Another Hidden American Pandemic: Diabetes
The United States just went through a pandemic, but there is currently an ongoing pandemic that many forget about, and that is the diabetes pandemic. Diabetes prevalence is increasing around the world, according to the International Diabetes Federation. The IDF Diabetes Atlas (2021) states that 10.5% of adults around the world (20-79 years) have diabetes, with nearly half undiagnosed. By 2045, it's projected that 783 million adults, or 1 in 8, will have diabetes, a 46% rise. On a more localized level, U.S. data mirrors this alarming global trend.
In 2019, the National Institute of Diabetes and Digestive and Kidney Diseases reported that diabetes affected 37.3 million people of all ages, constituting 11.3% of the population. Shockingly, 8.5 million individuals remained undiagnosed. This figure represents a twofold increase over the past three decades, especially considering that the diabetes prevalence in 1990 was only 4.9%. What factors have driven this dramatic surge in diabetes cases?
The alarming rise in diabetes, predominantly Type 2, can be traced back to multiple interconnected causes. The global proliferation of fast-food outlets offering calorie-rich, processed meals and a surge in sugar-laden diets has been a major contributor. This, coupled with the widespread adoption of sedentary lifestyles due to technological conveniences, has magnified the risk. Genetic predispositions in certain demographics and an aging worldwide population, which is naturally more susceptible to diabetes, are also factors. With its high-stress environments and potential exposure to environmental toxins, modern life compounds the problem by affecting insulin functionality. Tackling this escalating health concern necessitates a holistic approach, focusing on personal lifestyle choices and the larger societal influences shaping them.
Regardless of the reasons why diabetes is increasing rapidly, there needs to be improved educational practices for those who have the disease. According to the CDC, only 6.8% of people with health insurance receive any diabetes self-management education and support services (DSMES) within a year of diagnosis. Sure, bulldozing fast food restaurants, implementing regulations on processed foods and sugars, and dismantling our car-centric lifestyle would help end this epidemic, but at the very least, we need to do a better job educating diabetic patients.
Diabetes health literacy involves patients educating themselves on healthy eating habits, making an eating schedule, and improving self-efficacy and self-care behaviors. Making sure to get screened annually, at the least, is very important, especially checking your A1C, which is a good testing indicator. However, implementing these techniques to maintain a healthy lifestyle is difficult if people are not properly educated.
It's clear we're facing a diabetes crisis that's as serious as other health challenges we've recently faced. Our collective ‘love’ for fast food and stationary lifestyle are huge problems that have arisen mostly due to economic forces outside the realm of public health. While bulldozing the fast food restaurants, minimizing food deserts, and building pedestrian-friendly cities would certainly improve diabetes rates, at the very least, we need to improve diabetes patient education. While this is not a cure-all, it certainly would be a step in the right direction. Sure, recent advances in medications have provided diabetics with different ways to lose weight and take control of their blood sugar, however, a lifestyle intervention is still a highly recommended component of any treatment plan.
Recent progress in mobile health technology offers an optimistic outlook for the adoption of lifestyle interventions among individuals with diabetes. Noom, the weight loss coach, was recently approved to become the first online Diabetes Prevention Program approved by the CDC as of 2017, and currently, there are RCT being conducted to determine if this intervention is effective at educating and managing diabetes. While the results are yet to be published, Noom and other mHealth applications aimed at education and lifestyle interventions for diabetic patients could be a common practice in the near future.
In addressing the diabetes epidemic, the integration of mHealth solutions represents a promising adjunct to traditional care methods. The potential of applications like Noom, which has garnered CDC approval, underscores an emerging trend toward digital facilitation of diabetes education and management. The anticipated outcomes of ongoing randomized controlled trials (RCTs) may further substantiate the role of mHealth in supporting diabetic patients, suggesting a shift towards these tools as a standard component of diabetes care.