Cardiovascular Disease and Diabetes

Question: Discuss about the Cardiovascular Disease and Diabetes. Answer: Introduction Chronic diseases is a term used to refer to a group of long lasting diseases with persistent effects (AIHW, 2015). Examples of chronic diseases include diabetes, arthritis, cancer, chronic obstructive pulmonary disease, mental health conditions, back problems and cardiovascular disease. They result to 7 of 10 deaths annually (CDC, 2016). The Australian Institute of Health and Welfare (AIHW), state that of all Australians, approximately half have a chronic disease, with approximately 20% having atleast two, meaning that one in five Australians are affected by multiple chronic diseases. Diabetes is one of the most significant chronic disease affecting most people in the world, and whose occurrence and incidence has been increasing from decade to decade despite interventions being taken. In 1985, diagnosed individuals with the disease reached 30,million, in 1995 the number reached 135 million, in 2011 the number increased to 366 million and in 2030, the number is predicted to reach 552 million globally (Murea, Ma, Freedman, 2012). Additionally, the condition affects the health of many individuals and may result to other complications such as blood vessel and nerves damage. In this regard, diabetes is a chronic condition growing rapidly among populations, and its rate of growth is higher in comparison with other chronic conditions such as cancer, stroke and heart disease. This explains why this chronic condition was considered for exploration in this paper. The current paper, therefore, seeks to explore on diabetes as a chronic disease in Australia and worldwide, its public health significance, burden of disease, broad determinants and individual risk factors. Moreover, exploration of a framework utilized in prevention of chronic diseases and a review of its applicability to diabetes will be looked at. Diabetes can be categorized as either type 1, type 2 (diabetes mellitus), or gestational diabetes, and is among the most significant chronic diseases in Australia as well as globally. The condition comes about when the body fails to generate insulin or it is not produced in adequate amounts. Insulin is a hormone responsible for controlling blood glucose levels. Therefore, in its complete absence or not enouph, the blood sugar levels go out of control. Lack of enough production of insulin by the body results to type 1 diabetes. Type 2 diabaetes is characterized by the ineffective use of available insulin by the body and is the most common among all diabetes types (WHO , 2016). On the other hand, gestational diabetes, unlike type 1 and type 2 diabetes, is a temporary condition occuring in pregnacy. However, gestational diabetes increases the risk of developing type 2 diabetes. The impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT) are transitional conditions transiti oning diabetes and normal blood glucose. They increase the risk of stroke and heart attack (WHO , 2016). Type 2 diabetes, being the most common, is discussed in more detail compared to other types. As already mentioned, diabetes prevalence has been rapidly increasing consecutively for years now. The number rose from 30 million in 1985 to 135 million in 2011, and is expected to rise to 552 million in the near future, by 2030. According to World Health Organization, in 2014, about 422 million adults worldwide had and were living with diabetes, an increase from the 108million diabetic people in 1980 and an indication that since 1980, the global diabetes prevalence had doubled to 8.5 % from 4.7%. In this regard, the asssociated factors of risk of this disease such as obesity or overweight have increased. Additionally, diabetes prevalence has been found to rise more rapidly in developing nations as compared to developed nations. In Australia, about 1.2 million people had diabetes in 2014-2015, with one million hospitalization cases being associated with this disease (AIHW, 2016). Among this, one million were diabetes mellitus cases (4,4%)(AIHW, 2016). This numbers indicate a rise in numeral value of affected individuals in comparison to 2011-2012. Directly diabetes associated deaths were 1.5 million in 2012 globally. Moreover, the number of deaths indirectly associated with this disease added up to 2.2 million (WHO, 2016). These were deaths resulting from blood glucose higher than optimal, thus elevating cardiovascular as well as other diseases risk. 43% of the total number of deaths directly or indirectly associated with diabetes occurs in populations aged below 70 years. These statistics make diabetes the eighth leading death cause among both males and females (WHO, 2016). Among women, it was ranked as the fifth principal cause of mortality. In Australia, in 2014, 15740 deaths occurred, that is, 1 in 10 peoples deaths were associated with diabetes. Disability Adjusted Life Years (DALYs) According to Australian Institute of Health and Welfare, the burden of disease constitutes both the prematurely dying burden and the living with ill health burden. This burden can be measured by disability indicators such as Disability Adjusted Life Years (DALY), which are important in portlaying the general burden of disease picture, just like mortality. A single DALY represent one year of lost healthy life as a resu;lt of death or illness In general, in 2011, there were 201 lost healthy years for every 1000 individuals in Australia as a result of death, injury or disease (AIHW, 2016b). This represents an equivalence of a total of 4.5 million DALYs. Globally, diabetes was ranked the fourteenth largest DALYs cause Diabetes impacts the affected people, families and nations economically, with direct or indirect costs. Due to the costs associated with medical treatment, loss of work and lack of independency, economic losses are experienced even by health systems as well as national economies. The cost for diabetic patients usually result from outpatient and medical care but also the increased expenditure for analogue insulins which are prescribed in most cases significantly play a role in further contributing to economic losses. Diabetes is highly significant in public health due to various factors. Firstly is due to its increasing prevalence as already discussed above. Secondly is due to its high cause of mortality, either directly or indirectly. Thrirdly is because diabetes elevates the risk of other diseases (American Diabetes Association, 2013). The disease is correlated with a diverse other health problems. For example, studies suggest that diabetic individuals are at more likelihood of dying from other diseases such as cancer compared to non diabetic individuals (American Diabetes Association, 2013). Additionally, there is an association between diabetes and premature deaths from a wide variety of causes such as stroke and heart disease. According to American Heart Association, (2015), a strong association between cardiovascular disease and diabetes exist, with at least 16% and 68% of diabetic individuals aged above 65 years die from certain forms of stroke or heart disease respectively. This may be as sociated with to blood vessels, kidney, nerves and eyes damage, caused by diabetes over time. Moreover, the likelihood of diabetic individuals dying from hear disease is twice that of non-diabetic. Diabetic individuals in most cases also bear some other health conditions including hypertension, abnormalcholestrol and high levels of triglycerides (American Heart Association, 2015). The elevation of risk for such diseases such as cancer and cardiovascular disease contributes greatly to the public health significance of diabetes. Diabetes is also associated with other health complications that lead to adverse outcomes especially when not properly managed. Extreamly high blood glucose levels may trigger conditions such as hyperosmolar in diabetes mellitus and diabetic ketoacidosis in both type 1 and diabetes mellitus. On the other hand, abnormally low levels of blood glucose may result to loss of conciousness and seizures (WHO, 2016). Diabetes also increases the risk for development of foot ulcers and infections, resulting to limb amputation. Kidney failure and blindness are also health prolems linked to diabetes. All these complications related to diabetes makes it important to public health as it leads to adverse outcomes such as mortality rate increase . The public health significance of diabetes is also contributed by multiple chronic comorbidities (MCCs). This is because MCCs are not only prevalent, but also increase disease burden as well as cost. According to Lin, Kent, Winn, Cohen, Neumann, (2015), diabetic patients have considerable cormobidities such as hyperlipidemia, depression, obesity, asthma, hypertension, chronic kidney disease, cancer, arthritis, retinopathy and heart failure. The study revealed that 80% of diabetic patients had at least one other chronic condition and 51% had more than three. In this regard, diabetes is highly significant in public health. Broad Diabetes Determinants The underlying diabetes determinants are similar throughout the world. The wellbeing of diabetic patients is determined by a range of aspects including social, economic, behavioral, cultural and environmental determinants. Cormobidities has been shown to be a determinant too (Maddigan, Feeny, Johnstone, Majumdar, Farris, 2006). Social determinants include income, educational attainment, employment insecurity, living standards and life stress (Hill, Nielsen, Fox, 2013). These factors determine the development as well as progression of diabetes. Social determinants are correlated with disproportionate chronic disease development and the difficulties in managing them. The prevalence and incidence of diabetes have been shown to socially graded. Individuals with less education and who earn less are two to four times at more likelihood of developing diabetes compared to more educated and more economically advantaged. Similarly, individuals who are unemployed, have low standards of living and exposed to stress also are more likely to develop diabetes. Cultural determinants also significantly contribute to diabetes. Traditional practices and cultural beliefs affect all diabetes aspects (Sachdeva, et al, 2015). Such determinants include perception regarding the disease, its diagnosis and assessment, expectation from care givers and care seeking behavior. These cultural determinants influence the management of diabetes (Sachdeva, et al, 2015). Environmental determinants, either genetical or non-genetical, are also linked to diabetes, and particularly type1 diabetes. Such environmental triggers include early exposure to rubella, enterovirus infection, hyperbiliru-binemia and ABO incompatibility during pregnancy (TEDDY Study Group, 2008). Exposure to such factors has been proposed to progress type 1 diabetes, although research is still underway to clearly clarify this. For non-genetic envirinmental determinants, they include dietary suppliments, obesity, western lifestyles, glycemic control and exposure to organic contaminants (Murea, Ma, Freedman, 2012). Diabetes Individual Risk Factors The risk factors for diabetes depend on kind of diabetes affecting an individual. For type 1 diabetes, investigation and research studies are being conducted to determine the risk factors (International Diabetes Federation, n.d). However, the risk of developing this type of diabetes is elevated if it exists in the family. Moreover, exposure to some viral infections and other environmental factors have been proven to increase the risk of having type 1 diabetes (TEDDY Study Group, 2008).For type 2 diabetes, various risk factors have been outlined. These factors associated with elevated risk include increase in age, overweight, family history of the disease, physical inactivity, unbalanced diets, ethinicity, impaired glucose tolerance, high blood pressure, and poor nutrition through pregnancy (International Diabetes Federation, n.d). Increased risk due to ethnicity can be associated with genetics and adaptation to environmental influences of lack physical exercises and poor diets. In ad dition, gestational diabetic women have elevated risks of having type 2 diabetes. Framework for Prevention of Chronic Diseases There are various frameworks that have been proposed and implemented to prevent, control or manage chronic diseases. Among them is the stepwise framework for action which is utilized by Global Alliance Against Chronic Respiratory Diseases (GARD). The planning steps of GARD corresponds to strategic action plans and objectives of the World Health Organization (WHO, n.d). The stepwise framework can be broadly divided intpo planning steps and policy implementation steps as shown below. Here, the focus is on estimating the chonic disease burden as well as population needs. The risk factors are identified and surveillance undertaken for trends in burden, costs, quality and even care affordability. Additionally, action advocation to combat the disease is done to raise awareness . To ensure that chronic diseases are allocated the appropriate priority and organization of resources is efficient, a national policy and framework for planning is developed. The developed policy and plan should be able to promote health via prevention of the disease, recommend affordable and simple tools of diagnosis of the condition and control and ensure accessibility of drugs for the condition. The appropriate steps to be employed depending on the needs identified and policy developed are identified. Implementation Step 1: Interventions practicable to employ in the short range with existing resources put in action. Implementation Step 2: Inteventions feasible in the medium term with a projected increase that is realistic or resources reallocation are put in action Implementation step 3: Evidence-based interventions pastexisting resources' reach are put in action Stepwise Framework in Diabetes Prevention The stepwise framework can be effectively be applied in the prevention of diabetes. This framework proposes a practical and flexible public health strategy to help public health departments throughout the world balance the many needs as well as priorities while at the same time implementing interventions that are evidence-based (Epping-Jordan, Galea, Tukuitonga, Beaglehole, 2005). The framework has been implemented in nations such as Phillipines, Indonesia,Tonga and Vietnam to prevent different chronic diseases, an indication that the it is applicable. In this regard, it can be applied to prevent diabetes in both developed and developing countries, where precise interventions will be applied depending on the results after each steps discovery. According to World Health Organization, n.db, while using the stepwise framework, each country is supposed to consider diverse factors so as to establish priorities. In this regard, the framework is applicable in prevention of a number of chronic conditions including diabetes since specific needs and risk factors will be assessed, a specific policy formulated depending on the discovered needs and appropriate implementation steps identified. The implementation action will then be chosen after careful consideration of various factors. Applicability of this framework is thus, not limited to any country or chronic condition. This makes the stepwise framework an important tool in prevention and control of diabetes. The stepwise framework is applicable in preventing diabetes in all three prevention stages which include primary deterrence, secondary avoidance and tertiary prevention. For primary deterrence, protection of non-diabetic individuals will be achieved through public awareness that will be created. Awareness will be emphasized regarding importance of healthy diets, avoiding obesity and physical activity. In regard to secondary prevention, the framework will assist in developing interventions to assist individuals with early diagnosed diabetes to control and reduce its impacts on their daily lives. Lastly, the framework will also develop evidence-based interventions to assist diabetic individuals whose conditions have been longterm, progressing to cause other complications and disabilities. All the prevention dimensions can be achieved through the stepwise framework since interventions are developed depending on the needs and population of patients under consideration. Conclusion Therefore, diabetes is a chronic disease still of concern to the public health and although measures to reduce its prevalence, incidence, mortality and complications have been done in Autralia as well as other countries globally, adequate measures are still deficient. The disease is still a significant burden to individuals, families and nations. Governments ought to consider diabetic issue more , raise public awareness regarding important characteristics of the disease and advocate fo prevention and control measures at individual as well as nation-wide level. Knowledge of risk factors by the public will further enable prevention. Additionally, application of prevention and management frameworks will assist in reducing the complexity of reducing the burden of this disease. References American Diabetes Association, ADA. (2013). Diabetes Increases the Risk of Other Diseases. 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