Running head: TYPE 2 DIABETES MELLITUS 1

Type 2 Diabetes mellitus

Name of Student

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Type 2 Diabetes mellitus

Introduction

Diabetes mellitus is an example of a metabolic disease that causes irregularities in the

protein, fat, and carbohydrate metabolism, as well as hyperglycemia. The chronic disease

accounts for 90% of the Diabetes cases, with its particular characteristic being a comparative

insulin deficiency and some level of insulin resistance. The disease poses a considerable

challenge when it is not managed efficiently as it results in long and short term complications

(Reusch & Manson, 2017). Timely type 2 Diabetes mellitus diagnosis is necessary to increase

awareness among the patients and caregivers on appropriate self-management skills and support

programs to maintain the required glucose level and minimize complications. The treatment goal

includes appropriately addressing the risk factors contributing to the complications, both

microvascular and macrovascular. The intervention also aims to alleviate the symptoms, reduce

mortality, and ensure patients live a quality life.

Development of Type 2 Diabetes in the United States and Developing Countries

Type 2 Diabetes mellitus is becoming a notable public health issue in both the United

States and developing countries, thereby presenting a considerable socioeconomic challenge. The

developing countries have seen a rapid upsurge in chronic disease, which was initially rare in

such countries. In developing countries, the age of the majority of type 2 diabetes patients is

between 45 and 65 years, while in the U.S., a more significant number is over 64 years.

Compared to the whites, Africans, South Asians, and other Asians develop diabetes at a reduced

body mass index and a decade earlier (Zimmet et al., 2014). They are also associated with

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dominant abdominal obesity and increased the development from prediabetes to diabetes. The

Diabetes complications burden, both micro and macrovascular, is more significant in developing

countries. The comorbidity of Type 2 diabetes with tuberculosis or HIV is more widespread in

developing countries than the U.S. The healthcare professionals' scarcity and cost of diagnostic

tests pose a considerable barrier in monitoring or diagnosis of patients. Prevention strategies

remain unsophisticated in many developing countries.

The standards of care in developing countries is generally of low quality. Many patients

in these countries are unlikely to attain treatment goals. The situation is further worsened by the

non-availability of insulins and drugs, high costs, "fatalistic attitudes," and delayed treatments.

The U.S. healthcare delivery system is mostly intact, with adequate clinical capabilities and

information, and its design supports coordinated chronic care delivery to achieve optimal care.

The U.S. dedicates a substantial portion of finances on Type 2 Diabetes management, with the

money spent through the health system. Considerable expenses in developing countries are out-

of-pocket (Zimmet et al., 2014). For instance, about 50% of diabetes medical expenditures in

Latin America are from the citizens' own pockets. Families of some of the poorest countries meet

the full cost.

Comparison of Prevalence in Texas and the United States

A report by the Center for Disease Control and Prevention indicates a gradual increase in

the incidences of Type 2 Diabetes both nationally and in Texas over the last ten years. About 2.3

million Texans (11.2%) had a disease compared to 30.3 million Americans (9.4%). Besides, the

incidences of new diagnoses that have escalated over the past years are less pronounced

nationally than Texas (Gurka et al., 2018). Approximately, newly diagnosed Diabetes cases were

187,000 or (11.1 per 1000) adults between the ages of 18 and 76 years in Texas compared to 1.4

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million (7.5 per 1000) adults in the U.S. in 2015. The rate of type 2 diabetes was significantly

higher among the Texas Hispanic population compared to the national average. Currently, 11.1 %

(or 680 351 people) of the Texas Hispanic population have Type 2 Diabetes.

There has been an upsurge in the prevalence of Type 2 Diabetes since the 1990s. The

population diagnosed with the disease increased from 6.4% to 9.6% among the Texans, and 5.1%

to 9.1% among the Americans between 1997 and 2010. Between 2011 and 2015, it increased

from 10.2% to 11.2% in Texas and 8.9% to 9.6% in the United States (Gurka et al., 2018). Texas

is considered to be among the ten states collectively, accounting for more than half of the

national diabetes management cost. According to the latest reports, the overall indirect medical

expenses attributed to the reduced inability to work or productivity and increased absenteeism

due to Type 2 Diabetes was $ 6.7 billion, while direct cost was $18.9 billion.

The Cost of Type 2 Diabetes Management

The overall cost of treating Type 2 Diabetes mellitus presents an appreciable challenge to

the health systems, patients and families, insurers, and the whole community (Reusch & Manson,

2017). The total approximated cost of diagnosed type 2 diabetes mellitus is $327 billion,

including $90 billion due to decreased productivity and $237 billion as direct medical expenses.

The sizable medical expenditure components are inpatient hospital care (30%), prescription

medications for managing complications (30%), diabetes supplies and antidiabetic agents (15%),

and physician consultations (13%). The average annual medical expenditure of people diagnosed

with Type 2 Diabetes is $16,752, with around $9,601 related to diabetes. The spending is about

2.3 times higher compared to that of a healthy population.

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The cost of a diabetic drug is lower compared to the cost of treating type 2 diabetes

complications. Studies reveal that oral antidiabetic drugs and insulin represented only 18% of the

entire cost, while non-diabetic drugs for managing macrovascular complications represented

16%. Therefore, more effective and appropriate use of diabetes drugs is associated with reduced

total drug expenditure and additional costs for managing long-term complications(Reusch &

Manson, 2017). Most of the higher costs for treating Type 2 Diabetes complications are more

frequent and more prolonged hospital admissions. Studies have demonstrated that maintaining or

achieving the goal values of hemoglobin AIC values delays or prevent diabetes-related

complications and reduces direct medical expenses.

Psychosocial Support of Type 2 Diabetes Patients

Complex emotional, behavioral, social, and environmental factors, which are the

psychosocial factors, have a significant impact on type 2 diabetes patients. Health practitioners

should adopt appropriate approaches to provide adequate psychosocial care. First, they need to

ensure psychosocial care is integrated with patient-centered and collaborative care and offered to

all Type 2 Diabetes patients, with the objective of optimizing the quality of life and health

outcomes (Young-Hyman et al., 2016). The practice of patient-centered and personalized

psychosocial care requires that diagnostic evaluation, psychosocial screening, problem

identification, interactions, and communications and intervention services consider the context of

the diabetes patient, including their preferences and values.

Secondly, they should also assess symptoms of cognitive capacities, disordered eating,

anxiety, depression, and diabetes distress using validated or standardized methods during the

commencement of visit, at regular intervals, and during changes in life circumstances, treatment

or disease. Including family members and caregivers in the assessments is also important (De

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Groot et al., 2016). Thirdly, health providers should monitor the patient's self-management

behaviors and the psychosocial elements that affect self-management (Bowen et al., 2015). The

fourth recommendation is for the assessment of life circumstances affecting psychological and

physical health outcomes is critical (Speight et al., 2020). Such factors should also be

incorporated into intervention approaches. The fifth suggestion is that the psychosocial problems

should be managed once identified (Young-Hyman et al., 2016). In case it is not possible to

initiate the intervention during the patient visit, the health professional needs to institute follow-

up visits or refer the patient to a behavioral health care specialist.

Addressing Type 2 Diabetes in the Workplace

Research suggests that environmental factors play a role in exposing individuals to type 2

diabetes risk factors. The exposure is linked to constraining or enhancing the physical,

psychosocial or behavioral stressors. The initial step in addressing type 2 diabetes in the

workplace is to conduct health surveys for workplace employees. The information derived from

the surveys will inform the need for diabetes, timely screening, counseling, and follow-up

services. The surveys are also essential tools for educating the individual workers on particular

health issues such as diabetes due to increased awareness. The next step shall be to incorporate

mobilization for increased access to physical activity resources. Studies indicate that physical

activity can improve diabetes glucose control, weight-loss strategies, cardiovascular risk factors,

and general well-being.

The third step would involve the initiation of self-management education programs. Self-

management among the type 2 diabetes patient has shown effectiveness in reducing the levels of

blood sugar, healthcare costs, and mortality risk. The fourth approach is to advocate for

employee in-company services, including yearly flu shots and pneumococcal vaccination.

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Research has shown that have abnormal immune functions hence at risk of increased mortality

and morbidity from infections, such as pneumococcal disease and influenza. The fifth step would

be to change the work schedule of the employees and inquire about the accommodations that

best suit them. Some diabetes patients may require private areas to perform glucose tests and

administer medications or time breaks for medical appointments. The sixth step would be to train

the company first aiders to identify common hypoglycemia symptoms and associated issues to

offer timely assistance. I believe the most critical step is the provision of self-management

programs. (Bowen et al., 2015) support this initiative by concluding that individuals with

increased self-efficacy treating diabetes had improved quality of life. (Chrvala et al., 2016) also

found that self-management education contributes to a significant reduction in A1C levels.

Conclusion

The burden of type 2 Diabetes mellitus is more significant in developing countries

compared to the United States. There has been a steady increase in the incidences of Type 2

Diabetes due to changing lifestyles. Patients with type 2 Diabetes require psychosocial support to

improve their quality of life. Efforts should be made to provide them with a favorable

environment, both at home and workplace. Self-management is critical in Type 2 Diabetes

management since it contributes to effective glycemic control.

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References

Bowen, P. G., Clay, O. J., Lee, L. T., Vice, J., Ovalle, F., & Crowe, M. (2015). Associations of

social support and self-efficacy with quality of life in older adults with diabetes. Journal

of gerontological nursing, 41(12), 21-29.

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for

adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic

control. Patient education and counseling, 99(6), 926-943.

De Groot, M., Golden, S. H., & Wagner, J. (2016). Psychological conditions in adults with

diabetes. American Psychologist, 71(7), 552.

Gurka, M. J., Filipp, S. L., & DeBoer, M. D. (2018). Geographical variation in the prevalence of

obesity, metabolic syndrome, and diabetes among U.S. adults. Nutrition & diabetes, 8(1),

1-8.

Reusch, J. E., & Manson, J. E. (2017). Management of type 2 diabetes in 2017: getting to goal.

Jama, 317(10), 1015-1016.

Speight, J., Hendrieckx, C., Pouwer, F., Skinner, T. C., & Snoek, F. J. (2020). Back to the future:

25 years of ‘Guidelines for Encouraging Psychological Well‐being’among people

affected by diabetes. Diabetic Medicine, 37(8), 1225-1229.

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Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M.

(2016). Psychosocial care for people with diabetes: a position statement of the American

Diabetes Association. Diabetes care, 39(12), 2126-2140.

Zimmet, P. Z., Magliano, D. J., Herman, W. H., & Shaw, J. E. (2014). Diabetes: a 21st century

challenge. The lancet Diabetes & endocrinology, 2(1), 56-64.

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