Diabeetus

Diabetes: Overview, Treatment, and Economic Impact

Diabetes has slowly become one of the most common diseases in America.  According to the Centers for Disease Control and Prevention, 29.1 million individuals (or 1 out of every 11 people) have diabetes (CDC, 2014).  As a result, diabetes was responsible for a 245 billion dollar economic cost in 2012 (American Diabetes Association, 2013).  Both of these numbers are staggering.  In addition to its prevalence, diabetes has also been linked to many other diseases including cancer (Gallagher and LeRoith, 2015).  The role it plays in development of other disease helps add to its virulence.  New medications are being developed to help treat and prevent the onset of diabetes.  Along with medication, increased awareness about the role obesity plays in diabetes may help decrease the number of individuals affected by this disease. 

  Diabetes can be diagnosed as type 1 or type 2.  Type 1 diabetes is characterized by an insufficient production of inulin usually due to the loss of pancreatic beta cells.  These beta cells are usually destroyed early on in life by immune cells mistaking them as foreign cells.  Type 2 diabetes is a little more complicated and is generally diet related.  Individuals with this type are typically obese and develop this disease later in life than compared to individuals with type 1.  This type can progress gradually over time as individuals consume more than recommended amounts of fats and sugars.  Eventually the amount of sugar in the blood will exceed the amount of available insulin, leading to hyperglycemia.  Prolonged hyperglycemia can cause pancreatic beta cells to gradually decrease in function, leading to even less insulin production.  In addition to sugar consumption and beta cell function, there are many other important hormones and signaling molecules that are involved in this process.  One of those hormones I learned about in histology class is adiponectin.  Adiponectin is produced by adipocytes (fat tissue) and is important for controlling glucose and lipid levels in the blood.  The interesting thing about adiponectin is that less adiponectin is released as the number of adipocytes increases.  This sounds counterproductive, but helps explain why type 2 diabetes is common in obese individuals.  Many other hormones are involved as well, but that is further into the scope of things than I will go.

  The widespread nature of diabetes has caused the pharmaceutical industry to bloom.  The diabetes market alone was valued at 16.4 billion dollars in 2012, and the insulin medication Lantus is one of the highest grossing pharmaceutical products (Statista, 2016).  The increased value in this field has led to increased research and production of medications.  One possible breakthrough medication is a GSK3 inhibitor.  This medication would work by inhibiting an enzyme known as glycogen synthase kinase 3 (GSK3).  This enzyme is involved in normal signaling pathways in the body, but has been found to inhibit regeneration of pancreatic beta cells once they have been destroyed (Mussman et al., 2007).  By inhibiting this enzyme, Mussman and his team were able to regenerate beta cells in rats.  They also found that it may play a role in treating Alzheimer’s.  Curing either of those diseases would be a monumental achievement.  Obviously the treatment hasn’t been approved for human trials yet, but provides promise in curing the disease.  This study also helps shed light on the complex issue that is disease treatment.  There are so many different hormones and other molecules that interact in a delicate balance it can be very difficult to treat the disease.  With continuing research of all these interactive enzymes we may stumble upon a cure for this disease or maybe even an unrelated disease as well.

  The link diabetes has with other diseases is very interesting.  Diabetes has been linked to diseases like hypertension, dyslipidemia, Alzheimer’s, renal complications, stroke, neuropathy, and even cancer.  All of these disease can be very serious and in some cases fatal.  The one I found the most interesting was the link with cancer.  In a recent study by Gallagher and LeRoith (2015) they found a direct correlation between individuals with diabetes and an increased risk of cancer.  Not only did patients have a 40-80% increased likelihood of developing some form of cancer, but the severity of the cancer may be increased due to the hyperglycemia that comes with diabetes (Gallagher and LeRoith, 2015).  This study focused mainly on obese individuals with type 2 individuals.  Many other studies have correlated the link between diabetes and obesity with other diseases.  Neuropathy is one of these diseases and can be a serious problem in diabetics.  Researchers have found increased nerve damage (especially in the eye) when they caused mice to be diabetic and obese (Yorek, 2015).  This can cause patients to have numb sensation in their extremities and may even lead to blindness in the eyes.

The link diabetes has with obesity and other diseases has hit close to home with me.  My dad is pre diabetic and obese and is on the path to diabetes if he doesn’t make any lifestyle and diet changes.  He has a typical American diet full of fried foods and soda pop.  A few years ago he was diagnosed with prostate cancer and had to have his prostate remove.  Luckily they caught it early enough that it hadn’t spread and become more serious.  Knowing that his obesity and hyperglycemia played a role in it makes a lot of sense now.  He also complains of neuropathy in his feet all the time, which I now know is also attributed to his obesity and hyperglycemia.  Now that I have learned all these things I might be able to convince him to take better care of himself.

The disease itself isn’t the only interesting thing about diabetes.  As previously mentioned, diabetes is responsible for an economic cost of 245 billion dollars (American Diabetes Association, 2013).  That’s just a little over 1% of the United States’ GDP.  I can’t believe one disease can cost that much.  Additionally the American Diabetes Association (2013) found that of the $245 billion, $69 billion dollars is attributed to the inability of some diabetics to go to work, loss of production at work, inability to get a job, and early mortality.  25 million days of work were missed by diabetics resulting in an economic cost of $5 billion.  Another 113 million days of work were spent with reduced performance, resulting in an economic cost of $20.8 billion.  That is a lot of money attributed to a diabetes without even including treatment of the disease itself.  The cost of direct medical expenditure is even more ridiculous.  Health care expenditures account for $1.3 trillion dollars annually.  Of this money, 23% can be attributed to the roughly 22 million people that have diabetes.  That means 7% of the population is responsible for 23% of the total medical expenditures cost in this country.  That blows my bind especially since all the hype in the medical field is about cancer.  With these kinds of costs I think diabetes should be getting talked about a lot more.

All of the economic costs involved with diabetes may seem like a bad thing, but it depends on which end of the spectrum you are.  If you have diabetes than all these numbers will probably make you shudder.  If you are a health care provider or involved in the medical field these numbers may excite you.  Thousands of individuals may not be able to work or may be limited, but thousands of jobs are also created to help treat the disease.  These jobs can include anything from the medical field to health insurance and diabetes supply sales.  This is definitely a trade-off though.  A lot of people have to suffer with the disease for individuals in this market to have jobs.  Additionally, the individual costs for diabetes can be very high and the individual may not be able to afford health insurance.  If these individuals are on Medicare or Medicaid it can cost tax payers millions or even billions each year.  So depending on how you looking at it, diabetes might be helpful or harmful to the economy in the U.S.

The socioeconomic status of an individual may also play a role in the onset of diabetes.  A study done by Darrell J. Gaskin and his team (2014) found that there was a higher rate of diabetes in poor neighborhoods than compared to non poor neighborhoods.  They also found that the prevalence among black individuals was higher than among white individuals.  This shows that environmental factors can also contribute to diabetes.  Several factors play into these results.  First of all, carbohydrates like sugar, noodles, and rice are a lot cheaper than healthier foods like fruits, vegetables, and proteins.  People with less money can consume a lot more calories on a smaller budget buying these cheap carbs.  Excessive consumption of these carbs can eventually lead to hyperglycemia and fat production all of which can eventually result in diabetes.  Access to healthy food is also a big problem, especially in black neighborhoods (Gaskin et al., 2014).  A lot of individuals in poor neighborhoods are further away from grocery stores or supermarkets than individuals of a higher economic status.  These neighborhoods are referred to as “food deserts” and have been found to be twice as likely to occur in black neighborhoods (Gaskin et al., 2014).  This helps contribute to the higher rate of diabetes in black individuals.  Government reform is in order to help lower the cost of healthy food and make it more accessible to people of a lower economic status.  

Due to the prevalent nature of diabetes, awareness is becoming increasingly important.  Awareness could help lead individuals to live a healthier life and prevent the development of type 2 diabetes.  Additionally, individuals need to be well informed about the disease in the case that their blood glucose levels become imbalanced and they have an episode.  The improper balance of blood glucose can lead to ketoacidosis and can be life threatening.  If the individual knows the warning signs of ketoacidosis like sweet smelling breath, nausea, and confusion, they can do something to treat in before it becomes a major problem.  There was a story in the news not that long ago about a little girl from Southern Utah that began to feel sick.  She wasn’t eating and threw up several times throughout the week.  After about a week they took her to the ER and the doctors diagnosed her with Type I Diabetes.  They life flighted her to Primary Children’s Hospital in Salt Lake, and as they did so her blood sugar dropped rapidly causing her to have multiple seizures.  The lack of glucose, in combination with her seizures, resulted in her having severe brain damage.  She passed away about 6 months later.  The family is now starting an awareness campaign in her name.  It’s sad that something has to happen like this, but it has definitely helped open people’s eyes and made them more aware of the symptoms of diabetes.   

Overall, diabetes affects more than just the individuals diagnosed with the disease.  We are getting closer to breakthrough treatments every day.  These treatments are part of a multi billion dollar industry that is just part of an even bigger economic market valued at over 245 billion dollars (American Diabetes Association, 2013).  This amount will continue to rise until we do something about the growing obesity problem in America.  We can help accomplish this by increasing awareness about obesity and its link to type 2 diabetes.  Increasing awareness about the lack of healthy food in poverty stricken areas may also help reform government policy to help these individuals.  We can all work together in this country to help reduce the impact this disease has on the nation.        

References

American Diabetes Association. 2013. Economic costs of diabetes in the US in 2012. Diabetes Care 36(4): 1033-1046.

Centers for Disease Control and Prevention. 2014. Diabetes Latest. Web.

Gallagher, Emily J., LeRoith, Derek. 2015. Obesity and Diabetes: The Increased Risk of Cancer and Cancer-Related Mortality. Physiological Reviews Vol 95:727-748. 

Gaskin, Darrell J., et al. 2014. Disparities in Diabetics: The Nexus of Race, Poverty, and Place. American Journal of Public Health Vol. 104(11): 2147-2155.

Mussmann, Rainer et al. 2007. Inhibtion of GSK3 Promotes Replication and Survival of Pancreatic Beta Cells. Journal of Biological Chemistry Vol 282(16): 12030-12037.

Statista. 2016. Projection of global type 2 diabetes pharmaceutical market revenues by region in 2012 and 2022 (in billion U.S. dollars). Web.

Wohlne, Roger. 2016. 11 costliest dieseases in the U.S. MSN Money. Web. 

Yorek, Matthew S., et al. 2015. Effect of diet-induced obesity or type 1 or type 2 diabetes on corneal nerves and peripheral neuropathy in C57Bl/6J mic. Journal of the Peripheral Nervous System Vol 20(1): 24-31.