Implementation of a diabetes education, control and prevention program in Virginia

Diabetes mellitus is a group of disorders caused due to a rise in the blood glucose levels.  This increase in the blood glucose levels can be due to a drop in the insulin secretion, defective insulin secretion, increased resistance of the body cells towards insulin, etc.  A person suffering from diabetes mellitus develops several complications and can even meet with a fatal complication due to life-threatening conditions.  A person suffering from diabetes mellitus can also suffer from several conditions including cardiovascular disorders, gangrene of the extremities, blindness, neuropathy, renal failure, etc, which can prove to be life-threatening. 

Such complications would require hospitalization for a few days and would in turn reduce the productivity of the employee.  Besides, the costs for diabetes mellitus in terms of medications, hospitalization and loss of productivity are also high.  During the last decade, there has been a sudden rise in the incidence and seriousness of diabetes complications.  Besides, there has also been an increase in the mortalities that arise from diabetes-associated conditions.  Diabetes is not a disorder that can be given prompt treatment and cured, promptly.  The disorder belongs to the group of chronic conditions, in which the individual has to live with the disorder for the rest of his/her life and has to control the symptoms accordingly.

Hence, chronic disease management programs need to be available to help the individual overcome the hardships of the condition and to need a near normal lifespan.  A relevant thesis statement would be “Individuals with diabetes can lead a near normal lifespan and have a near normal lifestyle, if certain precautions/ measures are taken, which can be effectively enabled through diabetes-specific control programs”.  To launch these programs efforts from several parties including the state, local and federal government, educational institutions, healthcare organizations, hospitals, community organizations, NGO’s, etc, need to be initiated (West Virginia DPCP, 2006, & Virginia Department of Health, 2006).

Introduction to diabetes

Diabetes mellitus is of two types namely; type 1 diabetes mellitus or juvenile-onset diabetes mellitus and type 2 diabetes mellitus or adult onset diabetes mellitus.

Type 1 diabetes mellitus usually begins during the childhood or adolescent stages of life.  The pancreas tissue no longer makes insulin.  About 5 to 10 % of all cases of diabetes are due to type 1.  Such individuals require frequent injections of insulin, regular physical exercises and a planned diet.  The sugar levels needs to be frequently monitored (West Virginia DPCP, 2006, & Virginia Department of Health, 2006).

Type 2 diabetes mellitus or adult-onset diabetes mellitus is a condition in which the body produces certain amount of insulin, but the insulin is defective, insufficient, ineffective, etc.  Hence, there is a rise in the blood glucose levels.  The condition usually occurs in adults, after the age of 40 years, but the incidence of the condition is slowly becoming more and more frequent in youngsters.  Type II diabetes is the most common type of diabetes mellitus and accounts for 90 to 95 % of all cases.  Such a form of diabetes is usually treated by administering insulin, oral hypoglycemic agents, physical exercises and monitoring the glucose levels (West Virginia DPCP, 2006, & Virginia Department of Health, 2006).

Gestational diabetes is a condition that occurs during the second half of pregnancy and is characterized by a temporary rise in the blood glucose level.  Such a condition usually returns to normal after the delivery, but the women has a 20 to 50 % chance of developing type 2 diabetes later during life.  The condition is caused due to an effect of several pregnancy hormones or due to a deficiency in insulin levels.  About 5 % of all pregnancies develop this condition.  More frequently, the condition occurs in Blacks, Hispanic, Native Indians and other minority populations (West Virginia DPCP, 2006, & Virginia Department of Health, 2006).

Pre-diabetes is a condition in which the glucose levels rise to a level greater than normal, but are not all that high to be classified as diabetes mellitus.  The National Health and Nutrition Authority conducted an examination survey in 2003 on the Virginia population to determine the incidence of the condition.  It was found that about 30 to 40 % of the adult and senior population (between the ages of 40 to 75 years), had pre-diabetes.  This account to 800, 000 to 1,100, 000 of the population.  Pre-diabetes is frequently known as ‘silent diabetes’, as the symptoms and signs of diabetes do not develop, but the risk for several fatal conditions such as cardiovascular disease, heart attacks, stroke, etc, is higher.

The risk for pre-diabetes and in the future for the development of diabetes can be reduced through weight loss, physical activity, and diet control.  This would help cut down the risk for developing type II diabetes by over 58 percent.  One of the indicators for the risk of pre-diabetes is the blood glucose level monitoring, which returns to normal following the avocation of preventive measures (West Virginia DPCP, 2006, & Virginia Department of Health, 2006).

Some of the common symptoms of diabetes conditions include:-

· Polyphagia (intense hunger)

· Polydipsia (intense thirst)

· Polyuria (frequent urination)

· Feeling tired

· Loss of body weight

· Sores and cuts that take long to heal

· Dry and itchy skin

· Tingling sensation in the feet and the toes

· Blurring of the vision

Some of the tests that are required for diagnosing and monitoring diabetes include:-

• Blood sugar checks
• Urine sugar checks
• Annual eye examination
• Comprehensive food examination
• HbA1c tests every 6 months

Other interventions that may be required for diabetes in order to prevent complications from developing include:

• Vaccination against flu
• Vaccination against pneumococcal infections (West Virginia DPCP, 2006, & Virginia Department of Health, 2006)

Epidemiological/Demographic data of the specified population

Diabetes is a serious health problem in the state of Virginia.  As in the year 2003, the 6th largest cause of death was diabetes.  More than 535, 000 individuals in the state of Virginia suffer from Diabetes.  About 400, 000 have been diagnosed with the disease and about 135, 000 are undiagnosed.  This means that 7.2 % of the population above the age of 18 years has been diagnosed with the disease.  This rate is quite identical to the US national rates.  The diabetes cases in men and women seem to be equal.

  With consideration to race, diabetes is more common in Blacks (9.3 %), Whites (6.8%) and less common in other communities including Hispanics (5.3%) and others (5.9 %).  About 850, 000 to 1, 100, 000 individuals between the ages of 40 to 75 years are affected with prediabetes.  About 13.7 % of the individuals belonging from the lower socioeconomic groups (having a household income below dollar 15, 000 per year) were affected with the disease, and 4.5 % from the higher socio-economic groups were affected with the disease.  With consideration to education, 15 % of the affected had less than a high school degree, 8% had a high school/ intermediary degree, 6.7 % had a college degree and 4.1 % had an even higher degree.

This goes on to show that diabetes prevalence decreases with higher education levels.  In the year 2003, about 11500 people were treated for diabetes-related illnesses, which cost about 172 million dollars.  However, for any other causes related to diabetes, the costing is about 2 billion dollars.  Since the year 1995, more and more Virginians are reported to suffer with other conditions along with diabetes such as hypertension, high cholesterol levels, obesity, sedentary lifestyle, etc.  The incidence of such conditions is higher in people suffering from diabetes than the people who do not. However, since the last 8 to 10 years, the number of people who are affected with diabetes and get certain interventions done such as A1c level, eye tests, receive vaccines against flu and pneumonia, etc, have increased due to higher awareness and management programs.

  In the year 1999, a law was passed which ensured that insurance companies cover diabetes diagnosis, prevention, treatment and education costs.  Although the diabetes management practices in the state of Virginia are not up to the mark, they are slowly improving.  About 7.5 % of the Virginians who were affected with diabetes had healthcare plan coverage and about 6 % did not have coverage.  With relation to body weight, about 3.5 % of the affected people were overweight or obese, 6 % were overweight and 17 % were obese.

In various age groups, 0.1% were 18 to 24 years, 0.7 % was 25 to 34 years, 4.7 % were 35 to 44 years, 7.9 % were 45 to 54 years, 15.6 % were 55 to 64 years and 15.9 % were older individuals. With age, the incidence of diabetes seems to be increasing.  Between the years 2001 to 2003, the rates of diabetes in men and women varied significantly and did not follow any specific pattern.  In 2001, men had a slightly higher incidence of diabetes, whereas in 2002 women had a higher incidence, and in 2003, men had a higher incidence (Virginia Department of Health, 2006).

In Virginia diabetes seems to be the most common cause for end stage renal disease.  Most of such patients require renal transplant or frequent dialysis.  Most of the diabetics who belong to the minority groups are more often affected with end-stage renal disease.  For example, Blacks are 3.7 times more likely to suffer from an end-stage renal disease compared to Whites (Virginia Department of Health, 2006).

With consideration for the mortality rates, diabetes is the 6th most common cause of death in Virginia since the year 2002.  Amongst middle aged individuals, it is the 5th most common cause of death. Most of the deaths arising in diabetes are from associated cardiovascular diseases.  About 10 % of the individuals who die from cardiovascular disease also have diabetes.  In the year 2003 itself, about 1500 individuals died from diabetes, which accounts to about 2.7 % of all deaths (or 22.7 deaths from diabetes out of every 100, 000 individuals).  The highest mortality rate from diabetes was from Black males (which was double that of the state average).  The second highest mortality rate from diabetes was from Black females.

In whites, the male mortality rate was higher than that of the female mortality rate.  However, the White mortality rates were lower than the state average in both sexes.  The statistics should that for each year from 1999 to 2003, the mortality rates for diabetes increased by an exponential rate.  The mortality rates for the Black Virginia population between the years1999 to 2003 had remained more or less steady, whereas for the White population has increased only slightly.  The Southwest and the Central regions of Virginia suffered the greatest mortality rates from diabetes.  The highest mortality rate from diabetes was recorded in Bedford city which was 58 per 100000 individuals during 1999-2002.  The second highest mortality rate was recorded in Wythe city which stood at 52 during the same period.  The third and the fourth highest were recorded in Buena Vista (50) and Franking (49.9).  In comparison to other portions, Southwest Virginia is the most underdeveloped (Wade, 2005, & Virginia Department of Health, 2006).

The effect of the diabetes problem for the Virginia population in terms of costs also needs to be taken in consideration to determine the extent of the problem.  However, hospital discharge information would only present some of the costs of the problem, and it would be a rather underestimate.  One of the problems is that hospitalization occurring from secondary causes but related to diabetes are usually not considered.  One of the most frequent complications which require admission to the hospital is due to cardiovascular causes.  More than 100, 000 admissions in the year 2003, was due to a cardiovascular cause related to diabetes (Wade, 2005, & Virginia Department of Health, 2006).

In the year 2003, more than 11, 000 cases were hospitalized due to diabetes-related complications, and the total charges were more than 166 million dollars.  The average charge per stay for an individual was about 15, 000 dollars.  The total number of days of hospitalizations was about 60, 000 days, which was an average of about 5.3 days per individual.  Most of the hospitalizations for diabetes were from the age group of 45 to 54 years.  More hospitalizations were recorded in females compared to males, as females of the elder age group were more often affected.  One of the major causes for hospitalizations related to diabetes was due to extremity amputations.

This was preventable if good care (in the form of examination, medications, good footwear, etc) was being followed by the patients.  For an indication of the problem of lower extremity non-traumatic amputations, more than 60 % are as a result of diabetes.  Men were more often subjected to lower extremity amputations compared to females.  With age, the risk for lower-leg non traumatic amputations increases (Virginia Department of Health, 2006).

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