What is Type 2 Diabetes?

Type 2 diabetes is a critical and common chronic illness caused by an intricate inheritance-environment interface in addition to other risk factors such as sedentary lifestyle and obesity. It is characterized by a chronic hyperglycaemic condition due to the deficient action of insulin. The disorder alongside its complications comprises of a common global public health matter that impacts almost every developing and developed nation, with high mortality and morbidity rate. This paper seeks to consider type 2 diabetes with regard to its etiology and epidemiology, the primary food sources that cause it alongside the groups at risk of infection and the corresponding determinants. This paper will also critically examine two programs intended to address the disease.

The primary causes of type 2 diabetes include an amalgamation of genetic factors associated to compromised insulin secretion and insulin resistance alongside environmental factors such as a lifestyle of physical inactivity, obesity, depression, anxiety, overeating, and aging.  

There is a clear association between type 2 diabetes with a family history of diabetes. The substantive involvement of genetic factors in the development of type 2 diabetes was confirmed by the considerably higher concordance rate between monozygotic twins than in the dizygotic twins (Drong, Lindgren, & McCarthy, 2012). The association of genetic abnormality in the molecules associated with the system of glucose metabolism regulation has been the assumption of pathogenesis. Genetic defects have been identified in the assessment of candidate genes aimed at secretion of pancreatic beta cells via glucose-stimulated insulin, and the molecules consisting of the molecular mechanism for the action of insulin.  The KCNQ1 gene mutation has been associated with the abnormality in the secretion of insulin as an essential gene that is disease- susceptible in Japanese and the ethnic communities in Asia (Unoki et al., 2008). 

Examples of independent risk factors of pathogenesis include smoking, drinking alcohol, obesity, aging and inadequate intake of energy among others. Physical inactivity leads to obesity especially visceral fat obesity and is complemented with a drop in muscle mass, triggers insulin resistance, and is closely linked with the speedy increase in the incidence of the disease among aged patients. Alterations in food energy sources, especially increased consumption of fat, low intake of starch, use of large amounts of simple sugars, and the consumption of foods with little fiber leads to obese cases and contributes to declining of glucose tolerance. Obesity is one of the leading dietary factors that contribute to type 2 diabetes. For example, even low cases of obesity such as a BMI of less than 25 poses a five times risk of developing diabetes, especially when accompanied by the rise in visceral fat mass (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).  

Etiology of Type 2 Diabetes

According to the Global burden of diabetes (2011) in 2011, approximately 366 million people were diagnosed with diabetes mellitus, and it is estimated to reach 522 million people by 2030. There is an alarming increase in the diagnosed cases of diabetes across the globe with 80% of diabetic patients residing in low and middle-income countries. 4.6 million deaths in 2011 were caused by diabetes mellitus (Global burden of diabetes, 2011). 439 million people are expected to have type 2 diabetes by the year 2030 (Chamnan et al., 2010). The prevalence of type 2 diabetes varies significantly based on the geographical location due to risk factors such as lifestyle and environment (Chen, Magliano, & Zimmet, 2012).

A critical review of the existing literature indicates minimal data on the incidence of type 2 diabetes in Africa. However, the few existing studies that assess the epidemiology trends of type 2 diabetes in Africa show a significant increase in its incidence both in rural and urban settings, and equally impacting both genders (Guariguata et al., 2014). Type 2 diabetes records the highest disease burden in Africa with less than 10% of cases being recorded as type 1 diabetes. According to the 2011 report by Centre for Disease Control (CDC), approximately 25.8 million people in the US were affected by diabetes mellitus in 2011 with 95% of them being diagnosed with type 2 diabetes (Department of Health and Human Services, 2011).  Shaw, Sicree, & Zimmet (2010) predicts the frequent occurrence of type 2 diabetes to increase in the next twenty years in the developing countries particularly in adults of 45 and 64 years.

Different studies have examined the strong association between food choices and the relative risk of developing type 2 diabetes. Bauer et al. (2013) surveyed dietary patterns among diabetic patients using Netherland as a case study and found out that a diet full of junk food such as fries, chips, and soft drinks increased the risk of type 2 diabetes seven times.

Highly processed carbohydrates especially those sourced from the white flour, white rice, and white sugar are the leading food categories that cause diabetes. This is because these foods comprise of whole grains that have been stripped of vital fiber in addition to health vitamins and minerals. The 2010 study by Nanri et al. (2010) on Japanese men and women found out that the intake of heavily processed carbohydrates predisposed them to the risk of developing diabetes type 2 by 1.65 when paralleled to those who consumed whole foods. 

Independent Risk Factors for Type 2 Diabetes

Sweetened soft drinks such as sweet the teas and sodas have been associated with an increased risk of developing type 2 diabetes according to the 2010 study by Malik et al. (2010). The outcomes of the research indicated that there was a high risk of 26% of developing type 2 diabetes in individuals that consumed one to two sugary drinks each day compared to those that had less than one in a month.

Age

The risk for type diabetes increases with age. Adults aged 45 and above have a 25% risk of being diagnosed with type 2 diabetes (Wu, Ding, Tanaka, & Zhang, 2014).

Race

Studies have shown that type 2 diabetes is more prevalent in African Americans, Asian Americans, Latinos, and Native Americans (Wu, Ding, Tanaka, & Zhang, 2014).  

Family History

Individuals with a family history (especially first degree relatives) of type 2 diabetes are more prone to type 2 diabetes. Monozygotic twins have a concordance of 100% and 25% in those with cases of family history of type 2 diabetes (Wu, Ding, Tanaka, & Zhang, 2014).

Programs to Address Type 2 Diabetes

A community-Based Diabetes Prevention Programme in Sydney

Colagiuri et al. (2010) observe that this programme is based on the fact that type 2 diabetes can be detected early and prevented. It focuses on populations that are at risk of developing the disease or have been diagnosed with it. The objectives of this programme include:

1.    To improve early identification of populations prone to developing diabetes and to recommend a prevention aid
2.    To increase the initial diagnosis of diabetic patients and to offer control and support
3.    To offer expert knowledge to care providers to improve the quality of diabetes care services in the community

Programme Interventions

To effectively realize the objectives mentioned above, this programme will implement various services to the community members. During planning the community leaders who form part of the stakeholders are to be consulted about multiple community traditions and culture, and the prioritized needs of the community. The community members will first be screened using the AUSDRISK tool (Chen et al., 2010) to determine the prevalence of the disease in the community. Then those that will be positive to the test will be enlisted in the lifestyle intervention workshop which will be aimed at promoting lifestyle changes regarding healthy eating and increased physical activity. The lifestyle modification program forms the central part of the programme.

The objective of the lifestyle intervention programs include:

•    Spending a minimum of 30 minutes each day on average to intense physical activity in addition to aerobic exercises. Alternatively, additional days per seek alongside strength training twice a week.
•    Less than 30% reduction in the consumption of energy from total fat, and less than 10% from saturated fat
•    15g/1000 kcal intake of fiber or more
•    5% reduction of body weight within one year.

The primary intervention on lifestyle will take six weeks and includes weight management, providing healthy eating guidelines, reduction and elimination of tobacco, involvement in regular physical activity (measured using Physical Activity Scale for the Elderly (PASE) tool), and adequate sleep. These parameters have been found to foster the prevention and management of type 2 diabetes.

Prevalence and Epidemiology of Type 2 Diabetes

The screening and lifestyle intervention programme is useful because it approaches the burden of type 2 diabetes from a preventive perspective. Additionally, the lifestyle intervention for patients diagnosed with type 2 diabetes is easy and can be self-replicated at home after training. This ensures that minimal cost is incurred in the treatment of a disease in a population that is already burdened with disease.

The approach has also factored in the aspect of community engagement and involvement. The work of the trainers is to offer expert skills and guidelines on interventions such as weight management and physical activity. Ackermann et al. (2008) observed that the involvement of community leaders during planning ensures that the community participates in decision making and that the programme meets their needs.  Furthermore, the cultural relevance of the programme was ascertained through the involvement of the community leaders. This approach involved the normal activities of any culture such as eating. Thus it ensured that it did not violate any significant cultural practices. The evaluation framework for physical activity using the Physical Activity Scale for the Elderly (PASE) ascertained its reliability and validity (Copeland & Esliger, 2009). 

The objective of this programme is to reduce the modifiable risk factors of type 2 diabetes in high-risk adults using a community-based lifestyle change approach tailored to the Malaysian Culture (Ibrahim et al., 2016). The high-risk approach takes 12 months, and it involves five steps. The first step consists of the identification of individuals who are at high risk of developing type 2 diabetes using the Finnish Type 2 Diabetes Risk Assessment Form (Buijsse, Simmons, Griffin, & Schulze, 2011). The individual that is regarded to be at high risk of type 2 diabetes proceeds to the second step which involves the measurement of the risk for the development of type 2 diabetes. The presence or absence of IGT or IFG in blood glucose will be determined alongside the assessment of other risk factors for diabetes such as genetics, body weight, etc. The third step involves the intervention to lower the risk using lifestyle modification programs to lose weight through the average restriction of calorie, increased physical activity among others. Phase four consists of the implementation of the intervention using the group-based approach. The last step entails the analysis of the outcomes regarding long-term (after 12 months) and short-term (after six months).

The eligible subjects to the study must meet the inclusion criteria. They must be living or working within the community during the period of the study, and have to be aged between 18 to 65 years. The participants have to be at risk of type 2 diabetes and be able to read and comprehend English language or Bahasa Malaysia.

Lifestyle Intervention Program to Prevent Type 2 Diabetes

Critical Analysis

The use of lifestyle modification as an approach to prevent the escalation of type 2 diabetes has been ascertained by several studies (Hu, 2011; Li et al., 2008). This intervention makes the programme more effective because of programs such as weight loss increase insulin resistance in the short term (Hu, 2011; Li et al., 2008). Furthermore, physical activity is significant in maintaining weight loss, and increases insulin sensitivity and is recommended by IDF. The survey of individuals to be included in the programme involved the use of Finnish Type 2 Diabetes Risk Assessment Form. This tool gathers demographic and socioeconomic data, state of activity, quality of life, and the present medications.

Moreover, the Finnish survey tool is recommended within the physical activity aim of the Sydney Diabetes Prevention Program (SDPP), and it includes strength training during exercise lessons which increases insulin sensitivity (Copeland & Esliger, 2009)

Studies have ascertained the effectiveness of lifestyle changes in across different ethnic groups of varying cultures. For instance, studies on diabetes prevention and management in Sydney (Colagiuri et al., 2010) and India (Balagopal, Kamalamma,  & Misra, 2008) have confirmed this assertion. 

Furthermore, the inclusion criteria further ensured community engagement. For instance, those eligible for the study must have been residents of the community during the period of study. The evaluation framework is reliable since it consists of elements of behavioral change that are founded on socio-cognitive theories 23 and stages of change 22. The intervention outcomes are assessed after every six months to ascertain the progress and make any necessary adjustments, thus ensuring the reliability of the programme. The programme is also sustainable because it is based on simple steps or activities of lifestyle changes which can easily be carried out at home even after the termination of the programme.

Conclusion

Type 2 diabetes is amongst diet-related conditions that are on the increase across the globe. It is primarily as a result of a chronic hyperglycaemic state caused by the deficient action of insulin. The risk factors of the condition include environmental and genetic factors. Individuals from a family with a history of diabetic cases are at high risk of developing diabetes type 2.

On the other hand, a sedentary lifestyle, obese cases, aging, overeating are some of the environmental factors that predispose people to type 2 diabetes.  Additionally, African Americans, Asian Americans, Latinos, and Native Americans are more prone to the disease than other ethnic groups.  Over 366 million were diagnosed with the disease in 2011, and it is estimated to reach 522 million by 2030. This overwhelming increase is attributed to foods such as highly processed carbohydrates and sugar-sweetened drinks. Examples of programs to effectively prevent and manage type 2 diabetes include a community-Based Diabetes Prevention Programme and the High-Risk Approach to Prevention of Diabetes 

High-Risk Approach to Prevent Type 2 Diabetes

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