Diabetes Essay, Research Paper

Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Diabetes can be associated with serious complications and premature death, but persons with diabetes can take measures to reduce the likelihood of such occurrences. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugars to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States. People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE f the following symptoms: Frequent urination Excessive thirst Unexplained weight loss Extreme hunger Sudden vision changes Tingling or numbness in hands or feet Feeling very tired much of the time Very dry skin Sores that are slow to heal More infections than usual. Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes. The four types of Diabetes + Type 1 Diabetes: was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors are less well defined for type 1 diabetes than for Type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes. Lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections. The causes of type 1 diabetes appear to be much different than those for type 2 diabetes, though the exact mechanisms for development of both diseases are unknown. The appearance of type 1 diabetes is suspected to follow exposure to an “environmental trigger,” such as an unidentified virus, stimulating an immune attack against the beta cell of the pancreas (that produce insulin) in some genetically predisposed people. + Type 2 Diabetes: was previously called non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes. Treatment typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40% of people with type 2 diabetes require insulin injections. + Gestational Diabetes: develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and persons with a family history of diabetes. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future. + Other Specific Types : of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1% to 2% of all diagnosed cases of diabetes. In response to the growing health burden of diabetes mellitus (diabetes), the diabetes community has three choices: prevent diabetes; cure diabetes; and take better care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the US Department of Health and Human Services. Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. The NIH is involved in research to cure both type 1 and type 2 diabetes, especially type 1. CDC focuses most of its programs on being sure that the proven science is put into daily practice for people with diabetes. The basic idea is that if all the important research and science are not made meaningful in the daily lives of people with diabetes, then the research is, in essence, wasted. The Diabetes Gene Type I diabetes is what is known as a ‘complex trait’, which means that mutations in several genes likely contribute to the disease. For example, it is now known that the insulin-dependent diabetes mellitus (IDDM1) locus on chromosome 6 may harbor at least one susceptibility gene for Type I diabetes. Exactly how a mutation at this locus adds to patient risk is not clear, although a gene maps to the region of chromosome 6 that also has genes for antigens (the molecules that normally tell the immune system not to attack itself). In Type I diabetes, the body’s immune system mounts an immunological assault on its own insulin and the pancreatic cells that manufacture it. However, the mechanism of how this happens is not yet understood. About 10 loci in the human genome have now been found that seem to confer susceptibility to Type I diabetes. Among these are (1) a gene at the locus IDDM2 on chromosome 11 and (2) the gene for glucokinase (GCK), an enzyme that is key to glucose metabolism which helps modulate insulin secretion, on chromosome 7. Conscientious patient care and daily insulin dosages can keep patients comparatively healthy. But in order to prevent the immunoresponses that often cause diabetes, we will need to experiment further with mouse models of the disease, and advance our understanding of how genes on other chromosomes might add to a patient’s risk of diabetes. Several approaches to “cure” diabetes are being pursued: + Pancreas transplantation + Islet cell transplantation (islet cells produce insulin)

+ Artificial pancreas development + Genetic manipulation (fat or muscle cells that don t normally make insulin have a human insulin gene inserted then these “pseudo” islet cells are transplanted into people with type 1 diabetes). Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas. Complications of diabetes + Heart disease Heart disease is the leading cause of diabetes-related deaths. Adults with dia betes have heart disease death rates about 2 to 4 times as high as that of adults without diabetes. + Stroke The risk of stroke is 2 to 4 times higher in people with diabetes. + High blood pressure An estimated 60% to 65% of people with diabetes have high blood pressure. + Blindness Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old. Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year. + Kidney disease Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of new cases. 27,851 people with diabetes developed end-stage renal disease in 1995. In 1995, a total of 98,872 people with diabetes underwent dialysis or kidney transplantation. + Nervous system disease About 60% to 70% of people with diabetes have mild to severe forms of ner vous system damage (which often includes impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syn drome, and other nerve problems). Severe forms of diabetic nerve disease are a major contributing cause of lower extremity amputations. + Amputations More than half of lower limb amputations in the United States occur among people with diabetes. From 1993 to 1995, about 67,000 amputations were performed each year among people with diabetes. + Dental disease Periodontal disease (a type of gum disease that can lead to tooth loss) occurs with greater frequency and severity among people with diabetes. Periodontal disease has been reported to occur among 30% of people aged 19 years or older with type 1 diabetes. + Complications of pregnancy The rate of major congenital malformations in babies born to women with pre existing diabetes varies from 0% to 5% among women who receive precon ception care to 10% among women who do not receive preconception care. Between 3% to 5% of pregnancies among women with diabetes result in death of the newborn; the rate for women who do not have diabetes is 1.5%. + Other complications Diabetes can directly cause acute life-threatening events, such as diabetic ketoacidosis* and hyperosmolar nonketotic coma. People with diabetes are more susceptible to many other illnesses. For exam ple, they are more likely to die of pneumonia or influenza than people who do not have diabetes. New diagnostic criteria for diabetes The new diagnostic criteria for diabetes include the following changes: + The routine diagnostic test for diabetes is now a fasting plasma glucose test rather than the previously preferred oral glucose tolerance test. (However, in certain clinical circumstances, physicians may still choose to perform the more difficult and costly oral glucose tolerance test.) + A confirmed fasting plasma glucose value of greater than or equal to 126 milligrams/deciliter (mg/dL) indicates a diagnosis of diabetes. Previously, a value of greater than or equal to 140 mg/dL had been required for diagnosis. + In the presence of symptoms of diabetes, a confirmed** nonfasting plasma glucose value of greater than or equal to 200 mg/dL indicates a diagnosis of diabetes. + When a doctor chooses to perform an oral glucose tolerance test (by administering 75 grams of anhydrous glucose dissolved in water, in accordance with World Health Organization standards, and then measuring the plasma glucose concentration 2 hours later), a confirmed glucose value of greater than or equal to 200 mg/dL indicates a diagnosis of diabetes. In pregnant women, different requirements are used to identify the presence of gestational diabetes. Prevalence of Diabetes + 15.7 million people (5.9% of the population) have Diabetes. + 10.3 million people have been diagnosed with Diabetes. + 5.4 million people have not been diagnosed with Diabetes. Incidence of Diabetes + 798,000 new cases are diagnosed per year Prevalence of Diabetes by Age + Age 65 years or older: 6.3 million. 18.4% of all people in this age group have Diabetes + Age 20 years or older: 15.6 million. 8.2% of all people in this age group have Diabetes + Under Age 20: 123,000. 0.16% of all people in this age group have Diabetes Prevalence of diabetes by sex in people 20 years or older + Men: 7.5 million. 8.2% of all men have diabetes. + Women: 8.1 million. 8.2% of all women have diabetes. Deaths among persons with diabetes + Studies have found death rates to be twice as high among middle-aged people with diabetes as among middle-aged people without diabetes. + Based on death certificate data, diabetes contributed to 193,140 deaths in 1996. + Diabetes was the seventh leading cause of death listed on U.S. death certificates in 1996, according to CDC’s National Center for Health Statistics. + Diabetes is believed to be underreported on death certificates, both as a condition and as a cause of death. Prevalence of diabetes by race/ethnicity in people 20 years or older + Non-Hispanic whites: 11.3 million. 7.8% of all non-Hispanic whites have diabetes. + Non-Hispanic blacks: 2.3 million. 10.8% of all non-Hispanic blacks have diabetes.On average, non-Hispanic blacks are 1.7 times as likely to have diabetes as non-Hispanic whites of similar age. + Mexican Americans: 1.2 million. 10.6% of all Mexican Americans have diabetes. On average, Mexican Americans are 1.9 times as likely to have diabetes as non-Hispanic whites of similar age. + Other Hispanic/Latino Americans: On average, Hispanic/Latino Americans are almost twice as likely to have diabetes as non-Hispanic whites of similar age. (Sufficient data are not currently available to derive more specific estimates.) + American Indians and Alaska Natives: 9% of American Indians and Alaska Natives have diagnosed diabetes. On average, American Indians and Alaska Natives are 2.8 times as likely to have diagnosed diabetes as non-Hispanic whites of similar age. + Asian Americans and Pacific Islanders: Prevalence data for diabetes among Asian Americans and Pacific Islanders are limited. Some groups within this population are at increased risk for diabetes. For example, data collected from 1988 to 1995 suggest that Native Hawaiians are twice as likely to have diagnosed diabetes as white residents of Hawaii.

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