Diabetes+Mellitus

toc = 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. Worldwide, over 220 million people suffer from diabetes and 80% of deaths from diabetes occur in low and middle-income countries.

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. 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. Gestational diabetes is diagnosed during pregnancy and is only diagnosed in individuals who have not been previously diagnosed with diabetes of any kind.

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. 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 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. 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

__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 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.

__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. 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.

__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. Insulin resistance occurs during all pregnancies, but in 2-4% of women it can result in GDM. 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

__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. 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.

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.

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. 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. 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 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. 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. This area of research contributes public health initiatives aimed at improving disease management and treatment.

Online Resources
Diabetes: Zahida suffers impact of late treatment []

Social Media: American Diabetes Association Facebook page []

World Health Organization Diabetes fact sheet []

American Diabetes Association []

The Mayo Clinic: Diabetes []

Winner of the 2008 World Diabetes Day Young Voices video contest in NYC. []

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 media type="youtube" key="6QpqDNZoOwI" height="244" width="296"

Diabetes among the Pima media type="youtube" key="SfPdhhXcGRQ" height="209" width="253"