Type 2 diabetes (T2D) is a disease where insulin production cannot meet the requirements for the glucose in the blood, resulting in high blood glucose levels. Consumption of more glucose than the body can uptake and metabolize, leads to, in many cases, to reduced sensitivity in specific cellular glucose receptors. ‘Studies published in the early years of the twenty-first century further demonstrated that patients suffering from a variety of infectious diseases including hepatitis C and HIV, a well as those with autoimmune diseases such as rheumatoid arthritis, displayed insulin resistance’ (Kuby et al. 2013). Excess glucose in the blood is damaging, especially long term. Diabetes possesses the characteristic of being inflammatory by nature, especially long term.
I recall a case study from my immunology class that I took through my undergrad that substantiates this involvement of chronic inflammation with T2D: 'inflammatory cytokines act to inhibit the insulin signal leading to insulin resistance.' (Kuby 2013). This objective presented the direct correlation of increased chronic inflammation and its effect on the insulin signaling cascade via cytokines (specific interleukins) interference with signaling, which then results in hindered insulin binding on the cell receptor.
That being said, should chronic inflammation persist, sensitivity to insulin would thereby decrease as well. Chronic inflammation of any kind can pose other potential problems within the host as well, such as enabling a host to be more susceptible to specific infections, such as viral infections. An example in our present day could be with the current pandemic and Sars-Cov-2 and the inability of the cell to shut compliment the increased transcription of nFkB with decreased interferon response. With little or no interferon response the body inadequately recognizes viral infection, meanwhile inflammation increases (nFkB), so existing subgroups such as diabetics who may also have pre-existing heart conditions (cardiovascular disease) are going to be hit harder. And therefore, when such unforeseen global health scenarios such as pandemics arise, costs will be increased to accommodate this demographic due to their increased susceptibilities, adding to the already existing financial strain on the healthcare system from T2D alone.
Type 2 diabetes is also strongly associated with cognitive impairment as neuronal cells are unable to properly uptake glucose for absorption for required cellular metabolism. (Kandimalla et al. 2017). In fact, Alzheimer’s disease which is currently untreatable is also affected through various cellular mechanisms that are shared with T2D insomuch that some researchers are suggesting that Alzheimer’s disease is the new “Type 3 Diabetes”. Some such shared mechanisms include insulin growth factor signaling, inflammatory cytokine signaling and glycogen synthase kinase signaling to name a few. (Kandimalla 2017). And just as a side note about Alzheimer funding in Canada: ‘The estimated monetary costs of dementia for the same year also varied, from $910 million to $33 billion’(Report summarys: Prevalence and monetary costs of dementia in Canada (2016): a report by the Alzheimer Society of Canada Alzheimer Society of Canada (nih.gov)).
Type 2 diabetes is a chronic disease that effects ‘415 million people worldwide, and an estimated 193 people have undiagnosed diabetes. Type 2 diabetes accounts for more than 90% of patients with diabetes and leads to microvascular and macrovascular complications that cause profound psychological and physical distress to both patients and carers and put a huge burden on health-care systems.’ (Type 2 Diabetes: Chatterjee. S; Khunti, K., Davies, M., 2017). ‘Between 2011/12 and 2021/22, new cases of diabetes are estimated to result in $15.36 billion in Canada health care costs, almost two-thirds of which will be spent on acute hospitalizations and physician services…' Government of Can website (The cost of diabetes in Canada over 10 years: Applying attributable health care costs to a diabetes incidence prediction model - HPCDP: Volume 37-2, February 2017 - Canada.ca)
Applying a multi-level of diagram to the disease of Type 2 diabetes we could further increase our understanding of potential intervention by examining each component and applying it to T2D, respectively. The purpose of such an exercise is to bring awareness to possibilities of disease mitigation through furthering our awareness through education and discussion.
The following image has been applied from Bing Images website found here.
“Values and Goals” could include decreasing the prevalence of this disease amongst the world’s population.
Competences/Resources could include including more frequent testing in individuals having greater susceptibility to succumb to the disease such as: individuals that reach a specific age or have a known hereditary disposition to the disease, individuals that have an overweight or obese bmi.
Opportunities could be occurrences where primary care providers meet with such patients during their check-ups. Such check-ups could provide invitation for more frequent check-ups or invitations for high risk patients to purchase a blood glucose meter to monitor their own blood sugar at designated times and to record the readings for presentation for their next check up/visit with the health care provider.
Health Promotion Action could include increased intervention abilities of care providers with their collected medical data of the individual where respective planning oriented around the individual’s unique needs to help decrease their likelihood of succumbing to the disease. This could include ordering for routine glucose monitoring for the patient to do at home at set intervals. It could also include a referral to a dietitian for diet assistance. It could serve as an instance to encourage the individual to seek counselling if the care provider suspects an emotional component to the risk factors for the patient, as well as suggesting an increase in their physical activity by inspiring the individual to reflect inward of activities they enjoy doing that may help promote an increase in physical activity. ‘Early detection through screening programs and the availability of safe and effective therapies reduces morbidity and mortality by preventing or delaying complications. Increased understanding of specific diabetes phenotypes and genotypes might result in more specific and tailored management of patients with type 2 diabetes, as has been showing in patients with maturity onset diabetes of the young.’ (Chatterjee. S, et. Al 2017,).
Environment could be considered how the individual chooses to set up their plan for success based on the suggestions and orders placed by their care provider. Creating an environment in their home or at work where they feel comfortable with their diagnosis in terms of the new changes that are required for the affected individual to succeed with managing this health condition.
Early intervention with prevention measures could potentially mitigate this disease’s occurrence amongst the population saving lives, but also helping increase a positive and healthy lifestyle for some in that they have adapted to healthier practices in terms of diet and physical activity. In turn this could relieve health systems around the world by removing significant strain, as this disease is known to incur. The end result is an increased improvement upon “health”.
I believe that a country's perception of health in general will manifest itself through not only the allocation of downstream funding but also the accountability of how these finances are being used right down to a micro level so that the utmost efficiency and productivity can be maintained and therefore maximizing optimization of healthcare to the patient who is the one paying for it with their taxes.
References
Kandimalla, R., Thirumala, V., & Reddy, P. H. (2017). Is Alzheimer’s disease a Type 3 Diabetes? A critical appraisal. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, 1863(5), 1078–1089. https://doi.org/10.1016/j.bbadis.2016.08.018
Kuby, et al. Immunology 7th ed. W.H Freeman and Company, New York, 2013. P 511.
Chatterjee, S., Kunti, K., Davies, M., (Feb. 9, 2017). Type 2 Diabetes. The Lancet. Volume 389, Issue 10085, P. 2239 – 2251. DOI: https//doi.org/10.1016/S0140-67736(17)30058-2
Kern. D., Auchnicloss, A., Stehr, M., et al (Nov. 14, 2017) Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis. International Journal of Environmental Research and Public Health. (11), 1394. DOI: 10.3390/ijerph14111394
University of Alberta Virology class notes, Lecture 7: Pathogenic Coronaviruses, Oct. 2020. Retrieved Feb. 21, 2021.
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