Diabetes Relating to Health, Economic Costs and Low Income

Diabetes effects many people in the United States. More people have type II diabetes, which deals with insulin resistance, than type I diabetes, a genetic condition in which the body doesn’t produce insulin. Since the rate of incidence of diabetes is increasing, one in every three adults could have diabetes by 2050 (Yang et al., 2013). This disease has very adverse consequences and more people should know about them. Diabetes causes many health problems that can contribute to an early death. With the amount of health problems people with diabetes have, the economic costs associated with it are huge. There are many contributors, including social factors such as income, which can lead to diabetes.

Obesity is one of the main factors that leads to diabetes. People become obese because of their poor diets and sedentary lifestyles. The Centers for Disease Control and Prevention found that about 38% of adults in the United States have obesity (2016). It seems that all of the health related problems people have with being obese, including type II diabetes, would be enough to cause a change in people’s unhealthy habits. But as the number of people who are obese keeps rising, it seems that it’s not enough. New research done by Gallagher and LeRoit in 2015 has shown that obesity and type II diabetes increases the risk of getting cancer. Although the health related problems including heart disease, stroke, high blood pressure, breathing problems, nerve damage, blindness, and amputations are enough for me to have healthy behaviors to avoid becoming obese and getting type II diabetes, hopefully adding cancer to the list will make other people really think more about their unhealthy behaviors.

            All the health risks associated with obesity and type II diabetes seem extreme to me, but an increased risk of cancer definitely puts a bigger scare on the disease. Being obese can lead to cancer because adipose tissue releases toxins or hormones that can cause cancer. Men and women who are obese have a 40-80% increased risk of dying from cancer (Gallagher and LeRoit, 2015). That risk is huge. I didn’t know that obesity can increase the risk of cancer, so I can assume there are many people who don’t know that. Like I said, all the other risks associated with obesity should be enough for people to prevent it or lose weight, but making sure people know the increased risks of cancer could be helpful. I really hope that knowing obesity has an increased risk of cancer will make people change their unhealthy behaviors, but I presume that if it wasn’t enough to know that obesity could lead to blindness and amputations, knowing they could get cancer won’t be enough to change their behaviors either.  

            An interesting factor associated with obesity is gut microbiomes. They change for people with obesity and type II diabetes and even contribute to those problems (Gallagher and LeRoit, 2015). In obese individuals, the proportions of two classes of bacteria, bacteroides and firmacutes, are altered (Bradlow, 2014). Firmacutes is the dominant bacteria in obesity and it releases metabolic endotoxins. These endotoxins then get into the bloodstream because the intestinal lining in obese individuals is weaker and allows the endotoxins to get through. This is problematic because it causes chronic inflammation. Bradlow (2014), in “Obesity in the Gut Microbe”, along with Gallagher and LeRoith (2015), in “Obesity and Diabetes”, discussed the effect of taking gut microbes from obese animals and putting them in lean animals. It was found that the lean animals had an increase in adiposity, showing how the gut microbiomes do contribute to obesity. Bradlow took his study a step further and did the reverse. He put microbes from lean animals into obese animals. This was found to cause weight loss. This idea is interesting to me because it seems like a possible treatment plan for obese individuals, or a preventative measure for those who are at risk for obesity. This treatment could even be used for people who just want to lose weight but aren’t necessarily obese or becoming obese. Since eating yogurt is supposed to help keep healthy bacteria in your gut when you are on antibiotics, I wonder if getting microbes would be as easy as ingesting it. If the treatment would be that easy, it could become very profitable since people are always looking for new ways to lose weight. This treatment could be beneficial to many people.  

            While the most obvious effects of diabetes are health related, there are also other major effects of the disease. Diabetes imposes a huge economical effect. The amount diabetes costs really puts into perspective how much of a burden this disease has. In Yang et al. study, they found that in 2007, about 17.5 million people in the U.S. had diabetes. In 2012, there were about 22.3 million people who had diabetes, which is a 27% increase in just 5 years. So, not only do a lot of people have diabetes, this number continues to increase. It’s no wonder the costs associated with diabetes are so high. Yang et al. also found that the total cost of diabetes in the United States in 2012 is estimated to be $245 billion. These costs can be broken down into two categories: the direct costs and indirect costs. $176 billion is in direct costs and $69 billion is in indirect costs. Direct costs include hospital inpatient care, prescription medication, antidiabetic agents and diabetes supplies, physician office visits and nursing/residential facilities. The highest costs come from hospital inpatient care, contributing to 43% of the total direct costs. Indirect costs include absenteeism, reduced productivity while at work, reduced productivity for those who don’t work, inability to work, and lost productive capacity because of early mortality (Yang et al., 2013). Yang et al. show that there are many different aspects that contribute to the high economic costs of diabetes, which makes the cost so great.

            It makes sense that as the incidence of diabetes increases, the costs associated with it would increase as well, but the cost has actually increased more than what would be expected. While the number of people who have diabetes has increased by 27% since 2007, the costs associated with diabetes has increased by 41%. This increase is accounted for by the increased number of people with diabetes, but also because of inflation and even increased costs above normal inflation rates (Yang et al., 2013). The cost of diabetes estimated by Yang et al. is lower than the actual number. The cost would actually be much higher if they were to include costs such as family members who take time off work to care for a child, parent or other family member with diabetes; the costs of accommodations for people who have retinopathy, renal complications, or lower-extremity amputations; the cost of prevention programs; and including people in noncivilian populations or institutionalized populations such as prisons (Yang et al., 2013). Including these factors would increase both the total direct costs and indirect cost of diabetes.

            Diabetes is a financial burden on many people, especially those who have lower incomes. Having a lower income actually increases a person’s risk of developing diabetes. A study done by researchers from York University found that men who are in the lowest income bracket (less than $15,000/year) have double the risk of getting type II diabetes than men in the highest income bracket (more than $80,000/year), regardless of education, body mass index and physical activity. For women, the results are even worse. Women who are in the lowest income bracket have more than triple the risk of getting type II diabetes than women in the higher income bracket (Diabetes in Control, 2010). This shows how much of an impact income has on developing diabetes.

            The reason people with lower incomes have an increased risk of developing diabetes is because they don’t have the money to pay for healthy foods. It can get pretty expensive to eat healthy. Another reason people with lower incomes have a harder time eating healthy is because they live in food deserts. Food deserts are areas where access to healthy foods is limited because grocery stores are too far away. So people in these food deserts are more likely to eat at fast-food restaurants. In addition, people with lower incomes may be single parents, and I can image that they may not have time to cook healthy meals, so they would resort to fast food as well. People with lower incomes who develop diabetes also suffer more from the complications associated with it (Diabetes in Control, 2010). These people have a harder time getting medical care and medications. They are also the ones who will suffer from amputations, blindness and cardiovascular disease. People with lower incomes don’t have the money to make accommodations for having amputations or blindness. As a result, diabetes just continues to have a never ending negative impact on their lives.

            Diabetes effect too many people, especially when considering that this is a preventable disease. The unhealthy lifestyles people choose lead them to obesity and then diabetes. Diabetes causes an overwhelming number of health problems, which now is shown can lead to cancer. More and more people are developing diabetes, which is increasing the economic cost of diabetes, which is already high. There are many factors contributing to the development of diabetes, including social factors such as income. New treatments are being researched, which include using CRISPR and other gene editing techniques. While developing treatments is important, it is also important to prevent the disease. Otherwise, the number of people with diabetes will continue to increase and the economic costs will continue to rise.

References

Bradlow, H. L. (2014). Obesity and the gut microbiome: pathophysiological aspects. Hormone Molecular Biology & Clinical Investigation 17: 53-61.

Gallagher, E. J., & LeRoith, D. (2015). Obesity and diabetes: the increased risk of cancer and cancer-related mortality. Physiological Reviews 95: 727-748.

Obesity and Overweight. (2016). Retrieved from http://www.cdc.gov/nchs/fastats/obesity-overweight.htm

Poverty a Leading Cause of Type 2 Diabetes, Studies Say. (2010). Retrieved from http://www.diabetesincontrol.com/poverty-a-leading-cause-of-type-2-diabetes-studies-say/

Yang, W., T.M. Dall, P. Halder, P. Gallo, S.L. Kowal, and P.F. Hogan. 2013. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 36: 1033-1046.