Public Health & Diabetes
This research paper addresses the topic of public health and the diabetic epidemic, specifically, the intersection between public health measures and the increasing number of individuals diagnosed with diabetes each year. This will be accomplished by approaching the topic through the following lens. First, defining the meaning of the phrase public health. Second, explaining the meaning of diabetes. Third, discussing how public health awareness is advanced through health promotion. Fourth, examining the diabetes education programs in public health settings and whether or not these programs have been successful. Fifth, exploring future trends in diabetes education by public health agencies. For reasons related to space and scope, this paper will focus on the diabetic communities in the developed world and examine the supportive environments needed to assist with self-care, an important component of diabetic management. This paper was researched by reading peer-reviewed journals and grey literature about the topic. The search terms used for this paper were the following: ‘diabetes’; ‘public health’; ‘health promotion’; ‘public health policy diabetes’; ‘diabetes education’; ‘diabetes medications’; and, ‘metabolic diseases’.
The research question of this paper is the following: Do the education activities of public health agencies really bring about increased awareness about diabetes and its repercussions?
The thesis statement of this paper is the following: Public health education about diabetes needs to become more visible so that there is a broader public awareness about the disease.
The rationale for this research question resides in the stark reality that many diagnosed diabetics have difficulty with self-care. As self-care is a very important component in the diabetic treatment process, it is imperative that there be a better understanding of how public health systems address awareness and education in this matter.
Diabetes is a chronic disease that is increasing in prevalence across the world (Zimmet, et al., 2005, 295). Once a first world disease, the disease is now found in middle-income countries and is not defined by socio-economic level. In developed countries, healthcare policies and practices exist that provide the care that diabetics need. As well, access to diabetic education is available to those diagnosed with the disease. In developing countries, the picture is not as clear, as there is not as much access, if any, to healthcare and the supportive environment needed to ensure appropriate self-care. What all communities across the world face, however, is a need to control diabetes, whether through diet, exercise and/or medication. Without this control, there are “dire consequences for health and well-being” (WHO, 2016, 6). The complications from diabetes can affect the heart, leading to a heart attack; having strokes; can lead to kidney failure, amputations; can be the cause of loss of vision; as well as nerve damage. In the event of gestational diabetes, that is, diabetes during pregnancy, fetal death is a possibility, as well as other health complications (WHO, 2016, 6).
Definition: Public Health
Public health addresses the care of individuals on a population-based level. Specifically, WHO, quoting Acheson, defines public health as “…the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” (WHO, 2017). Important to this discussion is the matter of community in public health activity. A community cannot be safe and healthy unless the community works with public health in implementing and supporting public health initiatives. MacQueen, et al. (2001), note, “…community is, literally, where prevention and intervention take place” (MacQueen, et al., 2001, 1929). With this in mind, it is also important to note that in the context of public health policy, research indicates that “…effectiveness of collaborations for improving community health[,] indicate that they can be effective” (MacQueen, et al., 2001, 1929). In other words, when public health authorities and communities work together, public health policy practices can be successful and can lead to successful health outcomes.
There are different types of diabetes and the following is a brief synopsis of these types of diabetes. Type 1 Diabetes (T1D), or juvenile diabetes, is the result of “…b-cell destruction, usually leading to absolute insulin deficiency” (Diabetes Association, 2012, S11). There is Type 2 Diabetes (T2D), which is characterized by adult onset of glucose intolerance. Zimmet, et al. (2005), note T2D “…is responsible for over 90% of all cases of diabetes” (Zimmet, et al., 2005, 295). Notable about this prevalence is the fact that younger people are being diagnosed with the disease. Of added concern is the fact that diabetes sufferers are also at risk of metabolic syndrome, a complication which is defined as “… a constellation of CVD risk factors which apart from glucose intolerance … includes dyslipidaemia, hypertension, central obesity, insulin resistance, hyperinsulinaemaia, and microalbuminuria” (Zimmet, et al., 2005, 296). There is gestational diabetes mellitus (GDM), which is defined as “…diabetes diagnosed during pregnancy that is not clearly overt diabetes” (Diabetes Association, 2012, S11). There are other types of diabetes that are related to other factors. For example, “…genetic defects in b-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation)” (Diabetes Association, 2012, S11). The above indicates the multiple types of diabetes and the breath of considerations needed in providing treatment, self-care and maintenance education and awareness.
Public Health Awareness & Health Promotion
In 1980 the number of individuals with the disease was 108 million (WHO, 2016, 6); the figure in 2014 was 422 million (WHO, 2016, 6). In other words, there was an increase from 4.7% of the adult population to 8.5% (WHO, 2016, 6). Of note is the number of deaths from the diseaese. The deaths from the disease were 3.7 million in 2012, all of which occurred before these individuals were 70 years of age (WHO, 2016, 6). The World Health Organization notes that this is “higher in low- and middle-income countries” (WHO, 2016, 6). Whether or not these deaths take place in high- or low-income countries, these figures are significant.
There are also financial considerations to the disease. The cost of treating diabetes is expensive to individuals, their families, the health systems within which the individual lives, and to the national economies in terms of provincial and national health care costs. For the individual, specifically, the costs associated with diabetes related to the cost of medication, the cost of the daily glucose monitor, the needles and test strips. In some cases, there is also cost associated with loss of work and wages when the disease impacts the individual’s ability to work, whether this work is skill appropriate or skill reduced if sight or mobility is impaired. Diabetics must eat nutritious foods on a timely basis, and this can be impacted by the cost of food and/or work hours or routines that are time and routine restrictive. Diabetics must exercise. While simply walking can be exercise enough, work constraints can impact how often diabetics can simply go out for a walk.
Current Prevention & Delay Strategies
The following are prevention and delay strategies for T2D and GDM. For T2D, if the individual has an A1C reading of between 5.7 and 6.4, the individual is encouraged to follow a responsible weight loss regime in order to lose 7% of current body weight and to exercise for 150 minutes per week (Diabetes Association, 2012, S11). Regular, follow-up diabetes counselling is also important, as well as consideration, in consultation with a physician, of Metformin therapy. This latter is for those with A1C readings between 5.7 and 6.4, who are below 60 years of age and who have a BMI above 35 (Diabetes Association, 2012, S11). In the instance of gestational diabetes, individuals with risk factors should be tested in the first trimester; screening 6-12 weeks postpartum; life-long screening for individuals who were diagnosed with GDM; and, life-style interventions and changes (Diabetes Association, 2012, S15).
Diabetes Education Programs Provided by Public Health Agencies
Diabetes education is imperative in providing the support that diabetics need in order to better manage diabetic self-care. The following are examples of diabetic education initiatives that assist in this regard. In Ontario, the Diabetes Education Program provides education and ongoing support of both diagnosed adults and their families; provides counselling for patients and families; and, assists in creating life plans in order to minimize symptoms (Government of Ontario, 2017). In BC, of particular note is the diabetes programs directed at children. There are provincial standards of care directed at caregivers, school administrators and health authorities, defining roles and responsibilities (Government of BC (a), 2017). These practices are “based on best practice developed by Child Health BC” (Government of BC (a), 2017). There are even instructions for keeping and maintaining student records and medical alerts (Government of BC (b), 2017). Parents can even request Nursing Support Services and also formally request medication administration for children who require glucagon during an emergency (Government of BC (a), 2017). In Nova Scotia, there is the Diabetes Care Program which provides information about services and resources that can be accessed by healthcare providers, in prevention and management of the disease (Government of Nova Scotia, 2017).
Future Trends in Diabetes Education
The advance of technology has allowed diabetics to better manage their day-to-day glucose tracking and management. For example, there are many glucose-monitoring systems such as Dexcom, which is a continuous glucose monitoring system (Dexcom, 2017). As well, there are numerous apps that are easily accessible and easy to use, such as Fooducate, Glooko, Glucosio, Health2Sync, and MyNetDiary PRO (Cronenberg, 2017). These resources can be incorporated into an individual’s self-management program to good effect.
Areas for Future Research
This brief review of the topic of diabetes and public health indicates that while resources exist for the provision of educational resources and these are easily accessible, there seems a disconnect between the macro-level planning and provision and the micro-level reality of daily diabetic care. It seems a national-level online monitoring program that is accessible by all levels of public health, as well as the healthcare professionals and the individuals diagnosed with the disease, is needed, and that this resource be constructed to send alerts and information to all stakeholders. It is understood that not every individual has access to a computer, but most individuals have a smart phone and an app developed to integrate into such a system and this could be the link to the national monitoring program. Such as system would allow cost savings all across the board, as improved data would allow cost efficiencies in the treatment, education, and monitoring of diabetes.
To conclude, while there is evidence that provincial public health across the country does have innovative education programs, a review reveals that there needs to be more granular information and maintenance resources available to individuals diagnosed with the disease. This would facilitate a broader public awareness about the disease and, preferably, a one-stop information portal for both healthcare professionals and patients.
Cronenberg, C. (2017). The Best Diabetes Apps of the Year. Retrieved August 25, 2017, from Healthline: http://www.healthline.com/health/diabetes/top-iphone-android-apps
Dexcom. (2017). Dexcom G5® Mobile App. Retrieved August 23, 2017, from Dexcom: https://www.dexcom.com/apps
Diabetes Association. (2012). Standards of Medical Care in Diabetes – 2012. Diabetes Care , 35 (1), S11-S63.
Government of BC (a). (2017). Diabetes. Retrieved August 25, 2017, from Government of BC: http://www2.gov.bc.ca/gov/content/education-training/administration/kindergarten-to-grade-12/school-health/diabetes
Government of BC (b). (2017). Classroom Assessment and Reporting. Retrieved August 25, 2017, from Governemnt of BC: http://www2.gov.bc.ca/gov/content/education-training/administration/kindergarten-to-grade-12/assessment/classroom
Government of Nova Scotia. (2017). Diabetes Care Program of Nova Scotia. Retrieved August 25, 2017, from Government of Nova Scotia: http://diabetescare.nshealth.ca
Government of Ontario. (2017). Diabetes Education Program. Retrieved August 25, 2017, from Government of Ontario: https://www.ontario.ca/page/diabetes-education-program
MacQueen, K., McLellan, E., Metzger, D., Kegeles, S., Strauss, R., Scotti, R., et al. (2001). What Is Community? An Evidence-Based Definition for Participatory Public Health. American Journal of Public Health, 91 (12), 1929-1938.
WHO. (2016). Global Report on Diabetes. WHO. Geneva: WHO.
WHO. (2017). Public Health Services. Retrieved August 25, 2017, from WHO: http://www.euro.who.int/en/health-topics/Health-systems/public-health-services