their blood sugar becomes seriously difficult, and they can end up having an insulin pump. This is a device that is permanently attached to them, and it monitors their blood sugar and gives them insulin as they need it. They must not take it off or go without it, and it becomes very inconvenient for many individuals who feel that their diabetes has damaged their quality of life (Gilliland, Azen, Perez, & Carter, 2002). For these Type I diabetics, diet is important but will not control the insulin problems that they are facing on a daily basis.
For those with Type II diabetes, lifestyle changes such as exercising and losing weight, coupled with a proper diet, are sometimes enough to control their problems. If not, they can take what is commonly called a ‘sugar pill,’ but is not actually sugar. These medications are designed to help people with Type II diabetes control their blood sugar without the need for insulin shots, by helping them process the insulin that their body is making more efficiently. They do not need the extra insulin that the shots would give them, they only need to convince their bodies to use their current insulin levels (Gilliland, Azen, Perez, & Carter, 2002). For these individuals diet is very important, as it can help to control their disease very well in many people, and this is especially true of younger people who are just developing Type II diabetes or are at risk for developing it because they are overweight and have a sedentary lifestyle. If they can be addressed and their lifestyles changed, this could also help the next generation avoid diabetes.
Through interviewing a large group of Americans, researchers discovered that many Americans were not eating the type of diet suggested for those who either have diabetes, or are at risk for diabetes (Kramer, 1992). There was a lack of fruits and vegetables, for example, in the typical American diet. Fat intake was also rather high. Researchers concluded that many Americans were not following proper dietary guidelines, and this was, in part, the cause of the high rate of diabetes among the population.
The prevalence of Type II diabetes in the American population, while cause for concern, is not entirely surprising when the research into the subject is examined. For example, many studies mention obesity as an issue for many Americans. The correlation between obesity and diabetes has been well documented in other research. Research does seem to indicate, however, that those with Native American blood have a greater propensity to develop Type II diabetes when other risk factors such as obesity or smoking are placed into the equation. Not only do these studies indicate that Type II diabetes is a problem for many Americans, but there is also an indication that Type II, or adult onset, diabetes is occurring at younger ages. Researchers find this particularly troubling, as it shows a disease that is developing much more rapidly than anyone would hope for.
Acton, Kelly J., Shields, Ray, Rith-Najarian, Stephen, Tolbert, Bernadine, Kelly, Jane, Moore, Kelly, Valdez, Lorraine, Skipper, Betty, and Gohdes, Dorothy. 2001 Jan. Applying the Diabetes Quality Improvement Project Indicators in the Indian Health Service Primary Care Setting. Diabetes Care, v24 i1 p22.
Costacou, Tina, Levin, Sarah, and Mayer-Davis, Elizabeth J. 2000 July. Dietary patterns among members of the Catawba Indian nation. Journal of the American Dietetic Association, v100 i7 p833.
Gilliland, Susan S., Azen, Stanley P., Perez, Georgia E., and Carter, Janette S. 2002 Jan. Strong in body and spirit: Lifestyle intervention for native American adults with diabetes in New Mexico. Diabetes Care, v25 i1 p78-83.
Gilliland, Susan S., Carter, Janette S., Skipper, Betty, and Acton, Kelly J. 2002 Dec. [hba.sub.1c] levels among American Indian/Alaska Native adults. Diabetes Care, v25 i12 p2178-2184.
Jacobson, Sharol F., Booton-Hiser, Deborah, Moore, John H., Edwards, Karethy a., Pryor, Sue, and Campbell, Janis M. 1998 Summer. Diabetes research in an American Indian community. Image: Journal of Nursing Scholarship, v30 n2 p161-166.
Kramer, B. Josea. Health and aging of urban American Indians. 1992 Sept. The Western Journal of Medicine, v157 n3 p281-286.
Lee, Elisa T., Welty, Thomas K., Cowan, Linda D., Wang, Wenyu, Rhoades, Dorothy
A., Devereux, Richard, Go, Oscar, Fabsitz, Richard, and Howard, Barbara V. 2002 Jan. Incidence of diabetes in American Indians of three geographic areas: The strong heart study. Diabetes Care, v25 i1 p49-54.
Studies in Pima and Pueblo Indians underscore link to diabetes. 2002 April 15. Diabetes Week, p3.
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