Beat it

Beat it

Nine things you need to know why fighting diabetes must start in cities



Urban areas are complex environments. A large number of environmental, social, cultural and economic factors have an impact on individual and population health. In the following, we will take a look at how urbanisation impacts lifestyle.
1. Diabetes is an emergency in slow motion
It may not have the immediacy of communicable diseases, such as malaria, tuberculosis, and HIV, but diabetes is a bigger killer globally than all of the above combined. (1) It is estimated that 415 million people, or about one in every 11 people, are living with the condition worldwide–that is 33 million adults more than in 2013. (2)
 A young girl visits a Mexico City hospital with her mother. Will she ever see a decline in the rise of urban diabetes?
2. Cities are the frontline of the battle against diabetes
Already today, two-thirds of all people with diabetes live in urban environments. Urban diabetes is on the frontline of the diabetes challenge. Without urgent action, the trajectory is clear:
•           In Mexico City, where diabetes is already the leading cause of death, the number of people with the condition could rise to over 6 million people–nearly 1 in 5 of the population–by 2040.
•           In Houston, diabetes rates are expected to jump from nearly one person in 10 to one person in 5 over the next 25 years. (3)
3. There are underlying social and cultural drivers
 By 2035 as many as half a billion people will have type 2 diabetes. (4)Medical treatment is essential but will not halt its rise. If we’re serious about changing the rise of type 2 diabetes, we must look at the problem in a different way. This means looking to the nearly 2 billion people worldwide who are at risk of developing type 2 diabetes. (5) It means looking at the social factors and cultural determinants that make people vulnerable in the first place–before they ever see a doctor.
4. Loneliness
One of the striking findings in the Cities Changing Diabetes study is the impact of living alone and lack of social support.
Living alone is an indicator of vulnerability to diabetes–influencing people’s ability to take care of their own health and prepare healthy meals. Instead they end up choosing easy solutions such as bread, frozen products or takeaways. (6) In Copenhagen, researchers found those living alone are nearly twice as likely to have diabetes. (7)
5. New normal
Obesity seem to impact the normative body images, and when these change, so do the perceptions of what ‘a healthy body’ might look like. In Houston, where there are high levels of obesity, the study found that when comparing your own body size and physical shape favourably to others, this can create a scenario where change can be perceived as un-necessary. (8)
 Habits are hard to break: “If she can, I can too”
6. Urban myths and misconceptions
The study found popularly held misconceptions about what causes diabetes. In Mexico City, where 74% of the adult population is either overweight or obese, people talked about the fear and stress of living in the city; Diabetes was an emotional or psychological issue. (9) In Tianjin, a huge city powered by petrochemical, car manufacturing and metalworking industries, beliefs about what causes diabetes was sometimes linked to water and air quality as well as hormones and chemical additives in food.(10)
7. Time pressures
 Do you manage your health as well as you manage your inbox?
Time constraints have a direct impact on diabetes vulnerability, as they dictate what is feasible in terms of prevention and management of diabetes. In Tianjin, researchers found that many did not see diabetes as a serious disease, and therefore do not pay much attention to everyday diabetes care. However, once diabetes-related complications occur, beliefs and attitudes towards the illness dramatically change; suddenly, diabetes is taken much more seriously. (11)
8. Sedentary lifestyles
Urban living encourages sedentary lifestyles. Overpopulation, road traffic density, excessive use of motorised transportation, poor air quality and too few green public spaces make physical activity difficult in cities. At the global level, absence of physical exercise and sedentary lifestyles are the fourth-largest risk factor for mortality. (12)
9. Inequality
Today’s urban areas are also characterised by increasing health inequalities.(13) In Copenhagen, for example, there are disparities in average lifespan of almost 7 years between areas of the city. People not in employment are almost 7 times more likely to have diabetes than those in employment. (14)
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Source:
1: http://www.huffingtonpost.com/entry/diabetes-deaths_5643e784e4b08cda348777bf
2: Diabetes atlas, 2013 and 2015
3: Cities changing diabetes briefing book
4: IDF Diabetes Atlas,
5: http://care.diabetesjournals.org/content/34/6/1249.full
6: Cities changing diabetes briefing book;

7, 8, 9, 10, 11: ibid

New diabetes screening recommendation misses more than half of high-risk patients


Latest screening guidelines don't identify many patients with diabetes, prediabetes, say experts

Northwestern University

Summary:
Fifty-five percent of high-risk patients were missed by diabetes screening guidelines, according to a new study. Not identifying patients with diabetes and prediabetes prevents them from getting the necessary preventive care. This is the first study to examine how the latest diabetes screening guidelines, issued in October 2015, may perform in practice.
The latest government guidelines doctors follow to determine if patients should be screened for diabetes missed 55 percent of high-risk individuals with prediabetes or diabetes, a new Northwestern Medicine study found.
The 2015 screening guidelines from the United States Preventive Service Task Force (USPSTF) recommend patients be screened for diabetes if they are between 40 and 70 years old and are overweight or obese. But the study found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities.
Not identifying individuals with dysglycemia (prediabetes or diabetes) in these high-risk groups means they will miss out on taking preventive measures, such as eating right and exercising or taking medications. This is the first study to examine how the new USPSTF guidelines, issued in October, may perform in practice.
Under a provision in the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. Therefore, a patient who falls outside the diabetes screening guidelines and requests a test may have to pay out of pocket.
"Preventing and treating diabetes early is very important, especially in this setting of community health centers, where many of their socioeconomically disadvantaged patients face barriers to following up regularly," said study senior author Dr. Matthew O'Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. "If you miss someone now, it might be years before they come back, at which point they have overt diabetes and maybe even complications, like heart attacks or strokes."
The study will be published in PLOS Medicine on July 12.
Fifty-four percent of white patients who developed dysglycemia fell within the screening guidelines, compared to only 50 percent of African-American patients and 37 percent of Latino patients, according to the study.
"Say I'm caring for an obese 32-year-old Hispanic woman with a family history of diabetes who had gestational diabetes with a previous pregnancy. She shouldn't be screened, according to the guidelines, but she's very likely to have either prediabetes or diabetes," O'Brien said.
The study looked at electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013.
O'Brien said the USPSTF is on the right track with their guidelines because they focus on the two risk factors -- age and weight -- that are most predictive of developing dysglycemia. However, physicians should be aware of this study's findings, so they can understand who may be missed by the USPSTF's criteria and decide whether to screen those patients, he said.
"We were interested to do this study because of population trends that racial and ethnic minorities are developing diabetes at younger ages and lower weights than whites," O'Brien said.
With these findings, O'Brien said next steps are to decide what other factors should be taken into account when determining who is at risk for diabetes and to use electronic health records to automatically prompt providers to screen patients who have those risk factors.
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Story Source:
The above post is reprinted from materials provided byNorthwestern University. The original item was written by Kristin Samuelson. Note: Materials may be edited for content and length.
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Journal Reference:
1.         Matthew J. O’Brien, Ji Young Lee, Mercedes R. Carnethon, Ronald T. Ackermann, Maria C. Vargas, Andrew Hamilton, Nivedita Mohanty, Sarah S. Rittner, Jessica N. Park, Amro Hassan, David R. Buchanan, Lei Liu, Joseph Feinglass.Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients.PLOS Medicine, 2016; 13 (7): e1002074 DOI:10.1371/journal.pmed.1002074