Diabetes - The Beginning

In this episode, Stan and Clarence sit down with Dr. Stuart Grande - a medical sociologist, Senior Lecturer, and Public Health Administration and Policy Program Director at the University of Minnesota - to chat about diabetes from a public health perspective.

This episode begins a mini-series that will explore various components of diabetes. Check back soon; our next episode accounts the life of a patient with Erin Collins.

Research Topics

Management and Prevention (main focus)

Currently no one knows how to prevent type 1 diabetes
More concrete prevention strategies for type 2 diabetes
Prevention Programs

Ex. National Diabetes Prevention Program (National DPP)

“Partnership between private and public organizations to offer evidence-based and cost-effective interventions that help prevent type 2 diabetes in communities across the United States”
CDC-recognized Lifestyle Change Program

Research-based program focused on healthy eating and physical activity
Has shown that prediabetic individuals can cut their risk of developing type 2 diabetes by almost 60%

Disconnect between physicians and programs?

Insulin costs

Research shows average insulin price rose 54% from 2014 to 2019 and has only reduced by 5% over the course of COVID-19
1 in 4 patients ration their insulin because they can’t afford it
As of 3/1/2022, a vial of insulin ranges from $50 to $1,000

Insurance can bring the price down to $30-$50

Three companies have a monopoly over the insulin market and keep costs high
Senators unveiled a bipartisan bill on 3/22/22 which would cap insulin at $35/month for people with private insurance or Medicare

Also seeks to make insulin more accessible by limiting authorization requirements
But does the bill take on the drug industry?

Access to programming and gadgets

Several apps for diabetes management
Content ranges from forums and food education to glucose tracking and 1:1 coaching
Most are free with in-app purchases available
What about limits surrounding access to technology?

What do we see in the state, nationally, and among populations?

State of MN (American Diabetes Association)

Approximately 386,480 people in Minnesota, or 8.8% of the adult population, have diagnosed diabetes.
An additional 118,000 people it n Minnesota have diabetes but don’t know it, greatly increasing their health risk.
There are 1,441,000 people in Minnesota, 33.7% of the adult population, who have prediabetes with blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.
Every year an estimated 33,674 people in Minnesota are diagnosed with diabetes

Nationally

11.3% of the US population had diabetes in 2019 (diagnosed and undiagnosed)
Incidence decreased between 2009-2019 after almost 2 decades of continual increase

Populations

Non-hispanic white people are more likely to develop type 1 than non-hispanic Black and hispanic people
Black, Latino, American Indian, and Alaska Native populations are at higher risk of developing type 2 diabetes than white populations
Members of some racial and ethnic groups are more likely to develop diabetes

American Indian and Alaska native adults had highest rates of diabetes in 2019, followed by non-Hispanic Black adults and Hispanic adults
There are also varying rates of diabetes within racial groups

Mexican and Puerto Rican adults had highest rates in 2019 (Hispanic)
Asian Indian and Filipino adults had highest rates (Non-Hispanic Asian)

Do people die from diabetes?

Diabetes was the eighth leading cause of death in the US in 2020
Diabetes-related complications include smoking, being overweight/obese, physical inactivity, A1C, high blood pressure, and high cholesterol
Hyperglycemia(high blood sugar levels) and Hypoglycemia(low blood sugar levels) are both life threatening and can lead to coma and death if not treated
Diabetes complications are more likely to be the cause of death

Heart disease affects people with diabetes at higher rates than those without diabetes
People with type 2 diabetes are more likely to have high cholesterol, high blood pressure, and obesity which are risk factors for cardiovascular disease

Type 1 and type 2 diabetes can also lead to kidney disease and amputations (from vision loss, nerve damage, and infections)

Disease management & age

Adults 50+ years with diabetes die 4.6 years earlier than adults 50+ without diabetes
Highest prevalence of diabetes in the US is black men over 65 years old
Older patients have greater risk of hypoglycemia

Older adults are also more likely to have coexisting conditions like cognitive impairment and cardiovascular disease which can impact disease management

Little mention of older adults utilizing apps or tech for management

Mostly physician consulting, additional screening, collaborative care, and healthy lifestyle changes

Risk factors

Typical risk factors and are there any new factors we’re seeing come into play?
Type 1: immune reaction

Risk factors include family history and age

Usually develops in children, teens, and young adults

Non-hispanic white people are more likely to develop type 1 than non-hispanic Black and hispanic people
Currently there is no known prevention

Type 2

Risk factors include having prediabetes, age, being overweight, having a family history of diabetes, being physically active <3x per week, and race

Black, Latino, American Indian, and Alaska Native populations are at higher risk of developing type 2 diabetes

Unlike type 1 there are certain lifestyle changes that can address type 2 risk factors

Eating healthier, physical activity, losing weight, etc.

Prediabetes & Gestational Diabetes (diabetes while pregnant)

Risk factors for prediabetes are similar to type 2 risk factors
Prediabetes can be prevented or reversed with lifestyle changes
Gestational diabetes usually goes away after giving birth but can increase risk of type 2