Diabetes in the United States: Examining the National Crisis

What Is Diabetes?

The CDC defines diabetes mellitus as a set of conditions characterized by the pancreas’s inability to produce or the body’s inability to use insulin effectively. Insufficient insulin production or usage results in rising blood sugar as the body uses insulin to metabolize it into energy. As a result, high blood sugar levels can contribute to multiple health issues.

In general, the common symptoms of diabetes include dysuria, excessive urination, unintended weight loss, excessive hunger, visual disturbances, numbness in hands or feet, fatigue, dry skin, and susceptibility to infections due to a compromised immune system.

Diabetes is generally considered an uncurable healthcare condition; however, some sources hypothesize that certain types of diabetes can be reversed with lifestyle changes. While this is a rare occurrence, diabetes, and its effects, can be managed by maintaining a healthy weight, choosing health-conscious foods, exercising regularly, and taking medication as prescribed.

According to the CDC, roughly 37 million people in the US have diabetes, but approximately 20% are unaware they have diabetes. Over the past two decades, the rate of adult diabetes has doubled, indicating a lifestyle or environmental trigger that has resulted in the rising rates.

With the exceptionally high rates of the condition, it is the seventh leading cause of death across the US. Beyond fatality, diabetes is known to result in kidney disease or kidney failure, lower-limb amputations, and blindness.

There are three types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. Each of these types is characterized by varying physiological changes and managed differently.

What Is Type 1 Diabetes?

Type 1 diabetes (T1D) is an autoimmune disease in which the body attacks itself, preventing it from making insulin altogether. Although patients may be able to produce some, they do not have enough insulin. This condition historically was referred to as juvenile diabetes because it is often diagnosed in childhood, teenage years, or early adulthood; however, clinicians have shifted to calling it T1D or insulin-dependent diabetes as it does not always present in adolescence.

T1D may also be characterized by nausea, vomiting, and other gastrointestinal issues. Symptoms of type 1 diabetes will usually develop over a few weeks or months.

Considering the inability to produce insulin, nearly all patients with T1D — up to 10% of all diabetes patients — rely on insulin injections to manage the condition. Some data suggest that T1D is a genetic condition, as there is no effective way to prevent it.

Type 1 diabetes is significantly more common in people with a parent or sibling with T1D. Beyond family history, the condition is more common in White patients than in Black and Hispanic patients.

According to the CDC, T1D can be passed down from a parent to a child through a genetic mutation; however, most people with the gene will not develop T1D. Some theories have also suggested that environmental factors like viruses can trigger illness. Recently, clinicians have noted that COVID may be a viral infection that can trigger diabetes.

Regular insulin shots or using an insulin pump is necessary for individuals with T1D to manage blood glucose levels. Patients are also advised to check their blood sugar regularly.

What Is Type 2 Diabetes?

Despite common misconceptions, T1D cases are only a small portion of diabetes cases, while type 2 diabetes (T2D) makes up 90–95% of cases. In this condition, patients can make insulin but are unable to use it to metabolize sugars properly.

Previously called adult-onset diabetes due to its tendency to be diagnosed in adults, T2D rates are rising amongst younger patients such as children, teens, and young adults. T2D symptoms develop gradually over the years.

According to the CDC, this condition can be prevented and delayed with lifestyle changes, including weight management, diet, and physical activity. Although more insight is needed on the exact risk factors for T1D beyond genetics, research has proved time and time again that lifestyle factors are a significant contributor to T2D.

Additionally, polycystic ovary syndrome (PCOS), one of the most common causes of female infertility, is known to be a risk factor for type 2 diabetes, as many patients develop insulin resistance which is a significant contributor to T2D. Over 50% of people with PCOS will develop T2D by 40.

While T2D can develop in anyone, it is more common in individuals who are overweight, over 45, have a family history of T2D, exercise infrequently, have gestational diabetes, or are Black, Latino, or American Indian/Alaskan Natives.

What Is Prediabetes?

A precursor to diabetes, called prediabetes, is not a form of diabetes per se. Instead, a slightly elevated blood glucose level suggests an increased risk of type 2 diabetes. It is prevalent in over one-third of adults in the US; however, 80% of patients are oblivious to the condition. Prediabetes risk factors are the same as risk factors for T2D. Healthcare providers may recommend diabetes prevention strategies, including healthy lifestyle choices and managing health problems such as obesity for patients with prediabetes.

What Is Gestational Diabetes?

The final type of diabetes, gestational diabetes, can develop during pregnancy even if a patient does not have diabetes before pregnancy. Often, this condition is linked to the onset of T2D later in life and a higher risk of obesity and T2D in the child.

Gestational diabetes risk factors include the following:

• a personal history of gestational diabetes
• a birth weight over 9 lbs
• pregnancy at 25 or older
• a family history of type 2 diabetes
• PCOS
• being Black, Hispanic, American Indian, Alaskan Native, Native Hawaiian, or Pacific Islander

Often gestational diabetes resolves after birth; however, it does increase the risk of the pregnant individual and their offspring developing T2D later in life. Gestational diabetes has no unique signs but is usually detected through a test at 24–28 weeks of pregnancy.

Testing for Diabetes

The American Diabetes Association (ADA) recommends diabetes screening for anyone with a BMI greater than 25, a history of gestational diabetes or prediabetes, HIV, or anyone over 35. Providers can opt for multiple blood tests for these patient populations to monitor blood sugar levels.

According to the Mayo Clinic, the gold standard for testing for diabetes is an A1C test, a fasting blood test to measure the amount of blood sugar attached to hemoglobin. An A1C higher than 6.5% indicates diabetes; providers usually require two tests for a definitive diagnosis. An A1C level between 5.7% and 6.4% is considered prediabetes.

Another option to screen for diabetes is a random blood sugar test that does not require the patient to be fasting. In this case, a blood sugar level of 200 mg/dL indicates diabetes; however, the test may need further confirmation. If the blood sugar test is done while the patient is fasting, 100–125 mg/dL is deemed prediabetic, and anything over 125 mg/dL is diabetes.

Finally, a glucose tolerance test may be used to test for diabetes. This tool is mainly used for gestational diabetes. Patients are expected to fast overnight and then drink a glucose beverage in the provider’s office. The provider then monitors the patient’s blood sugar over two hours.

Complications

Although most cases of diabetes can be managed with medication and lifestyle changes, if left uncontrolled, diabetes can lead to multiple conditions, including cardiovascular disease, nerve damage, kidney damage, optical changes, amputation, skin conditions, and more.

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), diabetic patients have a significantly higher risk of heart disease because high glucose levels damage blood vessels and nerves in the heart. Other cardiovascular complications of diabetes include high blood pressure, heart attacks, high cholesterol, and stroke.

In addition to the damage to the heart’s blood vessels, diabetes may also damage blood vessels and nerves in the eye. As a result, patients may develop ocular dysfunction such as diabetic retinopathy, macular edema, cataracts, or glaucoma.

Improper diabetes management may also lead to hypoglycemia, or low blood sugar, if a patient takes too much insulin. To mitigate the risk of hypoglycemia and hypoglycemic emergencies, which may result in loss of consciousness or seizure, providers often recommend continuous glucose monitoring as a part of diabetes care.

Ongoing Research

As researchers continue to analyze diabetes, its subtypes, and treatment options, clinicians will alter their treatment plans to improve patient care and healthcare outcomes. While continuous glucose monitors, insulin autoinjectors, and artificial pancreas have already improved patient care, ongoing research hopes to provide additional insight and delay or cure the condition.

Recently researchers at Advent Health have been studying Provention Bio’s TZIELD to delay the onset of type 1 diabetes, allowing patients more time to adjust and prepare for managing the condition. When patients develop T1D, they can opt for a closed-loop system, known as a bionic pancreas, to manage the disease effectively.

For type 2 diabetes patients, a study in the Proceedings of the National Academy of Sciences has discovered certain pancreatic microRNAs that may be linked to T2D. Although the research must be confirmed, understanding the genetic predisposition to T2D can help develop new treatment methods or advise patients on appropriate lifestyle measures.

Regardless of the treatment used, like all other healthcare sectors, diabetes management is moving toward more personalized diagnostic procedures and treatment plans.