Introduction
The phenomenon of diabetes prevalence in the US population has been a subject of discussion over the past several decades. In order to better understand the implications of the disease, it is necessary to dwell on both scientific and analytical aspects of type 2 diabetes mellitus (T2DM). The present paper focuses on the research questions related to the topic of T2DM prevalence in ethnic and social minorities. Hence, the Level 1 research questions for both inquiries are as follows:
- What is the pathophysiology of T2DM?
- What are the statistical facts related to T2DM prevalence in the US?
The Level 2 research questions are:
- What are the pathophysiological implications of T2DM in minorities?
- What are the statistical implications of T2DM in minorities?
Level 1 Research Questions
T2DM Pathophysiology
T2DM is generally known as a metabolic disorder that affects the global community disproportionally competed to other conditions. According to Galicia-Garcia et al. (2020), “its development is primarily caused by a combination of two main factors: defective insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin” (p. 1). Insulin is a crucial hormone for the human body because it regulates the levels of sugar in the blood by releasing glucose to the body to produce energy. Having low insulin release in the body, people have high blood glucose levels and experience issues with the heart, vasculature, sight, kidneys, and central nervous system (Galicia-Garcia et al., 2020, p. 2). Thus, in order to combat the disease, the patients need to regulate their insulin and blood sugar levels with the help of medical interventions or changes to their lifestyle.
There are many risk factors that can potentially lead to the development of T2DM. These factors include genetic predisposition to the disease, obesity, poor dietary habits, tobacco or alcohol dependence, or stress-related mental disorders (Yuan & Larsson, 2020). All these factors lead to a higher risk of low insulin secretion and the development of hyperglycemia, or extreme blood sugar levels. As far as the physiology is concerned, the organs usually involved in the T2DM development are “the pancreas (β-cells and α-cells), liver, skeletal muscle, kidneys, brain, small intestine, adipose tissue… adipokine dysregulation, inflammation, and abnormalities in gut microbiota” (Galicia-Garcia et al., 2020, p. 2). The development of T2DM frequently leads to comorbid diseases and health complications such as chronic obstructive pulmonary disease (COPD), depression, hypertension, coronary heart disease (CHD), and chronic kidney disease (CKD) (Nowalowska et al., 2019). Hence, T2DM is a serious health complication caused by various widespread factors and contributes to the development of other chronic conditions. For this reason, the management and early detection of this disease of crucial for effective health care nationwide.
T2DM Statistics
T2DM is rightfully considered one of the most widespread metabolic conditions in the US. Currently, nearly 37.3 million people in the country have diabetes, whereas 90-95% of this number is constituted by T2DM (Centers for Disease Control and Prevention [CDC], 2020a). The statistics, however, cannot be exhaustive due to the fact that with every tenth person having diabetes, one in five people are unaware of this diagnosis, making the number of T2DM patients potentially higher (CDC, 2020a). The rapid T2DM growth among the population results in more than $300 billion worth of lost employment and medical costs related to T2DM management (CDC, 2020a). Hence, it is reasonable to assume that diabetes is a global health issue that has become a full-scale epidemic in the US.
Regarding different population groups, the statistics demonstrate that T2DM is more prevalent in male older adults. Thus, nearly 26.8% of the US population older than 65 had diabetes in 2016 compared to 4.2% of diagnosed cases in the 18-44 age group (CDC, 2020b). Similarly, the number of diagnosed diabetes cases is 2% higher in the male population, constituting 14% of the US men (CDC, 2020b). The tendency, however, has a chance to change over time, as the CDC (2020b) notes that cases of T2DM in children increase significantly. Thus, in 2014-2015, the number of newly diagnosed T2DM cases in children aged 19 and younger was more than 5,000 (CDC, 2020b). Hence, considering the current statistics, it may be concluded that T2DM remains a major challenge to the US nation and requires more attention from the public health care institutions.
Level 2 Research Questions
Pathophysiological Implications of T2DM in Minorities
Previously, some of the common risks for developing T2DM were discussed, with genetic factors, obesity, inactive lifestyle, and stress being some of the most significant aspects. Thus, in the context of minority populations in the US, the pathophysiology of the disease remains the same, whereas the predisposition risks grow substantially. For example, since ethnic groups such as the Latinx population are more prone to develop obesity due to socio-economic factors and genetic predisposition, the risk of developing T2DM becomes higher compared to the White population. For example, in the study by Cruz and Granados (2018), the researchers claim that obesity disproportionally affects Latino youth in the US. Moreover, the study reveals that the physiological peculiarities of Latino youth imply higher liver fat accumulation and “low insulin sensitivity” (Cruz & Granados, 2018, p. 17). It puts them at a higher risk of hyperglycemia.
Another study by Goff (2019) suggests that the T2DM peculiarities are different for every ethnic background. For example, for the Asian population, the metabolism patterns are different from the White population. As a result, it is necessary to reconsider the threshold for the overweight BMI should be lower (Goff, 2019). Finally, the evidence also demonstrates that stress-related factors relate to the obesity predisposition in minorities. Corliss et al. (2018) suggest that the lesbian and bisexual population has a higher level of stress-related mental difficulties, leading to higher obesity levels and, eventually, T2DM risk. Hence, it may be concluded that socio-ethnic minority groups in the US, although developing the same anatomic patterns of T2DM, have a significantly higher risk of developing the disease through the underlying risks. Public health specialists need to develop cultural awareness and sensitivity framework to mitigate the problem’s scope.
Statistical Implications of T2DM in Minorities
When analyzing the national statistics on T2DM prevalence, it is evident that the majority of instances occur in minority groups. Thus, according to CDC (2020b), out of all the T2DM diagnoses recorded in 2017-2018 among local adults, only 7.5% of cases fall into the “non-Hispanic White” category. Other instances belong to “American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), non-Hispanic Blacks (11.7%), and non-Hispanic Asians (9.2%) (CDC, 2020b, p. 4). According to Goff (2019), “among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher” than in White population (p. 930). Hence, it would be reasonable to assume that there is a distinct pattern of T2DM prevalence in ethnic populations, making it essential to rediscover the detection and management guidelines for the disease.
However, the striking statistical difference does not occur in different ethnic communities. Overwhelmed with the social pressure and stigmatization, lesbian and bisexual women are more prone to struggle with mental disorders and substance abuse. These factors, in their turn, contribute to higher levels of obesity. More precisely, the BMI mediation identified that lesbian and bisexual women “had a 27% higher risk of developing type 2 diabetes than heterosexual women,” especially at younger ages (Corliss et al., 2018, p. 1448). Hence, quantitative evidence demonstrates that nowadays, there is a major gap between the management and prevention of T2DM in minorities and the White cisgender straight population, mainly due to the lack of individualized and culturally sensitive care management.
Conclusion
The present paper focused on the two levels of research questions from the scientific and analytical perspectives on the matter of T2DM pathophysiology and prevalence in minorities. The answers to these questions lead to four primary outputs. First, T2DM is a complex metabolic condition that is characterized by low insulin release in the body and hyperglycemia. Secondly, the widespread risk factors for T2DM make it statistically one of the most common health conditions in the US. Thirdly, the increased predisposition to the risk factors and metabolic and cultural specifics makes minorities more physically vulnerable to T2DM. Finally, the statistics demonstrate that mental hardship, obesity, and different levels of insulin sensitivity and metabolism make the minorities’ risk of T2DM three to five times higher. Hence, it is of paramount importance to put more effort into the patterns of individualizing care for minorities.
References
Centers for Disease Control and Prevention. (2020a). A snapshot: Diabetes in the United States.
Centers for Disease Control and Prevention. (2020b). National diabetes statistics report 2020: Estimates of diabetes and its burden in the United States[PDF document].
Corliss, H. L., VanKim, N. A., Jun, H. J., Austin, S. B., Hong, B., Wang, M., & Hu, F. B. (2018). Risk of type 2 diabetes among lesbian, bisexual, and heterosexual women: Findings from the Nurses’ Health Study II.Diabetes Care, 41(7), 1448-1454.
Cruz, P., & Granados, A. (2019). Type 2 diabetes in Latino youth: A clinical update and current challenges.Current Problems in Pediatric and Adolescent Health Care, 49(1), 16-22.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275.
Goff, L. M. (2019). Ethnicity and type 2 diabetes in the UK.Diabetic Medicine, 36(8), 927-938.
Nowakowska, M., Zghebi, S. S., Ashcroft, D. M., Buchan, I., Chew-Graham, C., Holt, T., Mallen, C., Van Marwijk, H., Peek, N., Perera-Salazar, R., Reeves, D., Rutter, M. K., Weng, S. F., Qureshi, N., Mamas, A. M., & Kontopantelis, E. (2019). The comorbidity burden of type 2 diabetes mellitus: Patterns, clusters and predictions from a large English primary care cohort.BMC Medicine, 17(1), 1-10.
Yuan, S., & Larsson, S. C. (2020). An atlas on risk factors for type 2 diabetes: A wide-angled Mendelian randomisation study. Diabetologia, 63(11), 2359-2371.