The Good, the Bad, and the Diabetes

Chris Christiansen

        Over the course of human history mankind has been plagued with disease after disease. Disease is our oldest and most cunning enemy. Some of these diseases have been contained, some have been eradicated through science, and some have persisted despite science. These stubborn diseases have affected almost every aspect of human life. Diabetes is no exception. This disease first dating back to Egypt in 1552 B.C. has not only become one of the most pervasive diseases in the developed world but one of the deadliest. The issue with diabetes is that it is a slow killer. It takes its time to work on multiple organs until life can no longer be sustained. It is like a mob boss that has his hitman do the dirty work. The person dies from renal failure, or heart disease, or cancer, all of which are exacerbated by diabetes. In order to better understand diabetes and its far reaching effects we must continue to look deeper than just the obvious signs that diabetes offers us. Through the collaboration of different fields and the exploration of economic, social, psychological, and biological factors we can hope obtain a better understanding and thereby more efficiently treat this costly epidemic.

Costly Women

        A hot topic as of late is the overall cost that diabetes imposes on the U.S. Economy. According to the American Diabetes Association, in 2013 diabetes cost nearly 245 billion dollars in healthcare costs and lost productivity. This is an increase of 41% when compared with the cost in 2012. A diabetic individual uses 2.5 times more healthcare resources than the average American (ADA, 2003).  This cost is a huge drain on our economy and seems like it is going to get worse before it gets better.

There have been many studies in which it has been shown that physicians often take women’s pain or complaints less seriously than men’s. This often leads to lack of treatment, misdiagnoses, and higher mortality rates for women. Women are also more likely to suffer more serious effects from diabetes. This is the case in many of the major diseases such as heart disease and breast cancer. As discussed, significantly less time and resources often go into preventative care for many of diseases for women. This is also the case for diabetic women. When we examine the statistics we see a large cost disparity per capita for women compared to their male counterparts. The per capita healthcare cost is around 316,000 dollars for the average American. Males come in around 268,700 dollars and women cost about 361,000. (Berhanu Alemayehu, 2004). Two fifths of this cost can be attributed to female’s higher average longevity when compared to males. Despite women living longer this still leaves $60,000 dollars unaccounted for. This may be somewhat surprising considering women often get undertreated for their medical conditions. There are several main factors that may contribute to these differences.

As stated above we know that diabetics cost 2.5 times the average which puts female diabetics somewhere in the ballpark of 900,000 dollars and males around 620,000 dollars. According to the WHO statistics, there is little difference in the prevalence of diabetes among men and women with 5.5% and 5.9% respectively. Women in general are less likely than men to experience heart disease, cancer, and renal failure. However, diabetic women are prone to more of these significant complications than diabetic males. Female diabetics are more likely than male diabetics to develop heart disease. Once they develop heart disease their mortality rate skyrockets. Males in general are at higher risk of having a heart attack but those heart attacks are not nearly as deadly as their female counterparts. (Marianne Legato, 2011) As stated above that statistic changes once the woman is a diabetic, her risk is higher than that of males. A poll was taken of various types of physicians including cardiologist and the vast majority of them were not aware of this statistic. This combined with the fact that women frequently experience atypical symptoms which lead to untreated and undiagnosed heart attacks. So when a woman is sitting across from her doctor it is more than likely that the physician is not putting all these risk factors together.

Thus we can see a tale of two diabetics diverge here. If this was a male the proper steps would most likely be taken to ensure that the cardiac disease was immediately taken care of and the proper medications and follow up were prescribed. The female diabetic goes undiagnosed and would be waiting like a ticking time bomb until she has a massive heart attack, requiring a large amount of resources to try and resuscitate her. This same scenario can be roughly applied to several other chronic diseases. This lack of education and awareness may be one area in which we can attribute the large cost difference between the genders. It may also be an area in which healthcare providers can become more aware and knowledgeable to better treat diabetic patients.

Diabetic Discrimination

Obesity and Diabetes often go hand in hand especially in present day America. According to the CDC in 2010 36% of Americans were considered obese.  Nearly 90% of type II diabetics fall into the obese category. Obesity not only causes an increased risk of diabetes, along with a myriad of other health issues, but poses several discriminatory issues that diabetics must contend with on a frequent basis.

One of the more common places we see discrimination is in the workplace. A study involved separate interviews of 85 hiring personnel. They were asked whether being 10-20 pounds’ overweight would potentially handicap an individual. 79 out of the 85 hiring personnel stated they felt that 10 to 20 pounds’ overweight would be a handicap to the employee and that it would affect their decision to hire them. (Rebecca Puhl, 2001) This is not the only negative opinion that was expressed by those in management positions. According to the study overweight employees are assumed to lack self-discipline, be lazy, less conscientious, less competent, sloppy, disagreeable, and emotionally unstable. Obese employees are also believed to think slower, have poorer attendance records, and be poor role models. Stereotypes such as these could potentially affect wages, promotion, and termination. These discriminatory factors are a large hurdle for diabetics to leap. Not only does being obese put them at higher risk of being a diabetic and experiencing the chronic life threatening illnesses that go along with diabetes, but they may also be turned down from jobs, receive lower pay, and be fired more frequently than their trimmer co-workers. It is becoming common knowledge that lost productivity due to diabetes cost the US around 90 Billion dollars in 2013. This knowledge may also factor into the discrimination and screening process as businesses are looking to hire. As previously stated it is expensive to be a diabetic, and due to this bias and discrimination may be even harder to pay for those expenses if you are an obese diabetic.  

Sex and Conception

Studies have shown that the number of diabetics is growing rapidly each year. This growth can be attributed largely to lifestyle choices as well as some genetic components. Many risk factors such as vessel disease, obesity, and depression make it more difficult for diabetics to have children. How much of the diabetic epidemic is from lifestyle or genetic inheritance via the offspring of diabetics?

Sex is potentially limited for both males and females for several reasons. Females may experience increased depression due to the effects of hyper and hypoglycemia, making them feel less inclined to engage in sexual activity. Males and females alike may feel more irritable and or tired due to fluctuating glucose levels. This can make intimacy difficult if one or both partners are diabetic. Chronically elevated glucose levels can lead to vascular disease which can lead to erectile dysfunction for men. This symptom affects men as they age. Nearly 65% of diabetic men experience erectile dysfunction between ages 45 and 60. Younger diabetics experience erectile dysfunction at 115% the rate of their healthy counterparts. Chronically elevated glucose in men also reduces the amount of semen by 35%. (Cummings, 2004) In addition, there are 25-38% more mutations in the male’s sperm due to DNA deletions in the mitochondria. This decreases the chance of fertilization, and increases the chance for a miscarriage.  For diabetic women with chronically high glucose levels, there are biological complications as well. The high glucose levels damage the embryo making implantation less likely. If the embryo does implant it has a 30-60% higher chance of resulting in a miscarriage when compared to healthy pregnant women. These are only a few of the physical barriers that diabetics face when attempting to get pregnant. These statistics were made under the assumption that only one of the spouses was a diabetic. The process is even more difficult when both spouses are diabetic.

A study done in the UK states that diabetic women who were successful at implantation still had four times the stillbirth rate and perinatal mortality when compared with average pregnant women. The congenital abnormality rate was double the average rate. (Murphy, 2011) Those children that go on to live “normal” lives are still at high risk for developing diabetes. Due to the lifestyle their parents lead, which is usually sedentary, the child will also adopt such a lifestyle leading to obesity and eventually diabetes. While changes in sedentary lifestyles have shown promise in reducing diabetes and sometimes curing type II diabetes, there may be some changes the mother can make during pregnancy and afterwards to benefit the child.  It has been shown in mice that if the mother consumes a high fat diet during pregnancy and breastfeeding that it may have a large impact on the development of diabetes in the child. The trial is currently undergoing human research to verify the findings.

The lack of education about diabetes and its effects on contraception and pregnancy largely contribute to the complications that arise when one of both of the partners is diabetic. Diet and lifestyle information and resources are largely beneficial in reducing the risk of diabetic pregnancy as well as the likelihood of passing on diabetes to their offspring. Overall while no specific conception rates could be found concerning diabetics, the risks of pregnancy are quite high for those whose diabetes is not well managed. Furthermore, it would appear that the lifestyle that is passed on to the offspring significantly contributes to the perpetuation of the epidemic.

By examining many of the different facets of diabetes we can begin to understand the far reaching effects that this disease has. It is much more than just a physical disease. It affects nearly every part of a person’s life and in return affects much of the rest of the world. This is a complex disease with no simple answers. It has deeply rooted itself in our past and present with no end in sight. However, through research, investigation, and education much of diabetes can be better understood and therefore more effectively managed.

Works Cited

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