Diabetes Mellitus


Overview


Diabetes Mellitus (or Diabetes) is a chronic disease that affects glucose metabolism. Glucose metabolism is the way that the body utilizes and stores glucose, a major source of energy. Disruption of glucose metabolism can have severe consequences, since the body needs to utilize glucose in order to function properly. Diabetes has been recognized by humans for centuries, and the word comes from the Greek diabetes, to siphon, and the Latin Mellitus, honey, referring to the sweetness they observed in the urine of sufferers.[1] Worldwide, over 220 million people suffer from diabetes and 80% of deaths from diabetes occur in low and middle-income countries.[2]

There are three types of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes. In type 1 diabetes, the pancreas does not produce enough insulin to manage glucose in the blood. Type 1 diabetes was previously referred to as juvenile diabetes because is largely diagnosed during childhood, although diagnoses in adulthood do occur. [3] In type 2 diabetes, the body does not respond to the insulin being produced by the pancreas and does not allow glucose in the blood to be utilized by the insulin (insulin resistance). Type 2 diabetes was previously referred to as adult diabetes because it was historically diagnosed in adults, but today it is also commonly diagnosed in younger individuals.[4] Gestational diabetes is diagnosed during pregnancy and is only diagnosed in individuals who have not been previously diagnosed with diabetes of any kind.[5] [6]

Health Impact



Type 2 Diabetes

Risk Factors
Type 2 diabetes, or adult onset diabetes, is the most common type of diabetes worldwide, comprising 90% of total diagnosed cases.[7] Type 2 diabetes is most commonly associated with excessive weight gain and chronic lack of exercise but it can also be caused by genetic factors [8] [9] Other risk factors for type 2 diabetes include: age (older than 45), low levels of good cholesterol (high-density lipoprotein (HDL)) (<35mg/dL), high triglyceride levels (>250mg/dL), high blood pressure, history of gestational diabetes, polycystic ovarian syndrome (PCOS), previously diagnosed impaired glucose tolerance, and in some countries ethnicity.[10] Ethnicity as a risk factor for type 2 diabetes has more to do with lifestyle factors than 'ethnicity', although predisposition for type 2 diabetes can be intergenerational in certain populations due to epigenetic mechanisms[11]

Overweight and obesity
A major risk factor for type 2 diabetes is overweight/obesity. Although overweight/obesity has historically been considered a disease of the wealthy, poorer segments of the population are being increasingly affected due to globalization and the nutrition transition, contributing to the rise in type 2 diabetes worldwide[12] Due to lifestyle factors, indigenous populations worldwide have some of the highest rates of type 2 diabetes, such as the Pima Indians in the Southwestern United States, Native Pacific Islanders and Aboriginal Australians.[13]

Treatment
Type 2 diabetes can be successfully treated with diet and lifestyle changes, but unequal access to education, lack of economic resources and lack of access to resources (e.g. healthy foods) make these initiatives difficult in the poorest populations. In resource poor settings, it can be hard to get diabetes diagnosed and treated appropriately;therefore most people who die from diabetes are living in low or middle-income countries.[14] Diabetes Prevention Programs (DPP) in the United States have been successful, reducing the risk of developing type 2 diabetes by 58%, through changes in diet and exercise.[15]

Complications
Type 2 diabetes can lead to many health complications, including:
Atherosclerosis, coronary artery disease, nephropathy, neuropathy, retinopathy, erection problems, hyperlipidemia, hypertension, infections of the skin, urinary tract infections, peripheral vascular disease and stroke.


Gestational Diabetes

Diagnosis and Treatment
Gestational Diabetes Mellitus (GDM) is usually diagnosed after 28 weeks of pregnancy and affects approximately 4% of pregnant women in the United States.[16] Insulin resistance occurs during all pregnancies, but in 2-4% of women it can result in GDM.[17] Women can only be diagnosed with GDM if they have not previously been diagnosed with any kind of diabetes and do not remain diabetic after they give birth. Treatment for GDM depends on the severity of the condition. Lifestyle changes (i.e. diet and exercise) are common, but the use of insulin or drugs such as metformin may also be part of a treatment plan[18]

Complications
GDM can have negative health consequences for both the mother and fetus. After being diagnosed with GDM women have between a 17 percent and 36 percent risk of developing type 2 diabetes within 5 to 16 years.[19] Risks to the fetus include: macrosomia (4000-4500g) and increased risk for overweight or obesity, which leads to greater chances of developing type 2 diabetes or other metabolic problems in adulthood.[20]

Medical Anthropology/Applied Research


Medical anthropologists have been actively engaged in many aspects of diabetes research,and have used a variety of frameworks, such as cultural, biological and applied. From a cultural framework, anthropologists have studied explanatory models of diabetes beliefs in specific populations, most extensively in Latinos/Hispanics.[21] [22]

From a biological perspective, medical anthropologists have contributed to knowledge about why type 2 diabetes is more prevalent in some populations, such as Native Americans, who have some of the highest rates of diabetes in the world. For example, Daniel Benyshek at the University of Nevada, Las Vegas (UNLV) has completed ethnographic and biological research looking into the reasons that Native Americans have such astonishing rates of type 2 diabetes.[23] [24] Benyshek found that historical conditions that drastically altered the diets and lifestyles of Native Americans (and similar events that affected Native peoples worldwide) contributed to the present state of disease in these populations.[25] Using the developmental origins of health and disease paradigm, Benyshek used rat models to show that although a predisposition for type 2 diabetes (through insulin resistance) is heritable across generations, the effects reversed after 3 generations of a normalized diet[26] Benyshek is a strong proponent for intervention and prevention strategies for Native Americans and argues that part of the reason that this disease is so prevalent in these populations is the fatalistic attitudes that have developed from the many years of professionals telling Native Americans that this disease is simply genetic. He is currently part of a research team at UNLV that is running a DPP program for local Native Americans.

Carolyn Smith-Morris also works with Native American populations in the United States, but she focuses on GDM.[27] [28] [29] Smith-Morris has worked hard to reveal the difficulties in working with the Pima due to years of mistrust and fatalistic attitudes. Smith-Morris works with the Pima to help promote intervention and prevention strategies aimed at helping women with GDM in these communities.

Anthropologists have also researched diabetes management, which includes examining how individuals manage the disease on their own and within the realm of the clinical encounter between patient and health care provider.[30] [31] This area of research contributes public health initiatives aimed at improving disease management and treatment.

Online Resources


Diabetes: Zahida suffers impact of late treatment http://www.who.int/features/2005/chronic_diseases/en/index.html

Social Media: American Diabetes Association Facebook page https://www.facebook.com/AmericanDiabetesAssociation?fref=ts

World Health Organization Diabetes fact sheet http://www.who.int/mediacentre/factsheets/fs312/en/index.html

American Diabetes Association
http://www.diabetes.org/

The Mayo Clinic: Diabetes
http://www.mayoclinic.com/health/diabetes/DS01121

Winner of the 2008 World Diabetes Day Young Voices video contest in NYC. http://www.youtube.com/watch?v=DdF54FZu17I

National Public Radio: How Western Diets Are Making The World Sick
http://www.npr.org/2011/03/24/132745785/how-western-diets-are-making-the-world-sic

2008 Pacific Health Summit: the Nutrition Transition



Diabetes among the Pima



Further Reading


Bindon, James R., Douglas E. Crews, and William W. Dressler. 1990 Life Style, Modernization, and Adaptation among Samoans. Collegium Antropologicum 15:101-110.

Chowdhury, A. Mu'min, Cecil Helman, and Trisha Greenhalgh. 
2000 Food Beliefs and Practices among British Bangladeshis with Diabetes: Implications for Health Education. Anthropology and Medicine 7(2):209-226.

Cortes, L. M., Joel Gittelsohn, J. Alfred, and N. A. Palafox
. 2001 Formative Research to Inform Intervention Development for Diabetes Prevention in the Republic of the Marshall Islands. Health Education & Behavior 28(6):696-715.

Eaton, Cynthia. 1977 Diabetes, Culture Change and Acculturation: A Biocultural Analysis. Medical Anthropology 1(2):41-63.

Lieberman, Leslie Sue. 2004 Diabetes Mellitus and Medical Anthropology. ENCYCLOPEDIA OF MEDICAL
ANTHROPOLOGY I(5):335-353.

Szathmary, Emoke J., Cheryl Ritenbaugh, and Carol S. Goodby. 1987 Dietary Change and Plasma Glucose Levels in an Amerindian Population Undergoing Cultural Transition. Social Science and Medicine 24(10):791-804.

Young, T. Kue, J. Reading, B. Elias, and John D. O'Neil. 2000 Type 2 Diabetes Mellitus in Canada's First Nations: Status of an Epidemic in Progress. Canadian Medical Association Journal 163(5):561-566.

References


  1. ^ Insel, Paul, R. Elaine Turner and Don Ross. 2006 Discovering Nutrition: Second Edition. Boston: Jones and Barlett.
  2. ^ World Health Organization. 2011 Diabetes Fact Sheet http://www.who.int/mediacentre/factsheets/fs312/en/index.html Accessed April 10, 2011.
  3. ^ Insel, Paul, R. Elaine Turner and Don Ross. 2006 Discovering Nutrition: Second Edition. Boston: Jones and Barlett.
  4. ^ Insel, Paul, R. Elaine Turner and Don Ross. 2006 Discovering Nutrition: Second Edition. Boston: Jones and Barlett.
  5. ^ Insel, Paul, R. Elaine Turner and Don Ross 2006 Discovering Nutrition: Second Edition. Boston: Jones and Barlett.
  6. ^ Kaufman, FR. 2002 Type 2 diabetes mellitus in children and youth: a new epidemic. Journal of Pediatric Endocrine Metabolism. Suppl 2:737-44.
  7. ^ World Health Organization 2011 Diabetes Fact Sheet http://www.who.int/mediacentre/factsheets/fs312/en/index.html Accessed April 10, 2011.
  8. ^ Kaufman, FR. 2002 Type 2 diabetes mellitus in children and youth: a new epidemic.J Pediatr Endocrinol Metab. Suppl 2:737-44.
  9. ^ Insel, Paul, R. Elaine Turner and Don Ross 2006 Discovering Nutrition: Second Edition. Boston: Jones and Barlett.
  10. ^ American Diabetes Association 2011 Type 2 Accessed April 18, 2011.
  11. ^ Kuzawa CW, Sweet E. 2009 Epigenetics and the embodiment of race: developmental origins of US racial disparities in cardiovascular health. American Journal of Human Biology. 21(1): 2-15.
  12. ^ Popkin, BM and P Gordon-Larsen. 2004 The nutrition transition: worldwide obesity dynamics and their determinants. The International Journal of Obesity
  13. ^ American Diabetes Association. 2011 Type 2 Accessed April 18, 2011.
  14. ^ World Health Organization 2011 Diabetes Fact Sheet http://www.who.int/mediacentre/factsheets/fs312/en/index.htmlAccessed April 10, 2011.
  15. ^ Ratner, Robert E. 2006 An update on the Diabetes Prevention Program. Endocr Pract.12(Suppl 1): 20–24.
  16. ^ American Diabetes Association 2011 What is Gestational Diabetes? Accessed April 18, 2011
  17. ^ Edmond, Ryan A. 2003 Hormones and Insulin Resistance during Pregnancy. The Lancet 362(9398):1777 – 1778.
  18. ^ American Diabetes Association 2011 How to Treat Gestational Diabetes Accessed April 18, 2011
  19. ^ Smith-Morris, Carolyn S. 2005 Diagnostic Controversy: Gestational Diabetes and the Meaning of Risk for PimaIndian Women. Medical Anthropology. 24: 145-177.
  20. ^ American Diabetes Association 2011 What is Gestational Diabetes? Accessed April 18, 2011
  21. ^ Weller, S C, R D Baer, L M Pachter, R T Trotter, M Glazer, J E Garcia de Alba Garcia and R E Klein. 1999 Latino beliefs about diabetes. Diabetes Care 22 (5):722-728.
  22. ^ Poss, J. and Jezewski, M. A. 2002 The Role and Meaning of Susto in Mexican Americans' Explanatory Model of Type 2 Diabetes. Medical Anthropology Quarterly, 16: 360–377.
  23. ^ Benyshek DC, John F. Martin and Carol S. Johnston. 2001 A reconsideration of the origins of the type 2 diabetes epidemic among Native Americans and implications for intervention policy. Medical Anthropology 20(1):25-64.
  24. ^ Benyshek, Daniel C.
    2003 The Nutritional History of the Havasupai Indians of Northern Arizona:Dietary Change and Inadequacy in the Reservation Era and Possible Implications for Current Health. Nutritional Anthropology 26(1-2):1-10.
  25. ^ Benyshek, Daniel C.
    2003 The Nutritional History of the Havasupai Indians of Northern Arizona:Dietary Change and Inadequacy in the Reservation Era and Possible Implications for Current Health. Nutritional Anthropology 26(1-2):1-10.
  26. ^ Benyshek, DC, Carol S. Johnston and John F. Martin
    2006 Glucose Metabolism is Altered in the Adequately-nourished Grand-Offspring (F3 Generation) of Rats Malnourished During Gestation and Perinatal life. Diabetologia 49(5):1117-1119.
  27. ^ Smith-Morris, Carolyn S. 2005 Diagnostic Controversy: Gestational Diabetes and the Meaning of Risk for Pima Indian Women. Medical Anthropology. 24: 145-177.
  28. ^ Smith-Morris, Carolyn S. 2006 Community Participation in Tribal Diabetes Programs. American Indian culture and research journal 30(2):85-110.
  29. ^ Smith-Morris, Carolyn S. 2004 Reducing diabetes in Indian country: Lessons from the three domains influencing Pima diabetes. Human organization 63(1): 34-46.
  30. ^ Mendenhall, Emily, Rebecca A. Seligman, Alicia Fernandez and Elizabeth A. Jacobs
    2010 Speaking through Diabetes: Rethinking the Significance of Lay Discourses on Diabetes. Medical Anthropology Quarterly 24(2):220-239.
  31. ^ Ferzacca, Steve
    2000 "Actually, I Don't Feel that Bad": Managing Diabetes and the Clinical Encounter 14(1):28-50.