Type 2 diabetes, a lasting metabolic disorder characterized by insulin resistance, high glucose blood levels, and declining insulin production, makes up 90% of the diabetic cases presented. While type 2 diabetes is primarily due to environmental factors, there is a component of genetic predisposition. Having a family history of type 2 diabetes increases the chances of getting it. In addition, genes including TCF7L2, PPARG, and FTO appear to be significantly correlated with the development of type 2 diabetes. Some people are predisposed of genes that increase the likelihood of developing obesity, which is a 50% risk factor for Type 2 diabetes. Lifestyle choices such as physical inactivity, smoking, and drinking appear to act as epigenetic factors for type 2 diabetes(6). Research suggests that the aggregation of lipid metabolites in skeletal muscle results in inhibitory behavior on insulin-receptor substrate (IRS)-1 pathways. This correlates with decreased insulin-stimulated glucose transport activity. And thus, the cells are resistant to the presence of insulin, hence are insulin resistant, and glucose adsorption decreases(7). Once insulin production and secretion cannot surpass the insulin resistance, the person is said to have type 2 diabetes. The beta pancreatic cell encounters destruction due to glucotoxicity, lipotoxicity, and oxidative stress while the alpha pancreatic cell increases production of glucagon. Obesity contributes to insulin resistance via imbalancing the concentrations of hormones, increasing cytokines, and suppressors of cytokines, which alter the logistics of the balanced cellular pathways(8). Similar to Type 1 diabetes, hyperglycemia is a complication. Type 2 diabetes unlike type 1 diabetes, which generally starts from childhood, can be triggered by environmental factors at a greater range of ages. Therefore, it is more prevalent in our society.
A study conducted from 2002 to 2012 found that amongst young people, the rate of Type 1 diabetes cases increased by about 1.8% each year while the rate of Type 2 diabetes cases increased by 4.8% each year(9). Having type 2 diabetes has severe implications on health and to see such a fast growth rate is concerning. Amongst the myriad of macrovascular complications, there is an increased risk for heart attacks, stroke, and long-range blood circulation. The lack of circulation leads to the problem of “diabetic foot”, which is caused by nerve damage impairing the healing of blisters and bruises(10). Diabetic foot ulcers affect about 15% of all diabetic individuals and about 15% to 20% of those with foot ulcers need to undergo an amputation(11). Similar to type 1 diabetes, the microvascular complications include eye, nerve, and kidney damage(10). Nerve damage caused by diabetes shortens the lifespan in 25-50% of the patients within 5-10 years of diagnosing the nerve damages as severe autonomic diabetic neuropathy(12). All of these complications could lead to death. Health falls onto a spectrum of emotional to physical, and type 2 diabetes, unfortunately, impacts both. As people have to cope with type 2 diabetes, many tend to develop anxiety, depression, and fatigue. This presents a positive feedback loop as these negative feelings can reinforce the disease itself(8). This process works such that negative emotions increase resistance to insulin while treating the patient with insulin helps decrease the severity of depression(13). All of these health issues generally propagate more health issues.
The socioeconomic status of a person tends to be indicative of their lifestyle, which is the foundation for health. According to the studies done in Isfahan and Korea, there are trends between socio-economic determinants and incidence of type 2 diabetes. The study from Isfahan found a significant correlation between lower economic status and higher number of diabetic complications. The study concluded that this was due to the lack of time to perform leisurely activities and exercise daily, the likelihood of a sedentary lifestyle, and the increased consumption of fried food. Due to cheaper food being unhealthier, obesity has been correlated to both lower economic status and type 2 diabetes. If diagnosed with diabetes, people with lower incomes tend to lack the time to focus on the disease by removing themselves from the workplace. Another factor is the access to healthcare, rural regions tend to have significantly less doctors. Frequent check-ups are necessary to diagnose a compilation of symptoms before the disease becomes incurable. In addition, not everyone has the money to gain access to high quality health care and treatments in order to minimize the potential damage of diabetes(14). In the study conducted in Korea, an additional correlation found is that between lower educational attainment and diabetes. Someone who has the access for further education has the opportunity to gain so much more knowledge about health and the motivation of healthy behaviors. Attaining higher education also correlates with more money, more opportunities for better work, and a higher income. A higher income is important to gain access to better health care. If the person has a lower income, then the cost of the treatment will further burden their economic situation and their lifestyle(15). People of lower socioeconomic status tend to have a higher likelihood of diabetes and once diagnosed, they tend to have a harder time recovering- this is the cycle of inequality and it has a deteriorating impact on those with diabetes. These trends need to be further studied and addressed in policy-making.
According to the cost reports from the American Diabetes Association, the direct, annual cost of diabetes increased from $44 billion to $176 billion between 1997 and 2012(18). Breaking down the 2012 data, the cost o
f diabetes inclu
ded hospital inpatient care (43%), prescription medication (18%), supplies, physician checkups (9%), and residential faculty stays (8%). The amount that the USA has spent for diabetes is 1 out of every 5 health care dollars. An additional $69 billion was the cost of reduced productivity in the form of absenteeism, those who couldn’t work due to disease, and early mortality (16). The conclusion is that diabetes is definitely an economic burden on the country. However, given a disease, multifarious companies capitalize on the products to sell to doctors and to the public. Type 2 diabetes has several known medications on the market: lifestyle intervention, incretins, oral agents, and insulin. There are many workout programs set up by trainers to help reduce blood glucose and enhance the production of insulin. Incretins, GLP-1 and GIP, are hormone-like substances that encourage the release of insulin and decrease of glucagon. Some popular oral agents on the market are bile acid sequestrates, metformin, and bromocriptine(8). To clarify, this is a very limited list of the types of drugs on the market as there are many more. In addition to drugs on the market, there are a countless number of proposed solutions in the literature and clinical trial phase. One of the interesting concepts out there is a microneedle-array insulin patch that is lined by vesicles containing insulin and glucose oxidase. Glucose in the blood creates a hypoxic local environment that stimulates the reduction of a molecule, which triggers the release of the vesicles and the secretion of the insulin. As of right now, the patch has regulated the glucose in a mouse and the team is working to further develop the product, gain FDA approval over time, and release it into the market(17).
The trend of diabetes is a steep upwards growth- with one study extrapolating data that 1 in 3 US adults could be diabetic by 2050(16). With that in mind, the social determinants, awareness, and health care are among the few factors that need improvement.