Diabetes: What Women Need to Know

Shelley Chandler

Liberty University Online

Health 634-B02

Health Communication and Advocacy

February 25, 2018

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Introduction

Chronic diseases are a major factor of health care in the United States and are associated

with health damaging behaviors and aging. The most common chronic diseases: cancer,

hypertension, stroke, heart disease, pulmonary conditions, mental illness and diabetes are

reported to cause the US a $1.3 trillion economic burden 1. Diabetes, affects millions of

Americans and can be considered a precursor to other chronic diseases. It occurs when the body

cannot product enough of the hormone insulin or respond appropriately to it2. A poorly

functioning insulin signaling causes blood glucose levels to become elevated leading to other

metabolic abnormalities. Having diabetes means a higher rate of developing heart disease,

vision loss, stroke, kidney failure, amputation, high blood pressure, or high cholesterol as high

blood glucose damages the blood vessels and nerves that control your heart and blood vessels 3,4.

In 2015, 30.3 million Americans (9.4 %) was reported to have diabetes and 84 million have pre-

diabetes which if untreated can lead to type 2 diabetes within five years3. Rates of diagnosed

diabetes increased with age and of the millions of diabetics reported, more than 13 million of

them are women 3.

The purpose of this literature review is to discuss research of the disease burden of

diabetes and how it can be avoided or alleviated. The data from the research will support a

planned health communication intervention that will bring awareness to the dangers of diabetes

and knowing the importance of monitoring glucose levels through group education sessions over

a twenty-four-month period. The intervention is relevant and justifiable as reducing the disease

burden of diabetes and improving the quality of life for those affected or at risk is a goal of the

Healthy People 2020 initiative 2. Given the data prior mentioned, the communication

intervention will be geared towards women, targeting those over forty.

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This paper will be organized by the following sections: an introduction, body of

evidence, and summary. The current section, the introduction, explains the impact and burden of

diabetes and the need for a health communication intervention. The next section will discuss the

reference material by type along with a summary of the findings. The reference material used

was published within the past eight years and was selected based on content that included:

1. A description of diabetes

2. Prevalence and incidence trend

3. Differences in the diabetes between sex, gender and age

4. The effects of lifestyle changes

5. Barriers

Material excluded from that section were those that focused primarily on race. The concluding

section will summarize the literature review.

Body of Evidence

Bernell states in this journal discusses that the steep rise of type 2 diabetes and

associated complications go along with mounting evidence of clinically important sex and

gender differences 5. The purpose of the study is to increase awareness of health professionals in

the gender difference of type 2 diabetes. It points out that the prominent risk factor for both sexes

is obesity but is diagnosed at a lower age and body mass index (BMI) for men. The journal also

pointed out that psychosocial stress appears to have a greater impact on women than men, this

leads into women also having a greater increase of cardiovascular risk, myocardial infarction,

and stroke when compared to nondiabetic subjects 5. The study gave a detailed look at several

factors of diabetes which included; biological risk factors, health behavior, pathophysiological
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mechanisms, cardiovascular complications, cardiomyopathy, diabetic foot syndrome, diabetic

neuropathy, and other comorbidities. The overall conclusion was that the sex of an individual

plays a key role in the manifestation and management of type two diabetes and personalized

treatment must consider all the differences. The following journal focuses on women only but

adds justification for the age of the target audience of the intervention.

Healthy People 2020 objective was to find a relationship between type 2 diabetes and the

age of menopause. The relationship between menopausal age and cardiovascular disease risk is

well established but a relationship for type 2 diabetes remains unclear 6. The research used data

from the InterAct study, a cohort with an 11-year follow-up of post-menopausal subjects with the

median age of 59. Some values for screening included: BMI, lifestyle factors and hysterectomy

status. The result concluded that after 10.7 years an earlier age of menopause was associated

with higher rates of diabetes. The hazard of type 2 diabetes was 32% higher in women who

entered menopause before 40 as compared to those who were between 50-54. The next two

journals will examine the prevalence of type 2 diabetes in the United States.

The Center for Disease Control and Prevention used prior collected data in this journal.

The purpose of this study was to compare the incidences of lower-extremity amputations, end-

stage renal disease, acute myocardial infarction, stroke, and death from hyperglycemic crisis

between 1990-2010 7. By using the National Health Interview survey (NHIS) data on a 57,000-

adult sample they collected data that showed the rates of two of the mentioned complications had

significantly declined during the time frame, myocardial infarction and hyperglycemia related

mortality. Given the reductions for the two mentioned there was not a significant imminent

reduction in the overall burden of diabetes-related complications. There was an increase in the
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other comorbidities. The timeframe for this study is included in the timeframe covered in the

following study.

Geiss LS et al. used the NHIS data and examines long term trends in the prevalence and

incidence of diagnosed diabetes overall and not just certain comorbidities. This study is

inclusive of both type 1 and type 2 diabetes. Based on their reviewed data they did not see any

changes in the1980’s but did see a sharp increase between 1990 - 2008. This study relates the

near doubling to a doubling rate of incidence of diabetes among race subgroups 8. A deeper dive

into the health behaviors may give insight to the rising incidence of diabetes.

Hu FB, et al. looks at the relation between the combination of individual dietary and lifestyle

factors in relation to type 2 diabetes. With a sample of over 80,000 nurses who were free of

diabetes or comorbidity at the baseline. A low risk group was educated the on their diet, BMI,

smoking cessation, and a decrease in alcohol intake. During the 16 year follow up there were

3300 new cases in type 2 diabetes due to lack of exercise and poor diet among other negative

lifestyle behaviors. They concluded that most of cases of type 2 diabetes could be prevented by

the adoption of a healthier lifestyle 9 The following journal has a similar theme.

Gomez-Ambrosi’s study of over 4000 subjects showed that there is a direct correlation

between obesity and the presence of prediabetes or type 2 diabetes 10. Barriers to self-managing

diabetes may also play a part in in the prevalence of diabetes.

Rosland et al. examines if family influences can help or hinder an individual. The study

participants of this study included patients with diabetes or heart failure and they looked at

characteristics associated with family support and barriers. Family members in their study were

highly involved in the self-care of higher functioning patients 11. Their cross-sectional survey of
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439 (male and female) patients resulted in 75% of respondents reporting supportive family

involvement while the remaining 25% reported that their family caused barriers to self-care 11.

Health literacy of the patients were associated with the results. Women reported less family

support and more family barriers to self-care than men. Low health literacy, partnered status

with higher family function were associated with higher family support levels, while female,

older age, higher education, and more depression symptoms showed in the patients with family

barriers to self-care 11. This study shows that women may have more barriers in access to self-

care than men. The following study builds on this and discusses inner struggles for women.

Hu FB, et al.’s objective of this Swedish study is to examine how women handle the needed

lifestyle changes due to diabetes. The changes included regular to moderate physical activity

and a healthy diet, weight lose if the participant was overweight. The study uses ten women, ages

ranged from 37 to 87 with a mean of 65, with diabetes who had complications ranging from none

to stroke. The study concluded that perceptions of change posed a continuous struggle with

feelings of becoming a victim of pressurizing demands and were unfairly treated by life. The

overall conclusion was that healthcare professionals should be aware of deterrents to lifestyle

change to facilitate women’s struggle for improved health 12.

Summary and Conclusions

All the prior journals give relevance to the health communication intervention of diabetes

education to women over 40. These studies show that the incidence and prevalence of diabetes

has risen over the years despite acute care interventions. The minor differences may have been

the comorbidities discussed and two of the studies took place outside of the US. I included in for

my review as they speak to the burden of diabetes being global and not just confined to the

United States.
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The study regarding lifestyle changes may be flawed due to the small sample size. The long-

term impact of this intervention and subsequent similar interventions will help to decrease the

incidence of this chronic disease.