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Public Health Issue and Existing Program: Selection and Rationale Program: CDC-Recognized Diabetes Prevention Lifestyle Change Programs

The incidence of Diabetes in the US has been steadily increasing year by year. In 2014, the estimated population living with diabetes was 9.3%. (CDC 2014). It is estimated that in the US, a total of 30.3 million are diabetic, however, 7.2 million people are undiagnosed diabetics. That is, they are diabetic but are not officially diagnosed with this disease. As a consequence, they are not receiving any therapy. Under diagnosing is a major problem that has significant health and economical consequences. Diabetes as other chronic degenerative diseases when left untreated have severe consequences affecting nearly all organs. With these numbers, we can see that, approximately one out of every 4 patients with diabetes are undiagnosed.

Even though diabetes affects the entire population, there are indeed important differences when race, education level and socioeconomic level are taken into consideration.

Diabetes is more prevalent among American Indians, African American and Hispanics. (CDC 2017). Prevalence varies markedly by education level. This is an indicator of socioeconomic status. Specifically, in people with less than high school education, the prevalence is 12.6%, whereas the incidence is 9.5% and 7.2% of those with high school education and more than a high school education respectively. (CDC 2017, Geiss 2014).

Importantly, diabetes is a chronic disease that takes years to develop into a full-blown disease and most patients become prediabetic prior to developing the diabetes, however, this prediabetic state is a metabolic derangement that has multiple health consequences. The presence of 3 of the following 5 conditions: hyperglycemia, hypertriglyceridemia, high blood pressure, overweight, and low HDL encompass a condition called metabolic syndrome or prediabetes. This condition is known to be the most common cause of heart disease and precedes diabetes in most cases. It is estimated that 34% of the population are prediabetic. (CDC 2017). Furthermore, if we take into consideration that 97% of the people with metabolic syndrome are not aware of having the condition, it becomes clear that, we are failing to address a major epidemic properly and multiple years go by before adequate therapy is started.

In my own experience, on a daily basis I diagnosed diabetes in patients that regularly follow with a primary care physician and either they were not diagnosed with the condition or they were not aware of the diagnosis. The CDC-Recognized Diabetes Prevention Lifestyle Change Program has been developed to prevent diabetes. It is a year-long program that focuses on long-term lasting lifestyle changes. Given the impact diabetes and its associated health problems have as well as the familiarity I have with this condition, I felt it was the most appropriate program to be evaluated.

References

Beckles, G. L., Chiu-Fang, C., & Chou, C. (2016). Disparities in the Prevalence of Diagnosed Diabetes - United States, 1999-2002 and 2011-2014. MMWR: Morbidity & Mortality Weekly Report, 65(45), 1265-1269. doi:10.15585/mmwr.mm6545a4

Bo S, Ciccone G, Pearce N, Merletti F, Gentile L, Cassader M, Pagano G. (2007). Prevalence of undiagnosed metabolic syndrome in a population of adult asymptomatic subjects. Diabetes Res Clin Pract. 2007 Mar;75(3):362-5. Epub 2006 Aug 22. https://www.ncbi.nlm.nih.gov/pubmed/16930757. Extracted on February 18, 2018.

CDC. National Diabetes Surveillance System. National diabetes statistics report, 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/ national-diabetes-report-web.pdf

CDC, (2017). National Diabetes Statistics Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Extracted February 18, 2018.

Ford E, Giles W, Dietz W. (2002). Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287: 356–359.

Geiss L, Wang J, Cheng Y, et al. (2014). Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980–2012. JAMA 2014;312:1218–26. http://dx.doi.org/10.1001/ jama.2014.11494