Type 2 Diabetes

Social, Behavioral, and Psychosocial Causes of Disease: Type 2 Diabetes (T2D)


HSA 535 – Managerial Epidemiology


Social, Behavioral, and Psychosocial Causes of Diseases: Type 2 Diabetes (T2D)

Comparison of T2D in the U.S. and developing countries

Diabetes is known to be one of the most prevalent diseases in the United States. This disease has been affecting lives in the U.S. and developing countries for thousands of years. The discovery of disease suspected to be diabetes appears in Egyptian manuscripts dating back to 1550 BCE (Centers for Disease Control and Prevention, 2014). It is believed that ancient Indians, Greek, Persian, Chinese, Japanese, and Korean physicians were well aware of the condition, just unable to determine a cause.

It wasn’t until 1910; English physiologist Sir Edward Albert Sharpey-Schafer’s study of the pancreas lead him to the detection of a substance normally produced in non-diabetics: insulin (American Diabetes Association, 2014). Harold Himsworth, in 1936 was able to distinguish between the two types of diabetes, commonly referred to today as type 1 and type 2 diabetes, but it wasn’t until the 1950’s that oral medications were developed for the actual treatment of Type 2 Diabetes. These medications provided type 2 diabetes sufferers with control of their blood sugar levels by stimulating the pancreas to develop more insulin (ADA, 2014).

According to the CDC, the prevalence of diabetes in adults worldwide was estimated to be 4.0% (135 million) in 1995 and is estimated to rise to 5.4% (300 million) by the year 2025 with a surge between India and China with estimates of significant increase amid Africa and the West Indies (2014). While diabetes has been a worldwide rampant for many years, the alarming rate of increase in the disease prevalence in developing countries is of major concern. The disease incidence is said to be higher in developed than in developing countries. Even with the strides medical professionals have made since the detection of diabetes in ancient times, the disease still remains one of the leading sources of health complications and death in both the U.S. and around the world.

T2D statistics:

According to the Nashville office for the American Diabetes Association, Tennesseans are increasingly feeling the effects of diabetes as it is currently ranked as the 5th highest state in the nation with 12.7% of people having diabetes (ADA, 2015).

Diabetes is growing at an epidemic rate in the United States affecting nearly 30 million Americans, and its prevalence is no different in my home state of Tennessee. According to the American Diabetes Association, approximately 817,852 people in Tennessee, 12.7% of the population has diabetes (ADA, 2015). The heart and a multitude of other functions in the body are directly affected by diabetes. Risk factors include an unhealthy diet, sedentary lifestyle, and many other factors.

Unfortunately, many Tennesseans who are living with diabetes do not consistently make healthy lifestyle choices or modifications once diagnosed to prevent the dominance of the disease. In 2012, only 16.8% of patients with diabetes reported practicing healthy eating habits by consuming greater than 5 servings of fruits and vegetables on a consistent basis. Of that 16.8% only 9.5% reported being physically active on a regular basis (WHO, 2014). Healthy living with diabetes is a must if the goal is to stay healthy.

Cost of treating T2D in local community:

It is no surprise to health care providers that diabetes has developed into a widespread epidemic, threatening the health and well-being of the state’s residents. It is estimated that 36,000 people in Tennessee are diagnosed with diabetes each year leaving the costs of treatment at nearly 6.6 billion for the state annually (CDC, 2014). In the year 2012 alone, for both diagnosed and undiagnosed diabetes, Tennessee was projected to have spent 4.9 billion in direct medical expenses. According to Dr. Prather, Epidemiologist of the Knoxville Health Department, statistically Knoxville it is estimated to have diagnosed 19,034 individuals with type 2 diabetes in the year 2015 leaving the costs of treatment at an estimated 7,900 annually per person or 150 million in total for the community (Prather, 2015).

It is understood that living with diabetes can be challenging for individuals on many levels. Psychosocial factors that influence both the health and ability to manage the disease include social, behavioral, emotional stress, and complex environmental factors. For these reasons state guidelines encourage both comprehensive and personalized mental health assessment and treatment as part of an individual’s routine diabetes care. According to the ADA, the most common psychological factors affecting people with type 2 diabetes includes diabetes distress, depression, anxiety, and eating disorders (APA, 2016).

Diabetes distress refers to all the reservations and uncertainties that people with diabetes experience on a daily basis. Diabetes is a day-to-day and minute-by-minute burden that often feels like a full time job for individuals with the disease. Diabetes distress is common enough that screening and treatment of diabetes distress has been added to the ADA’s Standards of Medical Care in Diabetes 2017 guidelines (MedlinePlus, 2017).

Depression and anxiety leave an individual with diabetes at risk for poor outcomes. Having the disease takes a toll on mental health, and both depression and anxiety in turn makes it harder to find the motivation to care for diabetes. Getting exercise, eating right, and completing other basic tasks are difficult when an individual is struggling just to get out of bed in the morning. Being able to assist patients in reflecting on why diabetes care is such a low priority to them when it involves taking care of their health and quality of life can be helpful once they are able to make that connection on their own. When an individual is able to understand that if they do not manage the disease properly they will not be around to enjoy family, friends, or have a job it often provides them a purpose and motivates them to manage their disease effectively.

According to the anorexia nervosa and related eating disorders website (ANRED), diabetes and eating disorders both involve attention to body issues, weight management, and control of food (2011). Because of this some individuals are likely to develop a pattern in which they use the disease to rationalize or conceal the disorder. Complications such as blindness, kidney disease, impaired circulation, nerve death, and amputation of limbs from the combination of the disease and disorder can be fatal and for that reason responsible and healthy behavior is essential for this individual.

While statistically it has not yet been determined, clinicians believe that eating disorders are more common in individuals with diabetes than in the general population. The best treatment for this combination is team treatment. Involving multiple professionals for both the patient and family is essential. For example, involving a physician to manage the diabetes and effects of starving and stuffing, a mental health therapist to help the family and a dietitian to provide nutritional counseling and education to the patient and family can begin the restoration process of physical and mental health.

Below five prudent steps are listed addressing the psychosocial proliferation of the disease.

Educate the individual on coping mechanisms to reduce the effects of diabetes distress

For example, try to change the situation to get rid of the stress. Discuss the management of care and implement a plan that works specifically for that individual’s everyday life. This intervention will help to eliminate both depression and diabetes distress.

Develop an exercise regimen that is achievable for the patient

Move to the music and make exercise fun. Find ways to loosen up through movement by stretching, shaking parts of your body throughout the day, and walking. This will assist in relaxation and physical activity reducing levels of stress and anxiety.

Provide consistent counseling and education to patients with type 2 diabetes on the complications associated with the disease

Type 2 diabetes preventions can be done through primary and secondary prevention by developing effective lifestyle modifications.

Provide individuals with team treatment.

Implementing team treatment for individuals who suffer from diabetes and an eating disorder will assist in restoring the individual’s physical and mental health.

Make available intervention programs to the diabetic population

Community health programs across the United States should be actively developing and implementing intervention programs for all age groups. Example: Project Diabetes – Tennessee

T2D in the workplace:

The goal of employee related wellness programs is to enhance the overall health of an employee while reducing the health related costs for the employer. For example, my company has recently implemented a comprehensive wellness programs that focuses on preventive health and lifestyle modifications.

Get Fit Challenge – Every two hours the activities department at my job announces over the intercom “it’s get fit time.” When that happens employees are encouraged to take a break from what they are doing and complete 20 jumping jacks and 20 squats. The idea behind this is that an individual is more likely to complete 15-20 minutes of physical activity in a day when they have a partner or group in our case encouraging and completing the activity with them.

Choose to Move Challenge – between specified time periods given by the employer individuals are encouraged to incorporate walking into their daily routine. The idea is that during the chosen period individuals will track daily movements striving to achieve the goal of walking 150 minutes/week.

Health Screenings – Every six months we have optional health screenings offered to us through our insurance provider. The insurance company sends health professionals to our facility where individual health screenings are performed. These screenings are a great way to gain insight into an individual’s unique health needs and risks for chronic diseases such as type 2 diabetes.

Brown bag lunches – This is a program that was introduced in 2016 as a healthy option for employees. These lunches provide employees with a healthy meal option along with healthy snack options at minimal cost ($4.00/bag). The idea behind this program was to boost workplace performance while meeting recommended daily nutritional needs.

Employee Incentive Program – If an employee is able to pass certain biometric markers (healthy BMI, BP, or glucose levels) our employer will cover a percentage of the cost for the health insurance premium.

Of the six steps listed above in relation to workplace environment in my opinion health screenings are the most important. The perception behind this is that more often than not individuals are so busy with everyday life they do not take the time out to obtain an annual screening. Most people do not go to the doctor until they are sick or there body offers them reasons to have a checkup. These screenings have the potential to detect a health concern early which in turn may be the difference between developing and not developing type 2 diabetes.


American Diabetes Association. Economic costs of diabetes in the U.S. in 2015. Diabetes Care. 2015; 31(3): 1-20).

American Diabetes Association. Living with Diabetes. (2014). Nashville, TN: Retrieved from: http://www.diabetes.org/in-my-community/local-offices/nashville-

Anorexia nervosa & Related Eating Disorders. (2011). Diabetes and Eating Disorders. Retrieved from: https://www.anred.com/diab.html

American Psychological Association. (2016). Psychology Plays Vital Role in Tackling Diabetes. Retrieved from: http://www.apa.org/newsroom/press-releases/2016/ada-releases-psychosocial-recommendations-for-medical-providers.html

Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. (2014). Atlanta, GA: US Department of Health and Human Services (2014).

MedlinePlus. (2017). Dealing with Diabetes Distress. Retrieved from: https://medlineplus.gov/news/fullstory_163627.html

State of Obesity. (2015). The State of Obesity in Tennessee. Retrieved from: http://stateofobesity.org/states/tn/

Tennessee Department of Health, Division of Public Health, State Center for Health Statistics. (2015). Dr. Prather: Project Diabetes. Knoxville, TN: Retrieved from: http://www.knoxcounty.org/health/ preventive services.php

World Health Organization. (2014). Diabetes. Retrieved from: http://www.who.int/mediacentre/factsheets/fs312/en/