Running Head: ADULT ONSET DIABETES DISEASE

Adult Onset Diabetes Disease in the United States of America

Victoria Koroma
Cheryse Jackson
Vida Kwofie
Fatima Taylor
Coppin State University
Instructor Dr. Warren-Dorsey
Epidemiology (NURS 520)

Adult Onset Diabetes Disease

Adult Onset Diabetes Disease in the United States of America

Diabetes is a condition that describes a group of metabolic diseases where a

persons blood sugar tends to rise above the usual and required standard (McCarthy,
2014). Individuals with high blood sugar typically experience several symptoms. One
of the symptoms is the frequent passing of urine. They get thirsty most often. They
also experience frequent hunger. It is a long-term condition. Sometimes substantial
weight loss or weight gain can be a symptom (McCarthy, 2014).
The disease has two categories. The Type 1 Diabetes is a condition where the
pancreas does not produce any of the required insulin from the beta cells to maintain
functioning glucose levels in the body (McCarthy, 2014). It is a condition that affects
ten percent of all diabetes cases. There is also the type 2 diabetes. The pancreas makes
less insulin than is required by the body (McCarthy, 2014).

The Burden of the Disease in the United States of America

Lobo (2014), discusses the population estimates of the United States in the
year 2014 were approximately three hundred million. The undiagnosed makes up
27.8%. The diagnosed individuals add up to 21 Million Americans (Lobo, 2014).
The 2009-2012 National Health and Nutrition Examination Survey revealed that there
were more men living with diabetes than women. 15.5 million Men had diabetes as
compared to 13.4 million women. The comparison by age showed some facts too.
There were 13.4 million people from the ages of 45 years to 64 years old who had
Diabetes as compared to 4.3 million people between 20-44 years. From the age of 65
and above, there were only 11.2 million people (McCarthy, 2014).

Adult Onset Diabetes Disease

According to the Center for Disease Control and Prevention (CDC, 2014)
diabetes is the 7th leading cause of death in the United States. The estimated cost of
treatment and management of diabetes in the year 2012 was 245 billion dollars (CDC,
2014). The cost of treatment of individual with diabetes is 2.5 times more compared
to those without diabetes (CDC, 2014). CDC also estimates that, the mortality rate of
individuals with diabetes is 1.5 times more compared to those without diabetes (CDC,
2014).
According CDC, (2015) the disease has become a burden to the city of
Baltimore in the state of Maryland. When people, especially the very active adults
within the community die of diabetes, it robs the city of very productive citizens. The
city has to reallocate billions of dollars to control the disease (CDC, 2015). The city
has to concentrate on prevention awareness campaigns and treatment. It makes it
costly both to the city and to the population.
Diabetes has no cure; one can only manage the disease. Most of the research
work is yet to find the cure (CDC, 2015). Once someone acquires the disease, it
becomes part of his/her for life. With a greater percentage of people suffering from
the condition, it causes laxity in the labor force and a lot of expense in the budget.
According to the Centers of Disease Control and Prevention CDC (2015),
Diabetes can result in kidney damage, cardiovascular diseases, blindness, lower limb
amputations, and among other expensive and incurable complications. It reduces the
citys productive labor force. Diabetes causes many complications in the body (CDC
2015). As a result, people become unsettled at their workstations and insurance
companies also have the trouble of catering for the ailments.
The Prevalence of adults with diabetes in Baltimore and Houston, Texas has
drastically risen (CDC, 2015). It has been a tense process trying to educate people

Adult Onset Diabetes Disease

about the disease. People have had to adopt a different lifestyle in order to avoid
having the disease (CDC, 2015). The CDC (2015) has a program that outlines the
requirement and lifestyle program to prevent diabetes.
People with Type 1 diabetes are completely dependent on insulin therapy for
glycemic control either via injection or insulin pump. Individuals with type 2 diabetes
can either adopt life style modification, oral hypoglycemic agent and /or insulin
therapy to manage their diabetes. There are prevention campaign measures on the
social networks (Sepah, Jiang & Peters, 2014). Medication to control elevated blood
pressure should also be considered. Diabetes has caused people to develop a series of
complications. Some of them are heart disease and stroke, blindness and or eye
problem, kidney disease, and amputations (Sepah, Jiang & Peters, 2014).

Treatment /Management
According to the American Diabetes Association (ADA, 2015), the goal of
managing diabetes is to restore normoglycemic control and prevent the development
of target organ dysfunction. In protecting target organ damage, emphases must be
placed on preventing microvascular (eyes, kidneys), macrovascular (coronary,
vascular), metabolic and neurologic complications (ADA, 2015). The Center for
Disease Control and Prevention (CDC, 2015) recommends healthy lifestyle practices
(healthy diet, exercise, and smoking cessation) to be included in the treatment plan.
The patient must be involved in the decision making process to enhance compliance.
According to the American Association of Clinical Endocrinologist
(AACE, 2015) if unable to achieve euglycemia with lifestyle modification in Type II
diabetes, metformin (a Biguanide) as a monotherapy agent must be initiated. AACE,
(2015) indicates that a second agent such as glyburide (sulfonuylurea) should be

Adult Onset Diabetes Disease

added if unable to attain normoglycemic control or if metformin therapy is
contraindicated. The goal A1C level for ADA is less than 7.0mg/dl (ADA, 2015).
Both AACE (2015) and ADA (2015) recommend early initiation of insulin therapy in
complicated adult onset diabetes to prevent target organ damage. The family nurse
practitioner must collaborate with an endocrinologist and other interdisciplinary team
members in managing type I and complicated type II diabetes cases to ensure optimal
client outcome.
Treatment of hyperlipidemia/dyslipidemia and HTN must also be
included in the treatment plan to prevent macrovascular complications. Management
plan must include; annual eye dilation by an ophthalmologist, annual urine
microalbumin, A1C every 3-6 months, self- blood glucose monitoring, routine eye
and foot exam at each follow up visit (ADA, 2015). Patient education must be focused
on compliance to the treatment plan. Teaching on finger stick glucose monitoring,
daily foot examination, and adherence to dietary regimen such as whole grain, low fat,
low salt, and lean meat diet must be provided. Moderate exercise such as brisk
walking 30mimutes per 3-5 times a week must be encouraged to manage obesity.
Side effects of medication and insulin therapy (lethargy, diaphoresis, confusion) must
also be emphasized to prevent hypoglycemia.

Morbidity Rates and U.S. Census Data

According to the Center for Disease Control and Prevention (2014), the
number of adults in the United States aged 18-79 with newly diagnosed diabetes has
more than tripled from 493,000 in the 1980s to over 1.5 million in 2011. In
Baltimore, Maryland, specifically inner city Baltimore, health-related resources can
be scarce. Many people are more focused on financial concerns than consistent

Adult Onset Diabetes Disease

physician visits. Diabetes is a medical condition suffered by many. According to the
Baltimore Sun (2013), nearly 10,000 people in West Baltimore are diagnosed each
year with new cases of diabetes, hypertension and other forms of curable illnesses.
In juxtaposition, the Texas State Department Health (2014), of Harris County
Texas, more specifically in the city Houston, diabetes is one of many curable illnesses
that continues to rise. They also point out that, Texas, a state more than three times
the size of Baltimore City, with an extremely diverse population, new cases of
diabetes continue to rise. Additionally, the close proximity of Texas to Mexico brings
with it the frequent influx of new citizens and new cases of diabetes. The table below
shows the census data comparing Baltimore, Maryland to Houston, Texas between the
years 2004-2014.

According to the Texas state department of health (2014), more than one
million Texans have been diagnosed with diabetes and another half million are

Adult Onset Diabetes Disease

believed to have undiagnosed diabetes. Over the past 10 years, the United States
Census Bureau (2015), shows increasing growth in population rates for both
Baltimore City, Maryland and Houston City, Texas. As shown in the first table below,
Houston continued to report over 20, 000 cases of adult onset diabetes annually,
seeing a gradual decline from 2012 through 2014. However, in Baltimore annual
cases of adult onset diabetes remained steady at just over 5,000 also seeing a decline
from 2012 through 2014. The second table illustrates the morbidity rates as compared
between both Houston, Texas and Baltimore, Maryland from the 2004 through 2014.
Houstons morbidity rate remained steady between 800-1,000 people per 100,000
over the years, with the exception of a peak from 2006 through 2009. Baltimores
morbidity rates averaged approximately 900 people per 100,000 and showed
promising decline between 2012 through 2014.

Adult Onset Diabetes

Baltimore City

Houston, TX

30,000

27,213
25,371
25,193
25,000
23,468
21,769
21,403
20,883
20,806
19,474
20,000
18,273
17,273
15,000
10,000
5,5205,5555,8355,8355,8255,4455,6135,633
4,6394,2263,956
5,000
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

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Morbidity Rates
1400
1200
1000
800
600
400
200
0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Baltimore

Houston

Conclusion
Diabetes, whether type 1 or 2, is a condition affecting the life of many
Americans (McCarthy, 2014). Millions of individuals are suffering from diabetes
because of a lack of healthcare and costly resources (CDC, 2014). The family nurse
practitioner needs to be familiar with the screening guidelines to help diagnose the 8.1
million Americans who have not yet been diagnosed (CDC, 2014). Early diagnoses
and treatment will help prevent microvascular, macrovascular, metabolic and
neurologic complications; this will improve the overall health of individuals with
diabetes.

Adult Onset Diabetes Disease

References
American Association of Clinical Endocrinologist. (2015). AACE Comprehensive
Diabetes Management Algorithm. Retrieved from
https://www.aace.com/publications/algorithm
American Diabetes Association. (2015). Type 2. Retrieved from
http://www.diabetes.org/diabetes-basics/type-2/?loc=db-slabnav
Centers for Disease Control and Prevention. (2014). National Diabetes Statistics
Report, 2014. Retrieved from
http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-reportweb.pdf
Center for Disease Control and Prevention. (2015). Diabetes Surveillance Data [Data
file]. Retrieved from http://www.cdc.gov/diabetes/atlas/countydata/atlas.html
Lobo, P. (2014). New diabetes screening recommendations in the USA. The
Lancet Diabetes & Endocrinology, 2(12), 934. doi:10.1016/s22138587(14)70182-2
McCarthy, M. (2014). Nearly one in 10 US residents has diabetes, CDC
reports. BMJ, 348(jun11 10), g3962-g3962. doi:10.1136/bmj.g3962
Sepah, S., Jiang, L., & Peters, A. (2014). Translating the diabetes prevention
program into an online social network: validation against CDC Standards. The
Diabetes Educator, 40(4), 435-443. doi:10.1177/0145721714531339
Texas State Department of Health. (2014). Diabetes Care [Data file]. Retrieved from
http://www.dshs.state.tx.us/diabetes/diabetescare.shtm
United Stats Census Bureau. (2015). Quick Facts Data [Data file]. Retrieved from
http://quickfacts.census.gov/qfd/states/24/24510.html

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Walker, A. (2013, 02-10). Health Disparities in Baltimore. Baltimore Sun. Retrieved
from http://articles.baltimoresun.com/2013-02-10/health/bs-hs-enterprisezones-follow-20130210_1_health-disparities-health-care-reform-healthenterprise-zone