Professional Documents
Culture Documents
Shelley Chandler
Health 634-B02
Introduction
Chronic diseases are a major factor of health care in the United States and are associated
with health damaging behaviors and aging. The most common chronic diseases: cancer,
hypertension, stroke, heart disease, pulmonary conditions, mental illness and diabetes are
reported to cause the US a $1.3 trillion economic burden 1. Diabetes, affects millions of
Americans and can be considered a precursor to other chronic diseases. It occurs when the body
cannot product enough of the hormone insulin or respond appropriately to it2. A poorly
functioning insulin signaling causes blood glucose levels to become elevated leading to other
metabolic abnormalities. Having diabetes means a higher rate of developing heart disease,
vision loss, stroke, kidney failure, amputation, high blood pressure, or high cholesterol as high
blood glucose damages the blood vessels and nerves that control your heart and blood vessels 3,4.
In 2015, 30.3 million Americans (9.4 %) was reported to have diabetes and 84 million have pre-
diabetes which if untreated can lead to type 2 diabetes within five years3. Rates of diagnosed
diabetes increased with age and of the millions of diabetics reported, more than 13 million of
The purpose of this literature review is to discuss research of the disease burden of
diabetes and how it can be avoided or alleviated. The data from the research will support a
planned health communication intervention that will bring awareness to the dangers of diabetes
and knowing the importance of monitoring glucose levels through group education sessions over
a twenty-four-month period. The intervention is relevant and justifiable as reducing the disease
burden of diabetes and improving the quality of life for those affected or at risk is a goal of the
Healthy People 2020 initiative 2. Given the data prior mentioned, the communication
evidence, and summary. The current section, the introduction, explains the impact and burden of
diabetes and the need for a health communication intervention. The next section will discuss the
reference material by type along with a summary of the findings. The reference material used
was published within the past eight years and was selected based on content that included:
1. A description of diabetes
5. Barriers
Material excluded from that section were those that focused primarily on race. The concluding
Body of Evidence
Bernell states in this journal discusses that the steep rise of type 2 diabetes and
associated complications go along with mounting evidence of clinically important sex and
gender differences 5. The purpose of the study is to increase awareness of health professionals in
the gender difference of type 2 diabetes. It points out that the prominent risk factor for both sexes
is obesity but is diagnosed at a lower age and body mass index (BMI) for men. The journal also
pointed out that psychosocial stress appears to have a greater impact on women than men, this
leads into women also having a greater increase of cardiovascular risk, myocardial infarction,
and stroke when compared to nondiabetic subjects 5. The study gave a detailed look at several
factors of diabetes which included; biological risk factors, health behavior, pathophysiological
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neuropathy, and other comorbidities. The overall conclusion was that the sex of an individual
plays a key role in the manifestation and management of type two diabetes and personalized
treatment must consider all the differences. The following journal focuses on women only but
adds justification for the age of the target audience of the intervention.
Healthy People 2020 objective was to find a relationship between type 2 diabetes and the
age of menopause. The relationship between menopausal age and cardiovascular disease risk is
well established but a relationship for type 2 diabetes remains unclear 6. The research used data
from the InterAct study, a cohort with an 11-year follow-up of post-menopausal subjects with the
median age of 59. Some values for screening included: BMI, lifestyle factors and hysterectomy
status. The result concluded that after 10.7 years an earlier age of menopause was associated
with higher rates of diabetes. The hazard of type 2 diabetes was 32% higher in women who
entered menopause before 40 as compared to those who were between 50-54. The next two
journals will examine the prevalence of type 2 diabetes in the United States.
The Center for Disease Control and Prevention used prior collected data in this journal.
The purpose of this study was to compare the incidences of lower-extremity amputations, end-
stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis
between 1990-2010 7. By using the National Health Interview survey (NHIS) data on a 57,000-
adult sample they collected data that showed the rates of two of the mentioned complications had
significantly declined during the time frame, myocardial infarction and hyperglycemia related
mortality. Given the reductions for the two mentioned there was not a significant imminent
reduction in the overall burden of diabetes-related complications. There was an increase in the
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other comorbidities. The timeframe for this study is included in the timeframe covered in the
following study.
Geiss LS et al. used the NHIS data and examines long term trends in the prevalence and
incidence of diagnosed diabetes overall and not just certain comorbidities. This study is
inclusive of both type 1 and type 2 diabetes. Based on their reviewed data they did not see any
changes in the1980’s but did see a sharp increase between 1990 - 2008. This study relates the
near doubling to a doubling rate of incidence of diabetes among race subgroups 8. A deeper dive
into the health behaviors may give insight to the rising incidence of diabetes.
Hu FB, et al. looks at the relation between the combination of individual dietary and lifestyle
factors in relation to type 2 diabetes. With a sample of over 80,000 nurses who were free of
diabetes or comorbidity at the baseline. A low risk group was educated the on their diet, BMI,
smoking cessation, and a decrease in alcohol intake. During the 16 year follow up there were
3300 new cases in type 2 diabetes due to lack of exercise and poor diet among other negative
lifestyle behaviors. They concluded that most of cases of type 2 diabetes could be prevented by
the adoption of a healthier lifestyle 9 The following journal has a similar theme.
Gomez-Ambrosi’s study of over 4000 subjects showed that there is a direct correlation
between obesity and the presence of prediabetes or type 2 diabetes 10. Barriers to self-managing
Rosland et al. examines if family influences can help or hinder an individual. The study
participants of this study included patients with diabetes or heart failure and they looked at
characteristics associated with family support and barriers. Family members in their study were
highly involved in the self-care of higher functioning patients 11. Their cross-sectional survey of
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439 (male and female) patients resulted in 75% of respondents reporting supportive family
involvement while the remaining 25% reported that their family caused barriers to self-care 11.
Health literacy of the patients were associated with the results. Women reported less family
support and more family barriers to self-care than men. Low health literacy, partnered status
with higher family function were associated with higher family support levels, while female,
older age, higher education, and more depression symptoms showed in the patients with family
barriers to self-care 11. This study shows that women may have more barriers in access to self-
care than men. The following study builds on this and discusses inner struggles for women.
Hu FB, et al.’s objective of this Swedish study is to examine how women handle the needed
lifestyle changes due to diabetes. The changes included regular to moderate physical activity
and a healthy diet, weight lose if the participant was overweight. The study uses ten women, ages
ranged from 37 to 87 with a mean of 65, with diabetes who had complications ranging from none
to stroke. The study concluded that perceptions of change posed a continuous struggle with
feelings of becoming a victim of pressurizing demands and were unfairly treated by life. The
overall conclusion was that healthcare professionals should be aware of deterrents to lifestyle
All the prior journals give relevance to the health communication intervention of diabetes
education to women over 40. These studies show that the incidence and prevalence of diabetes
has risen over the years despite acute care interventions. The minor differences may have been
the comorbidities discussed and two of the studies took place outside of the US. I included in for
my review as they speak to the burden of diabetes being global and not just confined to the
United States.
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The study regarding lifestyle changes may be flawed due to the small sample size. The long-
term impact of this intervention and subsequent similar interventions will help to decrease the