A Biosocial Analysis of Determinants of Type 2 Diabetes Mellitus
By: Dorcas Omowole
Tags: Global Health, Diabetes

(Note: This paper was written in the first quarter of 2019 as part of an Introduction to Global Health course)

Introduction

In 2014, 422 million people were living with diabetes. This number represents almost a fourfold increase from 108 million in 1980 and a prevalence rate of 8.5% globally. World Diabetes Day (WDD) was created in 1991 by the International Diabetes Foundation (IDF) and the World Health Organization (WHO) in response to the escalating health threat posed by diabetes. World Diabetes Day became an official United Nations Day in 2006 and is marked every year on 14 November. The WHO projects that diabetes will be the 7th leading cause of death by 2030.[1]

Diabetes can be broadly categorized into three types: type 1 diabetes, type 2 diabetes and gestational diabetes. Type 1 diabetes occurs because the body does not produce insulin, a hormone that regulates blood sugar or glucose. People with type 1 diabetes are born with it and have to depend on insulin injections all their life. There are hypotheses, but the cause(s) of type 1 diabetes is unknown. Gestational diabetes often occurs in pregnant women during the third trimester of pregnancy. Sugar level spikes then comes down. Having gestational diabetes increases the risk of mother and child developing type 2 diabetes later in life. Type 2 diabetes occurs when the body does not properly process glucose because it cannot properly use the insulin it produces. Diabetes of all types can lead to complications in many parts of the body and can increase the overall risk of dying prematurely. Possible complications include heart attack, stroke, kidney failure, leg amputation, vision loss and nerve damage. In pregnancy, poorly controlled diabetes increases the risk of fetal death and other complications.[2]

This biosocial analysis focuses on type 2 diabetes, explaining the individual, relational, community and structural factors implicated in the prevalence and spread of the disease.

Individual factors

These factors can be grouped mainly into demographic and lifestyle factors.

Demographic factors include:

o Age: Diabetes often occur in individuals aged 45 or older. However, there has been an increase in onset of diabetes among younger aged individuals.

o Gender: Due to hormonal interactions, women are at a higher risk of developing diabetes. Women also have a general tendency to be obese, another risk factor for developing diabetes.

o Race: Globally the risk of developing diabetes is higher among Africans. According to the Center for Disease Control (CDC), the risks of developing diabetes is higher for “African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk).”[3]

o Genetic predispositions: Genetic and metabolic factors also increase the risk of developing diabetes[4]. Some body types are able to metabolize sugars better than other body types. Also, having a parent or sibling with diabetes means an individual is also at higher risk of developing diabetes.

Lifestyle factors include factors that could lead to being overweight. Some of which are:

o Diet: A diet high in sugars and fat, and lacks roughage, can make an individual overweight and increases the individuals risk of developing diabetes.

o Physical inactivity: A lack of exercise, a sedentary lifestyle or a job that requires little or no mobility.

Also, having had gestational diabetes or given birth to a baby who weighed more than 9 pounds increases one’s risk of developing type 2 diabetes.[5]

Relational factors

Individual interactions with others also impact on the risk of developing diabetes. For example:

o Neonatal and childhood factors: A mothers diet during pregnancy influences a child’s risk of developing diabetes later in life.[6] Exclusive breastfeeding during the first six months of life, weaning with lean meats, poultry, fish, grains and vegetables, and no sugary beverages in the first year of life increase a child’s immunity and reduces the risk of developing type 2 diabetes. Also, some parents are unable to identify or misread the warning signs for diabetes. The warning signs can include, “excessive thirst, frequent urination, a lack of energy, blurred vision, slow healing wounds, and numbness in the feet and/or hands.”[7]

o Peer influence: Lifestyle, life conditions, and the market may be seen as communicable.[8] Peer group influence contribute to increased smoking and drinking habits which reduce immunity and contribute towards obesity. Also, in some African settings, being overweight signifies that the individual is affluent. Exercise is not a common lifestyle, especially in rural areas, where those who are no longer engaged in farm work or long-distance walks to the streams do not replace this with other physical activity.

o Adherence: Individuals who are at risk of developing diabetes or already prediabetic are often given instructions for lifestyle changes to prevent them from developing diabetes. These instructions are often not followed because they represent a shift in lifestyle and habits and involve changes in many of the aspects of the individuals’ life. The individual might not make, or delay making these changes. This increases the risk of developing diabetes.

Community factors

General perceptions and attitudes in the community also contribute to the risk of developing type 2 diabetes.

o Awareness: Inadequate awareness on diabetes and its associated risks would create greater motivations to avoid the disease. This lack of awareness might also be due to lack of education to access and understand the available information on diabetes prevention. In some African context, people are not motivated to know about their health or ask questions. They continue to home treat symptoms and side effects until diabetes shows up or they slump for the first time and that’s when they know they have diabetes and begin to treat it. There is also need for education on the type and proper use of cooking oils and how to cook healthy meals.

o Early diagnosis: As a result of the lack of proper awareness, high proportion of diabetes is undiagnosed.[9] The longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be.

Structural/Policy factors

Individual efforts to avoid predisposing factors to developing diabetes are often constrained by existing structure of society and policies.

o Poverty: As at 2015, 10 percent of the world’s population lived on less than US$1.90 a day. [10] These population often have no choice than to consume calories that do not have adequate nutritional quality. They might work in jobs that do not afford them time to cook balanced meals. Some communities or neighborhoods may also be poorer than others due to structural injustice in society. These communities may also have increased risk to developing type 2 diabetes due to poverty related factors.

o Industry: Government regulation of industries that produce unhealthy products are often not stringent enough. For example, tobacco industries. Also, potentially harmful molecules are introduced into the body through food items via the market. For example, high corn fructose syrup in the US and high levels of sodium in most canned food.

o Health system capacity: Availability and easy access to basic diagnostics, such as blood glucose testing, and established systems for referral and back-referral would reduce the risk of developing diabetes.

The excerpts by Margaret Chan, Director General of the WHO in 2006, summarize the importance of structural factors and the linkages between structural and other factors.

“For governments, reducing the diabetes burden means putting policies in place that promote healthy eating and physical activity throughout the life course. Policies that promote breast-feeding and protect children from the marketing of unhealthy foods and beverages are especially important…It also means improving the diagnosis and treatment of diabetes by putting in place standard protocols and making the necessary medicines and technologies readily available and affordable.”

References

[1] On World Diabetes Day, UN calls for greater action to turn tide of growing global epidemic. 13 November 2015. https://news.un.org/en/story/2015/11/515422-world-diabetes-day-un-calls-greater-action-turn-tide-growing-global-epidemic

[2] World Health Day 2016. Global Report on Diabetes. Executive Summary https://apps.who.int/iris/bitstream/handle/10665/204874/WHO_NMH_NVI_16.3_eng.pdf?sequence=1

[3] Who’s at risk. 25 July 2017 https://www.cdc.gov/diabetes/basics/risk-factors.html

[4] World Health Day 2016. Global Report on Diabetes (powerpoint). https://www.who.int/diabetes/global-report/WHD2016-Presentation.pdf?ua=1

[5] Who’s at risk. 25 July 2017 https://www.cdc.gov/diabetes/basics/risk-factors.html

[6] World Health Day 2016. Global Report on Diabetes (powerpoint). https://www.who.int/diabetes/global-report/WHD2016-Presentation.pdf?ua=1

[7] Diabetes concerns every family — World Diabetes Day

https://www.worlddiabetesday.org/about-wdd/wdd-2018-19.htmlit

[8] Jens Seeberg and Lotte Meinert. Can epidemics be noncommunicable? Reflections on the spread of ‘noncommunicable’ diseases. 2015. Medicine Anthropology Theory 2, no. 2: 54–71; https://doi.org/10.17157/mat.2.2.171

[9] World Health Day 2016. Global Report on Diabetes (powerpoint). https://www.who.int/diabetes/global-report/WHD2016-Presentation.pdf?ua=1

[10] https://www.worldbank.org/en/topic/poverty/overview