Previously known as insulin-dependent, juvenile or child-onset, Diabetes Type 1 is a chronic disease characterized by insufficient insulin due to autoimmune destruction of insulin-producing beta cells in the pancreas. The onset of Diabetes Type 1 occurs mainly in children particularly at the time of puberty, but can also develop in adults. According to the World Health Organization (WHO), statistics project that Type 1 Diabetes makes approximately 5 to 10% of diabetic cases (Ogurtsova et al, 2017). As of 2018 report by the American Diabetes Association, reveals that Florida has approximately 2.35 million diabetic people. Usually, the chronic illness is managed by injection of insulin. A recent study done by (Kahanovitz, Sluss & Russell, 2017) reveals that if a person with Diabetes Type 1 does not receive insulin, glucose travels within blood vessels causing damage. The serious complications can potentially result in amputation of limbs, kidney disease, heart diseases, stroke and loss of eyesight. Currently there is no cure for Diabetes Type 1.
The purpose of this paper is to provide background information and significance of Diabetes Type 1 including definition, description, signs and symptoms and current prevalence in Florida as compared to the larger United States. Further, the paper will cover extensively the current surveillance methods and reporting processes, epidemiological analysis, screening and guidelines, and a plan of actions to measure the outcomes.
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Definition and Description
Diabetes Type 1 is a disease in which autoimmune destruction of pancreatic beta cells leads to severe impairment of insulin secretion sequentially resulting in insulin deficiency. Kahanovitz, Sluss & Russell (2017) define Diabetes Type 1 as a T-cell autoimmune disease in which the destruction of pancreatic beta cells causes insulin deficiency which results in hyperglycemia and a tendency to ketoacidosis. Individuals who stand a higher chance of developing Diabetes Type 1 are identified by specific genetic markers and autoantibodies. These markers of autoimmunity against beta cells include islet cell autoantibodies and those against insulin, phosphates of tyrosine, and glutamic acid. The rate of autoimmune destruction of beta cells varies in Type 1 Diabetic patients with rapid progression rates in infants than in adults. In addition to factors triggering the destruction of cells are immunologic and infections from viral factors. The specific viral factors and infections associated with Diabetes Type 1 include congenital rubella and enterovirus, rotavirus, herpes virus, cytomegalovirus, and endogenous retrovirus respectively (Shojaeian & Mehri-Ghahfarrokhi, 2018). Generally, Type 1 Diabetes occurs in children and adolescents but is now affecting adults up to 40 years of age.
Signs and Symptoms
Signs and symptoms of the disease include polyuria, polyphagia, and polydipsia, weight loss and fatigue (Mengibar, Capel, Bonfill, Mazarico, Espuria, Caixas and Rigla 2019). Usually, the signs and symptoms are due to the transport of glucose into tissues which results in elevated glucose levels in both the blood and urine. Consequentially the fluid and calorie levels in urine drop. At such low levels of insulin, lipolysis is impossible to suppress. As a result, ketone bodies accumulate in the bloodstream to metabolic acidosis. Also compensatory alkalosis occurs due to hyperventilation. If a Type 1 diabetic patient is left untreated with such low levels of insulin, the compensatory mechanism eventually fails, then develops cerebral edema, and unconsciousness, which could be fatal.
Current Prevalence/ Incidence in Florida.
Great affords have been made in a bid to assess the prevalence and incidence of Type 1 Diabetes in Florida. In Broward County, the chronic disease has become an epidemic with the annually ever-increasing numbers. As of 2015 approximately 7.3% of the population in Florida has been diagnosed with Type 1 Diabetes. It is also worth noting that in a recent study by Rogers, Rogers, and Basu (2018), findings reveal that the prevalence rate of Type 1 Diabetes for people aged 19 years and younger stood at 9.5 per 100,000 persons between 2001 and 2016. The incidence and prevalence of type 1 Diabetes in Florida have also been understood due to risk factors like race and ethnicity, education level, gender, and even income. According to a report by the Florida Health Department, the prevalence of Type 1 Diabetes by ethnicity was 14.1 % among African Americans, and 11.3% among Hispanics (Hu et al, 2015). On the other hand, prevalence is higher in women than in men. When considering income and education, men and women with a level of education below high school have a higher prevalence than those who cleared college and have n income.
Just like elsewhere Type 1 Diabetes is a major public health concern in the United States of America. Compared to the national statistics, the prevalence of type 1 diabetes stands at 1.25 million American children and adults ( Centers for Disease Control and Prevention 2016 ). Further the American Diabetes Association reveals that the incidence stands at 40,000 cases nationally on an annual basis (2018). Out of this number, 17, 900 are children and adolescents below 19 years of age. (Bullard et al. 2018), in their study found out that non-Hispanic white adults had a higher prevalence of type 1 diabetes compared to Hispanic and non-Hispanic blacks based on the NHIS data of 2016. According to the study. Americans need to make informed choices to live a healthier life. To prevent the risk of developing Type 1 Diabetes the people of Florida and the larger U.S. need to abandon sedentary lifestyles and achieve healthy weight. Below is a table of incidence/Prevalence rates of Florida compared to national statistics
| Indicator | Measure | Year | Age | The annual number of events | National |
| New cases per 100,000 | Per 100,000 of the total population | 2001-2016 | Below 19 | 643 | 65.8 |
| Hospitalization per 100, 000 | 2001-2016 | Below 19 | 64503 |
Above is a table representing the cases of hospitalization and new incidences in Florida as compared to the national statistics
Surveillance and Reporting
Both surveillance methods and reporting processes of type 1 Diabetes provide for an opportunity to address public health needs, inform etiological research, and plan for health care. The Centers of Disease Control and Prevention (CDC) defines epidemiological surveillance as a systemic collection, analysis, and interpretation of data which is essential for the health care industry in terms of implementation and evaluation with timely dissemination of information for those who need to know (Saydah & Imperatore, 2018). Collection of data regarding type 1 Diabetes can either be done actively or passively. Usually the latter is on individual cases based on one’s medical records. This can be done by contacting the persons. Active surveillance is rare and used in cases where a severe disease has been discovered or re-emerged. Other surveillance methods include Health Indicators Warehouse (HIW) and Behavioral Risk Factor Surveillance System (BRFSS).
As a user-friendly source of national, state, and local community health indicators, one of the current surveillance methods used for type 1 Diabetes is HIW. Information and data collected are a reflection of numerous dimensions of health among them population, determinants, risk factors, and health care. Indicators on HIW links have evidenced-based interventions and serves as a data and information hub for information regarding type 1 diabetes. HIW is managed by multiple stakeholders among them CDC’s National Center for Health Statistics and funded by Medicaid and Medicare services (Saydah & Imperatore, 2018) . For instance, the data on prevalence and incidence of Type 1 Diabetes not only in Florida but also across the larger U.S. is found on HIW.
In addition to surveillance methods, the CDC has also used the Behavioral Risk Factor Surveillance System (BRFSS). The role of this monitoring system is to gather data through surveys about the health of American population. Among information gathered include chronic health conditions, risk behaviors and factors of type 1 Diabetes, and preventative measures and services in various states across the U.S (Saydah & Imperatore, 2018) . In Florida, for instance, BRFSS provides data regarding type 1 Diabetes indicators for disease management and measures the progress of the objectives of Diabetes Control Program.
To combat the rising incidences of type 1 Diabetes, reporting processes have been made mandatory in the United States. The CDC has a responsibility of reporting to the American people and the health care industry regarding the prevalence and incidence of type 1 Diabetes. Usually, the reporting is done quarterly and annually through surveillance methods. In Florida, the Florida Department of Health reports up to date information on the incidences, prevalence, hospitalization, and even morbidity and mortality of type 1 Diabetes. The processes of reporting and surveillance methods are critical for national planning regarding the epidemiological problem.
Epidemiological Analysis
One of the most chronic childhood diseases, Type 1 Diabetes is caused by the deficiency of insulin following the autoimmune destruction of pancreatic beta cells. Until the establishment of supplementation of insulin, children diagnosed with the disease used to die within a very short time. The epidemiology of type 1 diabetes is understood from various studies conducted at national levels or in small sample populations. Estimation of epidemiological data is possible from these studies or even in cases of self-reporting.
Costs incurred from type 1 Diabetes represent a huge burden not only to the patients but also to the health care system and the U.S economy in general. As per the national data sets provided, each year costs the country an approximate of 11.5-17.3 billion of U.S. dollars in medical costs and lost income (Shojaeian & Mehri-Ghahfarrokhi 2018). That is a huge financial burden. Over the years the costs have been increasing gradually with the rising population of type 1 Diabetics. Typically, patients with Type 1 Diabetes suffer from the disease for a longer time, an average of 12 years since the time of diagnosis. The disease represents daily insulin shots and tools such as injection needles as well as constant medical monitoring. Hence representing a lifelong cost and time that is significant to the economy of the country. The long-term effects are likely to spill over other life aspects due to economic implications, particularly indirect costs. In a recent review of literature addressing the social consequences of Type 1 Diabetes, results indicate that children diagnosed with the disease are likely to miss school. For adults in workplaces, employment outcomes are worse. To cut on the financial burden and social costs of the disease, early effective type 1 diabetes management should be encouraged compared to standard treatment.
In Florida, type 1 Diabetes is epidemic. Costs involved could arise from amputation, kidney failure, stroke, cardiovascular diseases, and death. As per the Broward Department of Health, adults diagnosed with type 1 diabetes according to race include 10% Hispanic, 9.5% African Americans and 5.3% Caucasian (Smith et al, 2018). Further breaking down the numbers 9.8 % of the population in Florida has type 1 Diabetes.
Screening and Guidelines
Despite the high prevalence of Type 1 Diabetes in the United States, too many citizens go untreated partly because the chronic disease goes undiagnosed. Regular screenings in health care are critical for identification of type 1 Diabetes which translates in early and effective care. The primary screening test for type 1 diabetes is a random blood sugar test. Usually a blood sample is taken from the child at a random time regardless of when they last ate. When the test indicates a blood sugar level of 200mg per deciliter, type 1 Diabetes is present (Pippitt, Li & Gurgle, 2016). According to findings from a recent study, diabetes is normally diagnosed after onset. Further, results from the study indicate that the most accurate and simple tool for diagnosing diabetes is the hemoglobin A1C test because it does not require fasting. In addition, it considers glucose levels over a long period of time (James & Zaidi, 2019). Screening tools should be ordered in a timely manner to avoid lagging the process of treatment for the disease. Glycemic levels can be controlled and managed through the normal A1C levels. At the moment the link to genetic type 1 Diabetes is unidentified but with progresses specific genes such as HLA-DQA1 , HLA-DQB1 , and HLA-DRB1 may hold the key to future transmission markers from parent to child. It is interesting what the future hold for type 1 Diabetes (Kahanovitz, Sluss & Russel, 2017).
In a recent study by Dutta, Dudhe, Deb, Dasgupta, & Sarkar (2016), findings indicate the sensitivity of 90% and a specificity of 7.2% after a sample population of 100 people was tested with HbA1c. Further the positive predictive value stood at 76.72% as compared to the standard which is FPG> 126mg%. Usually a sensitivity test represents the probability of positive outcomes among people with diabetes. On the other hand, specificity represents the probability of negative outcomes among people without type 1 Diabetes. The conclusion from the study was that a cut-off value of 7.0% would give optimal sensitivity and specificity of HbA1c as a diagnostic criterion for Type 1 Diabetes.
Plan of Action
The plan of action will involve primary, secondary, and tertiary interventions. Primary intervention involves prevention of the disease. Self-management and education are key to preventing complications such as blood pressure. (Abubakari, Cousins, Thomas, Sharma & Naderali, 2016) reveal that educating patients reduced systolic and diastolic complications of type 1 diabetes. On the other hand, secondary intervention involves reducing the impacts of the disease. Secondary interventions range from diagnosis and treatment of the disease at an early stage. In addition regulating and requesting regular clinical examinations including the HbA1c test is critical in the prevention of type 1 Diabetes. Patients should also be advised to follow a particular diet as well as regular physical exercise. Tertiary interventions will soften the already available impacts of type 1 Diabetes. Actions range from forming a support group, controlling other issues related to diabetes as well as having a regular visit to a nutritionist.
Another critical action of plan for type 1 Diabetes is the integration of health policy advocacy efforts. Evidence-based action by health policy advocacy groups such as the National Diabetes Education Program is available. According to NDEP, every nurse is required to create awareness in the knowledge and seriousness of risk factors of type 1 Diabetes to prevent further complications (Kise, Hopkins & Burke, 2017). As a nurse practitioner, it is important in using all of the above plans of action in preventing type 1 diabetes due to the economic and social impacts it has on people and the economy of the country.
Conclusion
In summary, according to the WHO, approximately 5-10% of the American population has type 1 Diabetes. Interventions through education on changing the sedentary lifestyles are important because large populations are unaware. In addition they have misconceptions regarding the disease and the risk factors, especially at adulthood. While people may know they are at a risk depending on the incidences and prevalence highlighted, they may be still in denial that such health disparities can occur. Therefore, it is important to educate and create awareness.
References
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