Introduction
Diabetes mellitus commonly known as diabetes is a metabolic disease that exposes the patient to high levels of glucose in the blood over prolonged periods due to insufficient or no insulin production (Inzuchi et al., 2015). Acute and serious complications that arise from the disease include stroke, cardiovascular disease, coronary complications, foot ulcers, blindness, chronic kidney failure and fatality. Diabetes has grown to be one of leading causes of deaths in the United States of America due to the increased incidence of health risk behaviors such as consumption of process and fatty foods and lack of enough physical activity. Health interventions aim at mitigating the risk factors to reduce the prevalence and the high fatality associated with diabetes.
Overview
According to the Centre for Disease control and Prevention (CDC), diabetes is a significant public health issue that affects the United States based on the reported 800,000 diagnoses each year which equals to 2,200 cases per day (Seaquist et al, 2013). Furthermore CDC predicts that there is a projected increase in the future of new developments of the disease. In agreement, the National Health and Nutrition Examination Survey found that there are many adults are at high risk of diabetes due to the high rates of obesity and insufficient physical activity. High rates of cholesterol intake and increase in weight are the major factors that put people at high risk of having undiagnosed diabetes. However, today many people are aware of the importance of checking their nutritional intake and increasing physical activity to reduce the risk of diabetes diagnosis.
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The two known categories of Diabetes are type 1 and 2 (Inzuchi et al., 2015). Type 1 mainly occurs in children or adolescents younger than eighteen years, and the major causal factor is lack of insulin production. On the other hand, type 2 usually occurs in adults older than thirty years where the body tissues limit the production of insulin. Type 1 must be managed by insulin injections while type 2 requires behavioral and other medical interventions. These include regular physical exercise, avoiding tobacco use and keep a healthy body weight. Both types double the risk of death due to the diabetes-related complications. When it comes to prevalence and demographics, several non-behavioral risk factors and health behavior may make a person at risk of having diabetes.
Non-behavioral risk factors
In terms of age, the type 2 diabetes is increasing in prevalence with over ten million people over the age of thirty diagnosed with the disease with an estimate of over five million who have not yet confirmed as patients (Inzuchi et al., 2015). As the seventh leading cause of death in the US, the major fatal factor is the cardio-vascular symptom that associates with the diagnosis. In terms of gender, more men are at risk of cardiovascular disease as compared to women. The ladies, however, are more prone to coronary heart disease as a complication of diabetes than their male counterparts.
Other opportunistic conditions associated with diabetes include blindness, non-traumatic amputations, and ESRD also known as end-stage renal disease (Inzuchi et al., 2015). These health conditions reduce the quality of life of these people and cause disability. The level of knowledge of risk groups plays a significant role in determining the empowerment to fight the development of diabetes through proper health interventions. Vulnerable high-risk populations such as the elderly persons, Pacific Islanders, African Americans, American Indians, economically disadvantaged persons and Hispanics are at high risk of diagnosis.
The phenomenon is because of the lack of a proper diet with increased consumption of available and affordable processed foods. The category of the elderly persons is due to the deterioration of the insulin-producing cells and increased resistance to insulin after the age of 60. The elderly have a relative weakness during old age, lack of surveillance of health issues and insufficient intervention efforts to reduce fatality.
Health behavior
Apart from the non-behavioral risk factors of diabetes such as race, sex, age, and ethnicity, there are targeted health behaviors that put the American people at risk of having diabetes. The main behavioral risk factors include lack of physical exercise, inactivity, and ignorance on the benefits of a healthy diet and weight. Today there is an increase in the number of people in the US that category as overweight persons.
This phenomenon is due to the westernization of the US culture that includes overconsumption of processed food and high in fat diets (Cottrell, Girvan & McKenzie, 2009). For example, certain demographics such as the African American females are at risk of having diabetes due to the probably of maintaining such unhealthy diets and therefore gaining excessive weight. An African American woman, being in the minority group of people that are prone to have diabetes also may have insufficient financial resources to get access to a healthy diet. The affordability and the excessive production of processed and high-fat foods, therefore, lead to an unhealthy diet. In this example the behavioral and nonbehavioral aspects that are risk factors for diabetes intertwine.
The statistic base on the behavioral attributions such as increased consumption of fat, obesity and lack of physical activity that results in chronic disease epidemic, presents the starting point for health interventions (Inzuchi et al., 2015). With people under the age of fifteen reporting a high rate of diabetes two because of improper nutrition form an early age, the health care practitioners have a duty to address such risk factors so that they can mitigate the projected increase in diabetes diagnosis by the CDC. Teenagers that fall in this category also lack the required physical activity to burn calories because they spend most of their days watching television thereby limiting the physical activity. Therefore, behavioral interventions should target on the social, economic, ethnic, age and sex factors when dealing with people with diabetes.
Healthy People 2020
The health educators and Healthy People 2020 encourage the target population of minority groups, economically challenged, the elderly and overweight people to adopt or modify their healthy behaviors to improve health outcomes (Diabetes | Healthy People 2020). These healthy behaviors include a healthy diet, a lot of physical activity and frequent visits to healthcare institutions. These behaviors are targeted because they have proved effective in recent studies as per the surveys of the National Diabetic Educational Program (Seaquist et al., 2013). For instance, the intake of a healthy diet reduces the rate of excessive glucose in the blood and can, therefore, reduce the risk to diabetes and conquer the complications that exist as a result of diabetes such as coronary complications. Additionally, food that has low fat and cholesterol levels nourishes the body rather than subjecting it to obesity and other weight complications that lead to foot ulcers.
Healthy People 2020 Goals and objectives related to diabetes
The Healthy People 2020 have a goal to improve the lives of people that have Diabetes or are at risk of diagnosis and to reduce the diabetes burden to the minimum possible level (Diabetes | Healthy People 2020). By acknowledging the main causal factor as an improper function of the insulin production system, the Healthy People 2020 has a goal to evaluate and mitigate the disabling complications that arise from metabolic abnormalities. They establish that the main challenges in reaching their goal are the troubling rise in the number of diabetes cases and the faulty design of the healthcare system. By targeting each with diabetes, they can address the cormobities of diabetes such as fracture risk, incontinence, cognitive impairment and cancer prognosis (Seaquist et al., 2013).
The main objectives of the Healthy People 2020 initiative to address diabetes as a significant issue include the reduction of the new cases reported every year. The CDC statistic of eighty thousand new diagnosis reports and the ascertained rates of the people that have diabetes is a considerably large number that raises an alarm to the epidemic rate in the US. Furthermore, the Healthy people 2020 aims to also reduce the mortality rate among persons with diabetes by accessing the factors that cause fatalities (Diabetes | Healthy People 2020). Diabetes-related hospitalizations such as coronary problems and cardiovascular complications fall under this category. Therefore, by reducing the rate of all mortality causes and cardiovascular deaths, they can reach their objective.
Healthy People Interventions
Obesity: Worksite programs
The name of this program is the Obesity Prevention and Control program which aims at using worksite health promotion efforts that target nutrition and physical activity to improve employee weight status (Diabetes | Healthy People 2020). As a community guide recommendation, the program improves the health-related behaviors of employees by design. These health-related interventions improve health outcomes by focusing on mitigation of the development or complications arising from type 2 diabetes which is prevalent in the United States of America (Inzuchi et al., 2015). The program is targeting employees in all sectors, and therefore the physical context is the worksite.
The various components of this intervention include behavioral, informational, social, environmental, educational, and policy strategies that focus on the health-related behaviors and outcomes. In a breakdown, the informational and educational aspect of the program includes the outreach efforts by companies to show their employees the benefits of eating healthy and physical activity and how the two reduce the risk of developing diabetes. The social aspect involves the active engagement of employees in group and corporate activities such as walks and runs so as to increase their physical activities.
The environmental and policy design ensures that the employees promote healthy behavior by maintaining a healthy lifestyle when at the workplace such as availing healthier snacks during the work days and walking instead of driving to proximate distances. Through evaluation of the outcome of worksite programs by the Taskforce finding in February 2007, the strategies of the program show positive results in a reduction of weight of employees through increased physical activities and healthy diets. The risk of exposure and or the complications associated with diabetes also reduced significantly.
The National Diabetes Education Program (NDEP) Strategic Plan for 2014 - 2019
The NDEP and the Healthy People 2020 created five-year strategic plan that aims at improving diabetes outcomes. Through the use of the Strategic Planning Task Group, the NDEP and Healthy People 2020 targets community health workers that represent people at risk or with diabetes (NDEP Strategic Plan For 2014-2019). Through engagement with community-based organizations, the program aims at implementing its objectives in community, worksites, religious, recreational and residential settings. Through the use of linguistically appropriate programs and health literacy, the program aims at recognizing and addressing the unmet need of the high-risk groups (Inzuchi et al., 2015).
Another initiative is to provide adequate resources and materials, therefore, widening NDEP’s role in countering diabetes. By modeling sufficient intervention strategies, they aim at broadening the efforts to improve diabetes outcomes. The various components of the intervention include identification of the partner organizations that work with people that have diabetes. After identification, NDEP shares their vast resources and model programs that can help the patients effectively manage diabetes, sustain healthy lifestyles and improve health outcomes (NDEP Strategic Plan For 2014-2019). Through the promotion of the primary and specialist care at community health centers, the program can improve self-management efforts for people with diabetes.
The program has effectively improved the materials and resource that were needed to improve the lifestyle of people with diabetes. For example the provision of food for people that take insulin medication to ensure that they can manage a healthy diet. Providing food is therefore a viable intervention that mitigates the risk of complications from diabetes and maintains healthy weight (Seaquist et al., 2013)
The objectives that aim at mitigating risk behavior include improving physical activity, weight training programs and monitoring the ingestion of calories and fat into the diet of people with diabetes (NDEP Strategic Plan For 2014-2019). Other objectives include the increase the rate of the annual foot, blood pressure, dilated eye, glycosylated hemoglobin, urinary micro-labium and self-blood monitoring evaluation amongst people with diabetes. Another significant objective is to increase the knowledge of diabetes through education programs for the patients while improving diagnosis efforts to eradicate uncertainty.
The role of health educators in addressing diabetes
Based on the educational and prevention intervention programs, the health care educators have the role reduce the economic burden of diabetes and improve the quality of life. By using the statistics from the National Diabetes Educational Program and the Obesity Worksite Program, they can use the vast resources to reach out to each at risk or with diabetes and provide the educational resources to improve their knowledge on the disease risk factors, mitigation efforts and interventions.
Another role is identifying and empowering community based education programs that are affiliated with diabetes initiatives is another role for health educators (Diabetes | Healthy People 2020). Empowerment includes the provision of information on all factors that affect diabetes diagnosis and reduction of complications. Outreaching shall ensure that all the target population including the minority groups and the economically challenged persons have access to the necessary care to improve diabetes outcomes. Another role is to ensure that people that fall under the unhealthy weight category get a medical evaluation so that they can assess their status and reduce their cholesterol and fat intake so that they can reduce the risk associated with diabetes. Another role of the health care educators is to improve the lifestyle of the patients so that they can comfortably deal with other non-behavioral risk factors in the recommended settings.
Moreover, Another role of the health educator is to inform people with family members or relatives that have the disease on how to take care of a family member and monitor their progress so that they can reduce the level of complications associated with diabetes. By extending health information to the relatives, the health educators ensure that they reduce the mortality rates that are linked to diabetes.
Another role is to model new intervention strategies that mitigate the risk factors at a multidimensional level. By being the intermediary between different stakeholders in a community setting, healthcare educators can bring various agencies into play. These include employers, employees, government officials, non-governmental organizations, and the locals in a community set up to share ways of dealing with diabetes. Sourcing for financial and informational resources from the American Diabetes Association, the health educator can create databases that are simplified and freely accessible to the public to present a forum for intervention on health interventions. Modeling supportive databases also help people to ask questions and get useful information on their health statuses.
Conclusion
Diabetes as one of the leading cause of death in the US steadily increases in the number of diagnoses. However, today people are more aware and informed about health habits due to the desire to live a prolonged life and therefore its easier than in the past to intervene by involving community participation. The Healthy People 202 has initiatives that focus on this optimism that through the active involvement of persons with or at risk of diabetes. By focusing on the health behavior of a person, the Healthy People 202 can achieve their objectives on reducing the rate of diabetes prevalence and mortality. It is challenging to change the health behaviors of persons with diabetes, but through the use of multidimensional interventions, this goal is achievable.
References
"Diabetes | Healthy People 2020". Healthypeople.gov . N.p., 2016. Web. 15 Nov. 2016.
"NDEP Strategic Plan For 2014-2019". Niddk.nih.gov . N.p., 2016. Web. 15 Nov. 2016.
Cottrell, R., Girvan, J., McKenzie, J. (2009) Principles, and Foundations of Health Promotion & Education, 6th Edition. Benjamin Cummings Publishing
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care , 38 (1), 140-149.
Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., & Vigersky, R. (2013). Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes care , 36 (5), 1384-1395.
