Diabetes mellitus type 2 is a chronic non-infectious disease, whereas the rate of illness growth and prevalence has reached a global emergency scale. The threat is underestimated by most patients as they are oftentimes not informed about the disease. Moreover, those of the patients aware of their pathology are often ignorant of its complications, that T2D can take severe forms and lead to life-threatening conditions. The quantity of type 2 diabetes (T2D) cases is proliferating in developed countries.
The increased disease rate is strictly related to the obesity epidemic in Western countries. These days, T2D can be considered a lifestyle disease. The worldwide issue concerns high economic costs and social damage caused by increased diabetes and related complications, high disability and mortality. Therefore, it is required to evaluate the disease’s background and significance from the historical and societal perspective. It is also vital to assess incidence and prevalence and related healthcare costs.
Overview of Diabetes Type 2
Type 2 diabetes (T2D) is a violation of carbohydrate metabolism caused by predominant insulin resistance and relative insulin deficiency, which is a critical factor in pathogenesis. According to Chatterjee et al. (2017), it is detected beforehand; in most patients with type 2 diabetes, insulin deficiency increases gradually with age, against the background of depletion and apoptosis of β-cells. Reliable to etiology and pathogenesis, T2D is heterogeneous; it is a whole group of diseases with similar clinical picture and treatment tactics (Chatterjee et al., 2017). Over time, diabetes mellitus damages the heart, blood vessels, eyes, kidneys, and nerve system.
With regards to tendencies, the duration of the diabetic history increases. In the development of T2D, several factors have a significant function, including hereditary predisposition, age, obesity, a sedentary lifestyle, diabetogenic nutrition (Chatterjee et al., 2017). Consequently, the relative insulin deficiency is replaced by an absolute one (Chatterjee et al., 2017). This results in the emergence of a secondary insulin demand and patients’ appointment with insulin preparations (Chatterjee et al., 2017). With regard to symptoms, “the typical clinical picture is “thirst (polydipsia), frequent urination (polyuria)” (International Diabetes Federation [IDF], 2019, p. 13). These symptoms might not be distinguished so that the diagnosis may be hesitated or missed altogether (IDF, 2019). Referring to life span, people with T2D can lead long lives in case they practice constant check-ups, being under medication (IDF, 2019). Overall, society has faced an upward trend in the disease rate, recently being observed exclusively among adults, but it is increasingly affecting children.
Diabetes Mellitus Type 2 – Background and Significance
The widespread increase in the number of patients with T2D is a consequence of adverse lifestyle alterations and the resulting increase in the prevalence of obesity. The latter leads to the receptor complex’s deformation, accompanied by insulin resistance (Chatterjee et al., 2017). Therefore, the impact of a sedentary lifestyle on the development of T2D is approved as a physical activity that allows a person to utilize carbohydrates and fats from food, reduces the risk of obesity, and helps to normalize metabolism (Chatterjee et al., 2017). Moreover, systematic overeating and abuse of fast-food restaurants in the development of T2D remain the crucial factor, along with the food’s quality composition (IDF Diabetes Atlas, 2019). According to IDF Diabetes Atlas (2019), an increased accumulation of fatty acids in the pancreas islets leads to an acceleration of apoptosis in β-cells; other lipotoxicity mechanisms are also possible. Hence, the diabetogenic effect of fatty foods, hypodynamia and obesity, as a result, has been proven.
T2D can bring adverse outcomes leading to a fatal case. Diabetes is one of the principal grounds of blindness, kidney failure, heart attacks, strokes and lower limb amputations (Chatterjee et al., 2017). Moreover, there is a tremendous difference between people without T2D and those who have. Patients with the disease are subjected to “15% of increased risk of all-cause mortality, which is twice as high in young people, and in those who are younger than 55 years of age” (Chatterjee et al., 2017, p. 2239). Currently, 60% of the total medical care is provided to treat the disease and its morbidities (IDF, 2019). The principal task remains to improve the situation, so it is required to instill in citizens the concept that prevention is the most precise way to well-being.
Historical Perspective of Diabetes Types 2
For many decades, diabetes therapy has been focused on treating hyperglycemia. Despite the evidence, the achievement of normoglycemia does not reduce the number of cardiovascular issues (IDF, 2019). The combination of calorie intake exceeding the norm and diminished energy expenditure conducts to weight gain (IDF, 2019). Such imbalance started in the 20th century (IDF, 2019). It directed accelerated development in the proportion of T2D in the 1980s and 1990s (IDF, 2019). Since 1980, the number of individuals with diabetes has nearly quadrupled. Between 1980 and 2004, the global rise in obesity, inactive lifestyles, and an aging society have resulted in the T2D incidence and prevalence (Chatterjee et al., 2017). The first signals that the disease is spreading could be detected in the middle of the 20th century.
Nevertheless, in developing countries, the amount of high-calorie foods consumed by some people far exceeds their needs; thus, the epidemic is spreading. Concerning the US case, some historical issues could advance the development of such a disease in particular society portions (IDF, 2019). For instance, inequality to literacy was presented by Blacks’ anti literacy laws, persisted until the 1930s (Hill-Briggs et al., 2020). Consequently, a beneficial intervention to prevent sanctioned racial prejudice is adapting health elements for low-literacy suitability (Hill-Briggs et al., 2020). As some biases persist that African Americans are suffering more from T2D, the disease has affected the whole population regardless of race and ethnicity.
Societal Perspective of Diabetes Mellitus Type 2
Concerning the societal perspective, T2D has emerged from several social determinants of the disease. These are socioeconomic status, environment, neighborhood, food, health care, and social context (Hill-Briggs et al., 2020). For instance, physical and mental outcomes of T2D occur due to inequities in conditions and the circumstances in which people live (Hill-Briggs et al., 2020). Hill-Briggs et al. (2020) claim that lack of education and health care, accompanied mainly by poverty, significantly affects T2D diagnosis and issues. However, the topic of social determinants of the disease requires sufficient research. The US healthcare sector tries to implement social aspects into delivery, being an advantage policy.
Therefore, social factors need to be addressed to solve the problem of the increased disease rate. Citizens demand to start regulating foods’ fat and sugar content to possess healthier choices (Hill-Briggs et al., 2020). The food industry is advised to take a more responsible approach to their products by reducing fat and sugar and ending advertising fast food to adolescents (Hill-Briggs et al., 2020). Besides, concerning the US case, the society experiences a disproportion of health literacy between the middle-class and marginalized part of the community due to socio-political causes (Hill-Briggs et al., 2020). Food safety is considered indispensable; “partnerships bring bags of healthy groceries to low-income families living in food deserts are important to compensate for food deserts” (Hill-Briggs et al., 2020, p. 274). Another way should “target the absence of fresh food markets in the minority and lower-income neighborhoods” (Hill-Briggs et al., 2020, p. 274). As only through constant monitoring of the blood sugar level, a person with T2D might be ensured that complications arising from diabetes do not develop further.
Incidence and Prevalence
With regard to the incidence and prevalence, it increases progressively. According to Chatterjee et al. (2017), approximately five hundred million people worldwide are diagnosed with diabetes, while almost two hundred people are with undiagnosed diabetes. T2D is the most prevalent form of this disease, accounting for more than 90% of all reported cases of diabetes (Chatterjee et al., 2017). Approximately one in five patients with type 2 diabetes require insulin therapy and constantly receive insulin preparations to maintain an adequate metabolic state (Chatterjee et al., 2017). According to IDF (2019), “prevalence is lowest among adults aged 20–24 years; among adults aged 75–79 years, the disease prevalence is considered to be 19.9%” (p. 37). Moreover, according to Saeedi et al. (2019), the prevalence of T2D among women in 2019 is calculated to 9% and 9% among men. About 111 million age people are diagnosed with diabetes (Saeedi et al., 2019). Thus, compared to previous years, the number is increasing considerably annually.
The T2D prevalence differed in terms of the economic performance of countries. According to Saeedi et al. (2019), there is a more significant predominance of the disease among high-income and middle-income states than in low-income nations. Moreover, concerning the forecast, to the middle of the 21st century, T2D prevalence is suggested to amount to 11.9% in advanced countries and 4% in poor ones. More than half of people with diabetes live in urban areas; however, some researchers claim that these figures can be equal in terms of urbanization or ”westernization” of rural areas (Saeedi et al., 2019). Therefore, T2D has reached critical statistics and can be considered an influential health problem worldwide.
Diabetes and its complications necessitate considerable funds for patients with T2D, their families, the healthcare sector and the state economics due to direct medical costs and loss of jobs and wages. For instance, in the US case, the total cost of diagnosed T2D in 2017 is $327 billion (American Diabetes Association [ADA], 2018). The sum combines $237 billion of medical expenses and $90 billion in decreased work performance (ADA, 2018). According to ADA (2018), this number presents a 26% rise over five years. The largest spendings are inpatient care, medication prescribing to diminish disease complications, antidiabetic agents, diabetes supplies and practitioner office visits (ADA, 2018). While the primary source of costs is inpatient and outpatient care, rising amounts stimulate the increasing cost of insulin analogs. The latter are frequently prescribed despite insufficient evidence of significant benefits over cheaper human insulin options.
Furthermore, in addition to direct costs, healthcare also includes associated indirect sums. According to ADA (2018), in 2017, the total was estimated at $89.9 billion. The leading cause is determined as reduced employment, presenteeism, and premature mortality (ADA, 2018). Other aspects such as work days absent and reduced productivity are acknowledged as a moderately small share of the entire burden. Consequently, it directly affects gross domestic product (GDP). For instance, according to IDF (2019), in 2019, total health expenditure for diabetes treatment would reach $ 760 billion. Compared to 2017, this amount has been increased by 4.5% (IDF, 2019). For instance, North America and the Caribbean region are characterized by the highest total diabetes-related health expenditure, estimating around $324.5 billion (IDF, 2019). This figure reflects almost half of the entire disease medical expense in 2019 (IDF, 2019). According to IDF (2019), the estimated cost of treating and preventing T2D in the world by 2030 could amount to $90 billion. Thus, the tendency of the growing impact of T2D continues from the global perspective.
To sum up, type 2 diabetes mellitus is characterized by a relative deficiency of insulin. It develops in case a person has a particular genetic predisposition. Moreover, a sedentary lifestyle, fast food, frequent stress and a combination of risk factors such as age and overweight also affect the disease’s development. Diabetes mellitus can be treated, and complications arising in the background can be prevented or delayed with a preventive diet, physical activity, medications, and regular checking and treatment.
The issue of diabetes mellitus needs to be addressed as it remains a complex problem that includes social and economic aspects. Patients with T2D are more predisposed to die from heart disease and strokes, with the risk of blindness. Thus, non-communicable diseases, especially diabetes mellitus type 2, have severe socioeconomic consequences and are not exclusively a medical problem. This is a complex political and social issue that needs to be approached at the state level.
American Diabetes Association. (2018). Economic costs of diabetes in the US in 2017. Diabetes Care, 41(5), 917-928.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 Diabetes. The Lancet, 389(10085), 2239-2251.
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Haire-Joshu, D. (2020). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258-279.
International Diabetes Federation. (2019). Diabetes Atlas. Web.
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., & IDF Diabetes Atlas Committee. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice, 157(107843), 1-15. Web.