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Diabetes mellitus is a chronic condition affecting more than 21 million people in the United States and more than 190 million worldwide. If current trends continue, there will be almost a doubling in the numbers over the next 20 years, both in the U.S. and around the world. Diabetes is a disease in which the level of sugar in the blood becomes elevated over long periods of time - often years or permanently.
The U.S. Centers for Disease Control and Prevention (CDC) has labeled diabetes "the epidemic of our time," with the greatest increase in certain ethnic populations. According to the U.S. Office of Minority Health, the prevalence of diabetes among African Americans is about 70% higher than in Caucasians and the prevalence in Hispanics is nearly double that of Caucasians. As of March 2002, it is estimated that 2.3 million African Americans have type 2 diabetes in the U.S. alone. Hispanics account to 1.2 million.
A deadly complication of diabetes is heart disease. Certain ethnic populations, namely African Americans and Hispanics, are more insulin resistant than Caucasians, causing them to be at high risk for both type 2 diabetes and heart disease. The prevalence of diabetes has risen in recent years, and this trend is projected to continue. Furthermore, the prevalence of diabetes in people aged 20 years or older is varied in minority groups. For instance, Hispanics are 1.9 times more likely, African Americans 2.0 times more likely, and American Indians 2.6 times more likely to have diabetes than whites of similar age. Diabetes has become a global epidemic with severe economic consequences. According to the World Health Organization, the number of people with diabetes will double from 150 million to an estimated 300 million by 2025.
Increasing numbers of young people are being diagnosed with type 2 diabetes. Until a few years ago, this was extremely rare, but doctors in the U.S. states that anywhere between 8% and 45% of new diabetes cases in children under 18 are now type 2. In fact, most cases of type 2 in young people occur in the 12-16 age group, and the great majority of those affected are overweight.1
Diabetes cannot be cured, however, it can be controlled through a combination of diet, exercise, and insulin injections. It has been reported that diabetes is one of the leading causes of death for all adults. The death rates are highest in American Indians/Alaska Natives and black Americans. 2 However, many deaths resulting from diabetes could be postponed if diabetes was detected and treated appropriately. Approximately 17 million Americans have diabetes, with almost 800,000 new cases diagnosed each year.
Source: 1999-2001 National Health Interview Survey and 1999-2000 National Health and Nutrition Examination Survey estimates projected to year 2002. 2002 outpatient database of the Indian Health Service.
II. Determinants of Health
Family history increases one's risk of developing Type 2 diabetes. For instance, if you have one relative (sister, brother, or parent) with diabetes, the risk of developing the disease doubles at some point. Risk quadruples with having two relatives.
Without regular exercise, one is automatically at risk for diabetes. Physical activity controls weight, promotes the use of blood sugar for energy, makes muscle cells more sensitive to insulin, and improves blood circulation. Exercise also helps build muscle mass, which absorbs sugar from blood. Diet also plays a major role in diabetes. Americans have become famous for eating unhealthy diets. Foods that promote weight gain and obesity (such as high saturated fat, high sugar diet) make a person more vulnerable to Type 2 diabetes.
Underprivileged individuals are more susceptible to diabetes in that they are less likely to follow a healthy diet regiment since they are more expensive. Low income populations are also less likely to afford medical attention, thereby neglecting their health needs.
High stress level work environment plays a role in forming bad eating habits that may contribute to the elevated blood sugar levels. Some work environments don't provide lunch breaks and people have the tendency to just grab unhealthy foods for convenience.
Policies and Interventions
Policies and interventions can have a positive and powerful effect on the health of the community and of the individuals. One such example is group therapy. While some benefit from one-on-one encounters with a therapist, others gain more from weekly group sessions. However, many people find the combination of approaches to be a double benefit. Sometimes talking things out with other people helps a victim of the diabetes disease to find fresh solutions. These groups can foster mutual support, encourage camaraderie, and help combat the depression and isolation that often goes along with a diagnosis of diabetes. Group therapy has special advantages for people with diabetes. It can help them
learn that they are not alone;
discuss feelings, worries, and concerns that they may never have dreamed of discussing anywhere else;
explore who they are and who they are not;
discover new approaches to old problems;
reduce stress, which in turn may lead to better health.
CDC. National Diabetes Fact Sheet, 2007.
Source: SEARCH for Diabetes in Youth Study
NHW=Non-Hispanic whites; AA=African Americans; H=Hispanics; API=Asians/Pacific Islanders; AI=American Indians
III. Health Promotion
Pharmacists play a vital role in contributing to the improvement and prevention of diabetes by providing patient care beyond just medication information. Advice on drug interactions and side effects plays an important role in counseling patients. The pharmacist can also help guide the patient in blood glucose meters and over-the-counter diabetes supplies selection.
In addition, pharmacists can also provide foot screening to the individuals who are diabetic and have problems with foot care. Foot care is very critical to diabetic patients and it is an issue that must be addressed.
Public Health Strategies:
Another way pharmacists can become involved with diabetes education is by becoming certified diabetes educators. As a diabetic educator the pharmacist can raise awareness to community about the importance of testing their blood sugar, maintaining their weight, and also the importance of a healthy diet.
Free diabetes screenings can be provided to the community so that they may be aware of their blood glucose levels preventing future diabetic episodes.