Diabetes: A 21st Century Epidemic

Article Categories: Diseases and Conditions & Patient Education

The rise of patients with Type 2 diabetes is one of the nation’s most serious health concerns. The burden on providers and the entire healthcare system is enormous. Consider these facts from the Centers for Disease Control and Prevention (CDC), based on the latest available figures from the National Diabetes Statistics Report:

• The cost of diabetes and its complications is almost $250 billion a year. In 2007, the cost was $174 billion.
• More than 29 million people have Type 2 diabetes with 9.3% being Americans.
• One in four people has undiagnosed diabetes.
• Another 86 million adults ages 20 years or older; one in three Americans, has pre-diabetes. Pre-diabetes is defined as a fasting blood sugar of 100-125.
• For people with pre-diabetes, 15-30% will develop diabetes within five years, unless measures are taken to prevent the progression. Weight loss and exercise can be enough.
• African Americans, Hispanic, and Native/Alaskan Americans are twice as likely to develop diabetes as Caucasians.

Current treatment is based on controlling blood glucose levels and preventing complications. Type 2 diabetes is now treated in a similar manner to Type 1 diabetes, the most severe form of diabetes, most often occurring in children and teens, where the pancreas produces no insulin at all. With a stricter regime, Type 2 diabetics can manage their disease for many years by following these measures:

DIET: Nutrition and meal planning is more structured, following the guidelines of a Type 1 diabetes diet. Food choices, portions, and counting carbs are emphasized. Instead of simply handing a list of foods and suggested meals, Type 2 patients should be scheduled with a diabetes nutritionist and a Certified Diabetes Educator (CDE) for personalized instruction. Amy Campbell, MS. RD. CDE, a nutritionist at Joslin Diabetes Center, says, "The important message is that with proper education and within the context of healthy eating, a person with diabetes can eat anything a person without diabetes eats.”

EXERCISE: While exercise is important for everyone, people at-risk, or with diabetes must incorporate exercise into their lifestyle. Exercise allows muscles to utilize blood glucose, lowering the level and assisting with glucose resistance. A1C levels are improved. It also helps lower blood pressure, control weight, and increase HDL levels. Patients can use a variety of activities: walking, aerobics, strength and flexibility training, and general tasks such as gardening.

MEDICATIONS: Advances in treating Type 2 diabetes with medication now allow for specific treatment for each patient. Medication is still considered to be the second line of defense, after lifestyle changes. Medications have several actions, depending on which organ is targeted. There are also “second line” medications that can be added to the original therapy in order to achieve desired results. Ultimately, insulin injections, as either primary or supplemental, can be used to control glucose levels.

Registered Nurses encounter diabetics in every field or specialty. Because RNs are seen as experts by patients and the community, all nurses should become familiar with Type 2 diabetes and be prepared to offer education at every opportunity. Complications are serious, and can be life-threatening. Never hesitate to refer patients to their providers for testing.