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Running head: DIABETES V. WORLD 1

Diabetes versus the World

Adam Neal

Northern Arizona University

DIABETES V. WORLD 2

Abstract

The world is at war. People all over the planet are battling a debilitating endocrine disorder

called diabetes. The WHO estimates that 347 million people currently have diabetes (2013).

Diabetes is caused by ineffective or inadaequate amounts of a hormone called insulin. Insulin

carries glucose into the body’s cells where it is used for energy. Lack of effective insulin allows

glucose to remain in the blood instead of enter the cells. Diabetes is diagnosed through numerous

blood tests which evaluate the body’s ability to regulate blood glucose levels. The three primary

types of diabetes include type 1, type 2, and gestational. Type 2 diabetes is linked to lifestyle

factors such as obesity. The increasing rates of obesity and similar factors has largely contributed

to the growing prevalence of diabetes. This brief essay will provide an overview of diabetes as

well as a number of epidemiological statistics concerning diabetes in the United States and the

United Kingdom.

DIABETES V. WORLD 3

I. Part 1: Person, Place, Time Inside the U.S.

A. Disease/Condition Topic Selection

1. Diabetes

Diabetes is a noninfectious disorder that affects the body’s metabolism.

2. Background General Investigation of Diabetes

Glucose is used to for an immense number of tasks because it is the body’s primary

source of energy. Food is broken down into glucose and released into the bloodstream.

Once in the bloodstream, a hormone called insulin carries glucose into the body’s cells

where it is used for energy. Insulin is produced by certain cells of the pancreas called beta

cells. The pancreas is an oblong gland that lies in the abdominal cavity between the

stomach and spine (John Hopkins University, 2012). In healthy individuals, the pancreas

releases the perfect amount of insulin to transfer glucose from the bloodstream into the

body’s cells. This results in cells receiving energy and blood glucose levels remaining

stable.

In those with diabetes, the pancreas is unable to produce adequate amounts of

insulin, or unable to produce effective insulin. As a result, glucose remains in the

bloodstream and does not enter the cells. The excess glucose begins to build up in the

bloodstream. Sensors alert the body of the excess blood glucose and it begins to excrete

carbohydrates primarily through urination (National Diabetes Information Clearing

House, 2014). The body begins to starve for fuel because glucose cannot enter the cells

despite the overabundance in the blood. If left untreated, blood glucose levels continue to

rise and may lead to death.

DIABETES V. WORLD 4

The three major categories of diabetes include type 1, type 2, and gestational. Type 1

diabetes accounts for 5 to 10 percent of cases according to the NDIC (2014). This form of

diabetes can strike without warning since scientists believe that it is an autoimmune

disease. In a series of complex actions, the body’s own immune system attacks and

destroys the insulin producing cells of the pancreas (National Diabetes Information

Clearing House, 2014). Scientists do not have proof of the precise dynamics that cause

the immune system to attack itself, but believe that genetic, environmental, and viral

factors may be to blame (National Diabetes Information Clearing House, 2014). Once

damaged, the beta cells of the pancreas ceases to produce adequate sums of insulin. The

affected person is forced to make daily insulin injections for the remainder of their life.

This form of diabetes is often diagnosed in the young but can occur at any age (National

Diabetes Information Clearing House, 2014). According to the NDIC, symptoms may

present relatively quickly and include extreme hunger and thirst, frequent urination,

weight loss, and general weakness (2014).

Type 2 is the most common form of diabetes accounting for 90 to 95 percent of cases

(National Diabetes Information Clearing House, 2014). This type of diabetes is initially

characterized by adequate sums of insulin that is no longer effective at carrying glucose

into cells. This condition is called known as insulin resistance. As the disorder progresses

the production of insulin from the pancreas gradually decreases (National Diabetes

Information Clearing House, 2014). Scientists are unable to determine the precise

mechanisms behind insulin resistance. However, diabetes is often seen in conjunction

with obesity, physical inactivity, older age, certain ethnicities, and in those who have a

family history of diabetes (National Diabetes Information Clearing House, 2014). The

DIABETES V. WORLD 5

NDIC states that nearly 80% of type 2 diabetics are overweight which may provide clues

as to the origin of the disorder. Type 2 diabetes is often treated with prescription

medications and sometimes insulin. The onset for this form of diabetes is typically

gradual and includes most of the same symptoms as type 1.

The final category of this disorder is called gestational diabetes. According to the

NDIC, approximately 3 to 8 percent of pregnant women are affected by gestational

diabetes making it the least prevalent form of the disorder (2014). The pregnant woman’s

surging hormones and inadequate insulin production are the root of gestational diabetes

(National Diabetes Information Clearing House, 2014). Physical inactivity and obesity

may also be contributing factors. Symptoms typically reside after the mother gives birth,

but those who have had gestational diabetes are at an increased risk for developing other

forms of diabetes. According to the NDIC, women suffering from this disorder are often

unaware as they are asymptomatic (2014).

3. Diabetes Specifics

a. Stage of Susceptibility

Individuals are susceptible to diabetes when certain risk factors are present. These

risk factors include obesity, certain ethnicities, physical inactivity, genetics, and

previous gestational diabetes. According to Chan, Rimm, Colditz, Stampfer, &

Willett, there is a strong positive association between overall obesity and diabetes

(1994). It appears that ethnicity also plays a role with Asians, Hispanics, and blacks

having greater risk for developing diabetes than whites (Shai, Jiang, Manson,

Stampfer, Willett, Colditz, & Hu, 2006). Physical inactivity is yet another risk factor

for diabetes. A study performed from 2000 to 2002 showed an increase risk for

DIABETES V. WORLD 6

diabetes in those who are physically inactive regardless of obesity (Sullivan, Morrato,

Ghushchyan, Wyatt, & Hill, 2005). Type 1 diabetes has also been linked to 20

chromosomal regions suggesting that genetics create susceptibility to this disorder

(Pociot & McDermott, 2002). It appears that gestational diabetes can lead to type 2

diabetes later in life. According to Kim, Newton, & Knopp, some studies have shown

as high as a 70% incidence rate of type 2 diabetes following gestational diabetes

(2002).

b. Stage of Presymptomatic Disease

The stage of presymptomatic disease in diabetes is a condition called prediabetes.

This term refers to elevated blood glucose levels that are not high enough to diagnose

an individual with diabetes. One indicator of prediabetes is called impaired fasting

glucose in which fasting blood glucose levels are 100 mg/dL to 125 mg/dL (National

Diabetes Information Clearing House, 2014). The other gauge used to diagnose

prediabetes is known as impaired glucose tolerance in which an oral glucose tolerance

test results in a blood glucose of 150 mg/dL to 199 mg/dL (National Diabetes

Information Clearing House, 2014).

c. Stage of Clinical Disease

Diabetes can be diagnosed through numerous methods. According to the NDIC,

the primary means in which diabetes is diagnosed is through the fasting blood glucose

test (2014). This test consists of the subject fasting for 8 hours and having their blood

glucose checked. If the blood glucose test reads 126 mg/dL or higher, the subject is

diagnosed with diabetes (National Diabetes Information Clearing House, 2014). The

oral glucose tolerance test is another method that is useful in diagnosing diabetes.

DIABETES V. WORLD 7

This test consists of the subject consuming a beverage that contains 75 gm of

carbohydrates and having their blood glucose checked 2 hours later. If the blood

glucose test reads 200 mg/dL or higher, the subject is considered to have diabetes

(National Diabetes Information Clearing House, 2014). The oral glucose tolerance

test is also used to check pregnant women for gestational diabetes. However, the

criteria for diagnosing gestational diabetes are different than the standard test due to

the naturally lower blood glucose levels of a pregnant woman (National Diabetes

Information Clearing House, 2014). The NDIC states that diabetes can lead to heart

disease, stroke, kidney disease, nerve damage, and blindness (2014).

d. Stage of Recover, Disability, or Death

At present time, there is no stage of recovery for type 1 diabetes. Once the beta

cells of the pancreas are destroyed insulin can no longer be produced. However, there

is a sliver of hope for those with prediabetes or type 2 diabetes. A study performed to

test the effects of environmental change on diabetes showed a 58% reduction in

disease incidence for patients with pre-diabetes after altering their diet and activity

level (Venkat Narayan, Imperatore, Benjamin, & Engelgau, 2002). Taylor found that

substantial weight loss can lead to reversibility of type 2 diabetes in certain instances

(2013). This is often achieved through bariatric surgery that promotes rapid and

substantial weight loss. Disability associated with diabetes often comes in the form of

blindness and limb amputation. According to the NDIC, diabetes is one of the leading

causes of death in the United States (2014). Cardiovascular disease and stroke are

among the greatest sources of mortality associated with diabetes (National Diabetes

Information Clearing House, 2014).

DIABETES V. WORLD 8

B. Data & Measures Used

1. Epidemiological Measures Used for Tracking Diabetes

a. Incidence Rate Worldwide

Global estimates predict an increase of 114% of diabetes rates from the

year 2000 to 2030 (Wild, Roglic, Green, Sicree, & King, 2004).

b. Prevalence Rate Worldwide

An estimated 347 million people worldwide have diabetes according to the

World Health Organization (2013).

c. Mortality Rate Worldwide

Diabetes took the lives of 4.8 million people worldwide in 2012

(International Diabetes Federation, 2012).

C. Patterns of Diabetes in the United States

1. Diabetes in the United States.

a. Overall Prevalence Rate in the United States

The prevalence rate in the U.S. was 8.3% in 2010 which equates to 25.8

million Americans living with diabetes. (American Diabetes Association,

2014). The U.S. prevalence rate in 2012 rose to 9.3% which equals 29.1

DIABETES V. WORLD 9

million Americans affected by diabetes (American Diabetes Association,

2014).

b. Prevalence Rate by Gender in the United States

According to the CDC, the prevalence rate for diabetes in the U.S. was

11.8% for men and 10.8% for women in the year 2010 (2011). The prevalence

rate in 2012 was 13.6% for men and 11.2% for women (Centers for Disease

Control and Prevention, 2014).

c. Prevalence Rate by Race/Ethnicity in the United States

The CDC reports the diabetes prevalence rate in the U.S. of non-Hispanic

whites to be 10.2%, and non-Hispanic blacks to be 18.7% in 2010 (2011). The

CDC states that the prevalence rate in 2012 for non-Hispanic whites was

7.6%, and non-Hispanic blacks was 13.2% (2014).

d. Prevalence Rate by Age in the United States

The 2010 United States diabetes prevalence rate for those ages 20 to 64

was 11.3% and for those over the age of 64 was 26.9% (Centers for Disease

Control and Prevention, 2011). The 2012 prevalence rates for persons ages 20

to 64 was 20.3% and for persons ages 65 and over was 25.9% (Centers for

Disease Control and Prevention, 2014).

e. Prevalence Rate by Geographic Location in the United States

DIABETES V. WORLD 10

The CDC discovered a geographic location in the United States that has a

greater prevalence of diabetes than other portions of the country. This

geographic location known as the “diabetes belt” consists of 644 counties

spanning 15 states in the southeastern United States (Centers for Disease

Control and Prevention, 2014). According to the CDC, the prevalence of

diabetes within the diabetes belt is 11.7% in comparison to 8.5% outside of

the diabetes belt (2014).

f. Additional Measures Used for Tracking in United States

Incidence: According to the American Diabetes Association, the incidence of

diabetes in the U.S. was 1.9 million in 2010 (2014).

Mortality: There were 69,071 deaths in America during 2010 as a result of

diabetes (American Diabetes Association, 2014).

Obesity: The obesity rate in the U.S. is 34.9% according to the CDC (2014).

Cost: The American Diabetes Association places the total cost of diabetes in

the U.S. at $245 billion in 2012 (2014).

2. Diabetes Trends and Patterns in the United States

Diabetes prevalence is on the rise in the United States. In a matter of two

years, prevalence increased from 8.3% in 2010, to 9.3% in 2012 (American

Diabetes Association, 2014). The amount of people that have diabetes increased

by 3.3 million people in the same span of time (American Diabetes Association,


2014). This trend is likely to linger as the population of baby boomers continues

to age. The prevalence rate of prediabetes for those over the age of 65 was at 51%

in 2012 (American Diabetes Association, 2014). This represents a colossal

opportunity for diabetes to grow beyond the grasp of our control. Additionally,

the increasing sedentary lifestyle, poor diet, and obesity will add to the diabetes

epidemic. Lifestyle, aging population, and other factors have led the CDC to

predict that the prevalence of diabetes will increase by 165% in the United States

by the year 2050 (National Diabetes Information Clearing House, 2014). This

statistic paints a bleak picture of the future health of America.

II. Part 2: Person, Place, Time Outside the U.S.

A. Patterns of Disease in the United Kingdom

1. Diabetes in the United Kingdom

a. Overall Prevalence Rate in the United Kingdom

The overall prevalence rate of diabetes in the United Kingdom during 2011

was 4.45% (Diabetes UK, 2012). The diabetes prevalence rate in the U.K.

during 2013 increased to 6.0% (Diabetes UK, 2014)

b. Prevalence Rate by Gender in the United Kingdom

Diabetes prevalence in England was estimated to be 6.3% in men and 5.3%

in women during 2010 (Diabetes UK, 2012). The prevalence of diabetes in the


United Kingdom was 6.8% for men and 5.1% for women in 2013 (Diabetes

UK, 2014).

c. Prevalence Rate by Race/Ethnicity in the United Kingdom

Prevalence rates among ethnic groups in the United Kingdom include

averages of 7.3% for Bangladesh or Pakistani, 6.4% among African or

Caribbean, and 3.6% for those of Chinese decent in the year 2010 (Diabetes

UK, 2012). Diabetes prevalence rates of ethnic groups in the U.K. during

2013 include 8.9% for Bangladesh or Pakistani, 5.3% among African or

Caribbean, and 3.0% for Chinese (Diabetes UK, 2014).

d. Prevalence Rate by Age in the United Kingdom

Among those that had diabetes in Scotland during 2010, 10.6% were ages

15 to 44, 38.2% were ages 45 to 64, and 45.5% were ages 65 to 84 (Diabetes

UK, 2012). Among those that had diabetes in Scotland during 2013, 18.99%

were ages 50 to 59, 26.46% were ages 60-69, and 24.67% were ages 70 to 79

(Diabetes UK, 2014).

e. Prevalence Rate by Geographic Location in the United Kingdom

During 2011 the diabetes prevalence rate was 5.5% in England, 3.8% in

Northern Ireland, 4.3% in Scotland, and 5.0% in Wales (Diabetes UK, 2012).

The prevalence rate rose in 2013 in the U.K. with England at 6.0%, Northern

Ireland at 5.3%, Scotland at 5.2%, and Wales at 6.7% (Diabetes UK, 2014).


f. Additional Measures Used for Tracking in the United Kingdom

Mortality: 27,169 citizens of the United Kingdom lost their lives during 2012

to diabetes (International Diabetes Federation).

Obesity: 62% of adult women and 66% of adult men are overweight in the

United Kingdom (Diabetes UK, 2012).

Cost: It is estimated that the United Kingdom has spent nearly 404.9 billion

dollars on diabetes to date(Diabetes UK, 2014).

2. Diabetes trends and patterns in the United Kingdom

The prevalence of diabetes is increasing in the United Kingdom just as it is in

the United States. According to González, Johansson, Wallander, & Rodríguez,

diabetes prevalence in the U.K. rose from 2.8% in 1996, to 4.3% in 2005 (2009).

Current studies show diabetes prevalence to be an average of 6.0% in the U.K.

with Wales at 6.7% (Diabetes UK, 2014). The rise in diabetes prevalence can

largely be attributed to an increase in type 2 cases. The incidence of type 1

diabetes has remained stagnant yet type 2 incidence rose from 2.60/1000 persons

per year in 1996 to 4.31/1000 persons per year in 2005 (González et al., 2009).

The growth of type 2 diabetes in the U.K. may be the result of the greater

incidence of risk factors such as obesity. González et al. found an increase in

obesity in type 2 cases of 10% from 1996 to 2005 (2009). Currently, 2 out of

every 3 adults in the United Kingdom are overweight or obese (Diabetes UK,


2012). The United Kingdom must find a way to curb obesity in order to lower its

diabetes prevalence.

B. Summary & Conclusion

1. Diabetes Prevention and Management

The various statistics presented in this essay have provided a glimpse into the

current state of diabetes in both the United States and the United Kingdom. The

future of this disease will largely be determined by actions taken today. The

greatest impact on diabetes prevention can be made on those who are at risk for

type 2. Type 2 diabetes represents the vast majority of diabetes cases and can

often be prevented or delayed.

Once individuals develop diabetes, disease management focuses on

maintaining proper blood glucose levels. This accomplished through frequent

blood glucose checks and medications. Diabetes medications like insulin work by

allowing glucose to enter the body’s cells which lowers blood glucose. There is

presently no cure for diabetes which makes prevention so essential to battling this

disease.

One program that is working towards diabetes prevention in the U.S. is aptly

name the Diabetes Prevention Program. This program focuses on subjects who

have impaired glucose testing which are high risk for developing type 2 diabetes

(National Diabetes Information Clearing House, 2014). Prevention is

accomplished through intense exercise regiments and diet changes. Studies


performed by this program showed a 58% reduction in risk for developing type 2

diabetes (National Diabetes Information Clearing House, 2014).

The United Kingdom has taken a similar approach in prevention. Scientists

from the universities Leicester and Cambridge as well as the Medical Research

Council were awarded 3.2 million dollars to research diabetes prevention

(Diabetes.co.uk, 2012). The study is called Prevention of Diabetes through

Physical Activity Education with Different Levels of Ongoing Support

(PROPELS) and aims at prevention through education. The study hopes to

decrease type 2 diabetes through educating high risk patients about lifestyle

changes (Diabetes.co.uk, 2012). Much of the education will focus on the benefits

of increasing physical activity. Prevention programs like these provide hope for

the arduous war on diabetes.

a. The Impact of Globalization on Diabetes

Globalization of disease can be defined as the spread of a disease across the

world. The ability of an individual to step on an airplane and travel half way

across the world in a matter of hours has certainly contributed to the spread of

infectious disease. However, diabetes is a noninfectious disease and cannot be

spread in this manner. Nevertheless, globalization can still be attributed to

spreading diabetes. Urbanization, diet, and sedentary lifestyle have all been

implicated in the spread of diabetes (Hu, 2011).


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