Type 2 Diabetes
Type 2 diabetes is an endemic disease. It develops when the body can still make some insulin, but not enough for the body’s needs or when the insulin produced does not work properly. This type of diabetes usually occurs in people over the age of 40.
Effectively controlled Type 2 diabetes can reduce the risk of:
- Heart disease by 44 per cent
- Stroke by 46 per cent
- Kidney disease by 33 per cent
- Eye disease by 33 per cent.
In the past, Type 2 mainly occurred in people over the age of 40. Changing lifestyle factors have been responsible for the condition appearing in younger people.
Amongst the age range 15-44 years almost 100,000 people in the UK have Type 2 diabetes.
It is a fact that being overweight is a major factor of type 2 diabetes.
Type 2 Diabetes in Children
Type 2 diabetes in children is increasing and it has already been recognised as a public health issue.
Type 2 diabetes is extremely complex. There is an underlying genetic susceptibility that, when exposed to a variety of social, behavioural and environmental factors, unmasks diabetes. While this genetic background is important, the alarming increase in new cases of children with type 2 diabetes underscores the role of environmental factors.
Puberty has been identified as important in the development of type 2 diabetes in children. Changes in hormone levels during this period cause insulin resistance and decreased insulin action. Therefore it is understandable that type 2 diabetes in children mostly occurs during puberty although cases as young as 4 years of age have been reported.
Obesity is another significant factor. It is well understood that obese children produce too much insulin so that when the need for more insulin arises, they are likely to be unable to produce enough more. In addition, the presence of too much fatty tissue leads to insulin resistance.
On average:
- If either parent has the condition, the risk of developing it is 15 per cent.
- If both parents have the condition, the risk of developing it is 75 per cent.
- If a non-identical twin has the condition, the risk of developing it is 10 per cent.
- If an identical twin has the condition, the risk of developing it is 90 per cent.
Type 1 Diabetes
Type 1 diabetes develops when the insulin producing cells in the pancreas have been destroyed. It is not yet known for sure why these cells have been destroyed but it has been thought that they have been damaged likely to an abnormal reaction of the body to the cells. This may be triggered by a viral or other infection. It usually develops before the age of 40.
Effectively controlled Type 1 diabetes can reduce the risk of:
- Worsening of existing Eye disease
- Early kidney problems
- Nerve damage
The main aim of treatment of both types of diabetes is to achieve near normal blood glucose and blood pressure levels. This, together with a healthy lifestyle will help to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.
Table 3
The table below shows the estimated diagnosed with diabetes in the UK by age. It is based on a total population of 59,773,600.
Children with type 2 diabetes and their family or carers should participate in a diabetes self-management education. Ideally, the program selected should have a team of educators (physician, dietician, nurse, social worker, exercise specialist, etc) who are well-versed in education of children. Standards to look for are paediatric centres with Certified Diabetes Educators on staff and whose programs have met the National Standards for Diabetes Self-Management Education as identified by the American Diabetes Association. Education should include but should not be limited to: self-monitoring of blood glucose, medications and their use, exercise and meal planning.
Exercise speeds up calorie expenditure promoting weight loss. It also increases insulin sensitivity at the cellular level.
Currently, there are five classes of oral medications approved by the FDA for treatment of type 2 diabetes. It is important to note that few safety and effectiveness studies have been conducted in the paediatric population
The most effective way to quickly normalise blood sugar levels is with the use of insulin. Insulin therapy should be started in children with severely elevated blood sugar levels or children with intense thirst and frequent urination. There are a wide variety of insulin regimens that can be used. Once blood sugars are under control, Glucophage can be added while decreasing insulin dosage. It is important to monitor for ketones during this time to rule out type 1 diabetes in a honeymoon period.
Primary prevention should involve a public health approach that involves school and community-based programs, directed at improving overall nutrition and physical activity. The population of children with type 2 diabetes is growing perhaps to epidemic proportions.
The rising incidence of Type 2 diabetes is very closely linked to the epidemic of obesity.
- The majority of people with Type 2 diabetes are overweight.
- The risk of developing Type 2 diabetes increases by up to ten times in people with a BMI of more than 30.
- Britain has the fastest growing rate of obesity in the developed world.
- The percentage of obese adults in Britain has increased from 14 per cent of the population to 22 per cent in the last ten years.
- A quarter of children in Britain are overweight or obese.
Differences in diabetes prevalence are evident in minority ethnic groups, particularly South Asian communities living in the UK.
Both Type 1 and Type 2 diabetes involves genes and environmental factors. Researchers are trying to find the precise locations on chromosomes for different gene variations that make people susceptible to diabetes. Whilst there is the hereditary factor, it is still possible to have the condition and have no family history of it.
It is not enough just to have the genes; people also need to have a specific lifestyle to trigger these genes. With Type 2 diabetes, lifestyle factors such as being physically active and having a balanced diet can reduce the risk of developing the condition.
The UKPS published in 1998 the importance of controlling blood pressure and blood glucose levels to reduce long-term complications of Type 2 diabetes:
- Heart disease risk is reduced by 56 per cent.
- Stroke risk is reduced by 44 per cent.
- Kidney disease risk is reduced by up to 33 per cent.
- Eye disease risk is reduced by up to 33 per cent.
The Diabetes Control and Complications Trail highlighted the benefits of good control for people with Type 1 diabetes:
- New eye disease risk is reduced by 76 per cent.
- Worsening of existing eye disease reduced by 54 per cent.
- Early kidney disease risk is reduced by 54 per cent.
- More serious kidney problems reduced by 39 per cent.
- Nerve damage risk reduced by 60 per cent.
Statin therapy for people with diabetes can reduce the number of:
- Heart attacks by 36 per cent.
- Strokes by 48 per cent.
By the time a diabetic is diagnosed with Type 2 diabetes, more than 50 per cent them will have evidence of Cardiovascular disease. It is the greatest cause of morbidity and premature death in people with diabetes.
Kidney disease is one of the most serious micro vascular complications of diabetes and is a major cause of kidney failure and death. Kidney disease is caused by long-term high blood glucose levels that damage small blood vessels. This damage can cause the vessels to become leaky or in some cases to stop working, making the kidneys work less efficiently.
Eye disease is caused when the blood vessels in the retina become blocked or leaky. Generally it has no obvious symptoms so it may not be picked up until it is well advanced and irreparable damage has been done.
Amputation is a complication caused by damage to the nerves and blood vessels that serve limbs. In the UK, diabetes is the second most common cause of lower limb amputation and the most common cause of non-traumatic amputation.
Life expectancy and mortality rates
According to the National Service Framework for Diabetes Standards document published in 2001, life expectancy is reduced on average by more than twenty years in Type 1 diabetes and up to ten years in Type 2 diabetes. Mortality rates are up to five times higher for people with diabetes.
There is higher prevalence of Type 2 diabetes and poorer diabetic health outcomes in areas of high social deprivation. Mortality rates for those living in the poorest areas who has diabetes are 2.3 times the national average, compared to just 1.3 times the national average in the wealthiest areas.
Diabetes is only listed as an official cause of death in about 7000 people each year however death certificates often fail to take in account diabetes as an underlying cause. A Diabetes UK report published in conjunction with the British Heart Foundation said that 33000 deaths in the UK are attributed to diabetes, accounting for one in seven deaths.
Campaigns
There aren’t many campaigns against diabetes but Diabetes UK have released a couple of campaigns. Their newest campaign is called “Action today, health tomorrow”.
In order to ensure that the NHS is providing the best possible care, Diabetes UK is focusing on three care areas where action now can make a big difference through education, retinopathy screening and paediatric care.
As part of our Action today, health tomorrow campaign Diabetes UK is demanding that the NHS, with support from the government, ensures that:
- All people with diabetes are provided with the education they need to manage their condition on a day-to-day basis.
- All people with diabetes have their eyes checked annually.
- All children with diabetes are provided with access to local high quality specialist care.
There are many campaigns against obesity etc which could lead to diabetes. Jamie Oliver has tried to prevent childhood obesity with his famous TV programme “Jamie’s School dinners”. He didn’t have a big success as many schools still sell the greasy food to students.
Conclusion
The increasing prevalence of diabetes has a great impact, not only on the individual but also on the NHS and other health service resources. The Government is currently looking at public health initiatives which will include measures to combat obesity and therefore help to prevent diabetes.
The recent NHS improvement plan also draws attention to the health and cost benefits of effective Chronic disease management (CDM). The Department of Health has put an increasing focus on CDM stating it as “significant and exciting challenge for the NHS”. The UK has developed frameworks which outlines the standards for diabetes care.
Primary care trusts are establishing diabetes networks and putting eye screening and diabetes registers in place. Local targets need to be set in order for frameworks to be achieved and the lives of diabetes to be improved.
All the diabetes frameworks in the UK emphasise the principle of integrating service delivery to provide systematic care, including a focus on prevention and self management. If implemented effectively the frameworks need to improve people’s lives and provide significant cost savings in the long-term as early identification and better treatment decreases the incidence of complications.
Diabetes will continue to be a major health challenge in the future and publication of the frameworks is certainly a step in the right direction to meet the challenge. To provide high quality diabetes care across the UK, it is essential that their implementation is as effective as possible.
Sources
- Neil Moonie. Heinemann AS Health and Social Care for Edexcel.
- Mark Walsh, Paul Stephesn, Richard Chaleoner. Collins AS Health and Social Care.
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PUBLIC HEALTH
UNIT 6
RACHEL LAMPRECHT
