Diabetes is the leading cause of cardiovascular disease, blindness, lower limb amputations and kidney failure in the United States (CDC, 2013a; Green, Brancati, & Albright, 2012). Diabetes is also a major cause of diabetic neuropathy, retinopathy, stroke and the seventh-leading cause of death in the U.S. (CDC, 2013a; O’Connor, & Wellenius, 2012). The Centers for Disease Control estimated that diabetes would affect up to 33% of the U.S. population by 2050.
In 2010, nearly 26 million individuals living in the U.S. had been diagnosed with diabetes and about 79 million are at high risk of developing the disease; this figure is almost more than three times higher than the total population living with diabetes in 1980 (Green, Brancati, & Albright, 2012), (CDC, 2013a; O’Connor, & Wellenius, 2012; Zhou et al, 2012). About 1.9 million new cases are diagnosed annually in the U.S. and its prevalence has increased 5- to 7- fold in the U.S. (Green, Brancati, & Albright, 2012; ADA, 2013). About 90-95% of all newly diagnosed diabetes is directly linked to type 2 diabetes (CDC, 2013a; O’Connor, & Wellenius, 2012).
Diabetes was identified as a major public health problem in the 21st century. Another 8% of the total U.S. population has diabetes and about 7 million of them do not even know that have the disease (CDC, 2013b; Green, Brancati, & Albright, 2012). It is estimated that Americans born in the year 2000 will have an increased risk of developing diabetes; about 40% of females will acquire it and about 30% of males will do as well (Green, Brancati, & Albright, 2012). It is projected that the prevalence of diabetes will be at approximately 44 million people by 2034 (Zhou et al, 2012).
Economic Impact Diabetes, the fifth cause of death in the U.S. affects approximately 13% of adults and about $90 billion is spent annually towards medical care (Sieber, Newsome, & Lillie, 2012). Diabetes cost is estimated to be at $174 billion annually in the U.S.; the burden continues to increase and affects medical care systems and availability to resources (Green, Brancati, & Albright, 2012). Beyond the cost to directly fund the medical care that supports diabetes, it also accounted for one-tenth of the U.S. health care expenditures in 2007 (Zhuo et al, 2012). In 2002, lost workdays and disability costs of about $174 million was directly linked to individuals with diabetes; individuals with diabetes account for about 27 million outpatient office visits annually and more than 68,000 individuals die annually from a diabetes related complication (O’Connor & Wellenius, 2012).
Stakeholders Individuals living in rural communities report a high incidence of diabetes; they present as a significant public health challenge due to pre-existing health disparities, lack of access to financial resources and primary care providers (O’Connor & Wellenius, 2012). The significance of addressing diabetes as a critical public health concern is well recognized (Massey, Appel, Buchanan, & Cherrington, 2010). Evidence-based management interventions for diabetes are proven to be difficult especially for rural communities.
Rural communities often encounter difficulties in access to appropriate health clinics; cultural barriers exist; high rates of health illiteracy occur and financial limitations restrict healthcare (Massey, Appel, Buchanan, & Cherrington, 2010). In comparison to urban areas, rural areas report to about a 17% higher rate of diabetes. Individuals with lower socio-economic status are likely to suffer more from type 2 diabetes than individuals who are living in rural areas where access to financial stability is greater (O’Connor & Wellenius, 2012). Solutions to the Concern from Policy Perspective
The Centers for Disease Control’s Division of Diabetes Translation (CDC/DDT) began interventions in 2009 and the Affordable Care Act authorized funding for the program in 2010 (Green, Brancati, & Albright, 2012). Policy makers have established additional efforts to prevent type 2 diabetes. The Diabetes Prevention Program trial led by the National Institutes of Health is being delivered at the community level in collaboration with community-based organizations and health care providers to reduce the prevalence of diabetes and reduce its health care related costs (Zhou et al, 2012; ADA, 2013; CDC, 2013c).
The U.S Preventive Services Task Force has recommended diabetes testing for all adults with high blood pressure readings (Ackermann, 2012; CDC, 2013a). A variety of primary prevention interventions that include lifestyle modification have been rigorously tested and proven to be effective in decreasing the prevalence of diabetes in randomized controlled trials (RCT’s); conveying the harmful risks of diabetes; adjustment of caloric intake; weight management; promotion of physical activity (ADA, 2013; Ackermann, 2012, CDC, 2013b). Although, rural/ethnic/racial socio-economic disparities are identified as some of the key factors to acquiring diabetes, primary care and public health interventions are essential in rural communities to promote prevention strategies.
Additionally, infrastructure and funding needs to be in place to promote evidence-based interventions which in rural communities are limited (Green, Brancati, & Albright, 2012). Clinical interventions that address weight management and tobacco cessation may help reduce risk factors but a broader public health or government intervention to address poverty in rural communities will sustain a better health care system in the U.S. (O’Connor & Wellenius, 2012).
An established shortage of primary care providers limits access to proper medical care and screening in rural communities. Advanced practice nurses are at a good position to advocate and promote health interventions in rural settings. It was noted that an increase of nurse practitioners to about 12% during a 4-year period in 2008 might be able to fill in the gap (O’Connor & Wellenius, 2012). The Affordable Care Act has established funding that is supporting training of 600 new nurse practitioners by 2015 and has given nurse practitioners a historic opportunity to improve the health of millions of Americans (AFSCME, 2013).
Summary of Talking Points
• Diabetes is the fifth cause of death in the U.S. that affects approximately 13% of adults.
• Diabetes cost is estimated to be at $174 billion annually in the U.S.
• Individuals living in rural communities report a high incidence of diabetes due to lack of access to primary care providers, low socio economic status and health illiteracy.
• The Affordable Act Program established in the Obama Administration has established direct funding for 600 new nurse practitioners by 2015.
• Healthcare reform will increase the number of rural people seeking healthcare.
• Advanced practice nurses have an opportunity to promote healthy lifestyle modifications that will prevent the incidence of diabetes in rural communities.