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Course Project Part IV

Jonathan Bland
Issues in Public Health
Professor Aqueelah Barrie

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I choose Diabetes as my topic. Since diabetes is one of the leading diseases that
is affecting the United States at this moment in time. Diabetes is currently one of the
fastest growing medical issues affecting the youth of today. Diabetes is a killer of all
ages but it seems that diabetes is starting to hit the adolescent age groups. The youth
of today stay inside and play video games, whether it is on the computer, x-box,
PlayStation, or WII. The children do not get out and play. The articles I choose were
about how diabetes affects Hispanic Americans, White Americans, and African
American youth. Diabetes is one of the most common diseases in school-aged children.
According to the National Diabetes Fact Sheet, about 186,300 young people in the US
under age 20 had diabetes in 2007. This represents 0.2% of all people in this age group
(YourDiabetesinfo.org, 2008). Based on data from 2002-2003, the SEARCH for
Diabetes in Youth study reported that approximately 15,000 US youth under 20 years of
age are diagnosed annually with type 1 diabetes, while 3,700 are newly diagnosed with
type 2 diabetes. Type 2 diabetes is rare in children younger than 10 years of age,
regardless of race or ethnicity. After 10 years of age, type 2 diabetes becomes
increasingly common, especially in minority populations, representing 14.9% of newly
diagnosed cases of diabetes in non-Hispanic whites, 46.1% in Hispanic youth, 57.8% in
African Americans, 69.7 % in Asian/Pacific Islanders, and 86.2% in American Indian
youth. (YourDiabetesinfo.org, 2008).
Type 1 diabetes is an autoimmune disease in which the immune system destroys
the insulin-producing beta cells of the pancreas that help regulate blood glucose levels.
Type 1 diabetes mostly has an acute onset, with children and adolescents usually able

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to pinpoint when symptoms began. Onset can occur at any age, but it most often occurs
in children and young adults (YourDiabetesinfo.org, 2008). When the pancreas cannot
produce insulin anymore the people with type-1 diabetes are required to take insulin
shots or via insulin pump on a daily basis.
Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes, but
is the leading cause of diabetes in children of all ages, and in those less than 10 years
of age, type 1 accounts for almost all diabetes. A diabetes management plan for young
people includes insulin therapy, self-monitoring of blood glucose, healthy eating, and
physical activity. The plan is designed to ensure proper growth and prevention of
hypoglycemia. New management strategies are helping children with type 1 diabetes
live long and healthy lives. (YourDiabetesinfo.org, 2008)
The first stage in the development of type-2 diabetes is often insulin resistance,
requiring increasing amounts of insulin to be produced by the pancreas to control blood
glucose levels. Initially, the pancreas responds by producing more insulin, but after
several years, insulin production may decrease and diabetes develops. Type 2 diabetes
used to occur mainly in adults who were overweight and older than 40 years. Now, as
more children and adolescents in the United States become overweight, obese and
inactive, type 2 diabetes is occurring more often in young people. Type 2 diabetes is
more common in certain racial and ethnic groups such as African Americans, American
Indians, Hispanic/Latino Americans, and some Asian and Pacific Islander Americans.
The increased incidence of type 2 diabetes in youth is a first consequence of the

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obesity epidemic among young people, and is a significant and growing public health
problem. Overweight and obese children are at increased risk for developing type-2
diabetes during childhood, adolescence, and later in life (YourDiabetesinfo.org, 2008).
Another form of diabetes that affects children is maturity-onset diabetes of the young
(MODY). The first stage in the development of type-2 diabetes is often insulin
resistance, requiring increasing amounts of insulin to be produced by the pancreas to
control blood glucose levels. Initially, the pancreas responds by producing more insulin,
but after several years, insulin production may decrease and diabetes develops. Type-2
diabetes used to occur mainly in adults who were overweight and older than 40 years.
Now, as more children and adolescents in the United States become overweight, obese
and inactive, type-2 diabetes is occurring more often in young people. Type-2 diabetes
is more common in certain racial and ethnic groups such as African Americans,
American Indians, Hispanic/Latino Americans, and some Asian and Pacific Islander
Americans. The increased incidence of type-2 diabetes in youth is a first
consequence of the obesity epidemic among young people, and is a significant and
growing public health problem. Overweight and obese children are at increased risk for
developing type-2 diabetes during childhood, adolescence, and later in life.
Diabetes in the Hispanic youth population concluded that factors such as poor
glycemic control, elevated lipids, and a high prevalence of overweight and obesity may
put Hispanic youth with type-1 and type-2 diabetes at risk for future diabetes-related
complications (Lawrence, 2009). It was determine that the first was Hispanic

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Americans found that type-1 diabetes was more prevalent than type-2 diabetes,
including in youth aged 10-19 years.
The second was diabetes in non-Hispanic white youth. They found that the
prevalence of type 1 diabetes (at ages 019 years) was 2.00/1,000, which was similar
for male (2.02/1,000) and female (1.97/1,000) subjects. The incidence of type 1
diabetes was 23.6/100,000, slightly higher for male compared with female subjects
(24.5 vs. 22.7 per 100,000, respectively, P = 0.04). Incidence rates of type 1 diabetes
among youth aged 014 years in the SEARCH study are higher than all previously
reported U.S. studies and many European studies (Bell, 2009). They reached the
conclusions that the incidence of type-1 diabetes in the non-Hispanic white youth in the
US is one of the highest in the world. They discovered the second was diabetes in nonHispanic white youth. They found that the prevalence of type 1 diabetes (at ages 019
years) was 2.00/1,000, which was similar for male (2.02/1,000) and female (1.97/1,000)
subjects. The incidence of type 1 diabetes was 23.6/100,000, slightly higher for male
compared with female subjects (24.5 vs. 22.7 per 100,000, respectively, P = 0.04). They
reached the conclusions that the incidence of type-1 diabetes in the non-Hispanic white
youth in the US is one of the highest in the world.
The third was about diabetes in African-American Youth. Among African American
youth aged 09 years, prevalence (per 1,000) of type 1 diabetes was 0.57 (95% CI
0.470.69) and for those aged 1019 years 2.04 (1.852.26). Among African American
youth aged 09 years, annual type 1 diabetes incidence (per 100,000) was 15.7 (13.7

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17.9) and for those aged 1019 years 15.7 (13.817.8). A1C was 9.5% among 50% of
youth with type 1 diabetes aged 15 years (Mayer-Davis, 2009). Type 1 diabetes
presents a serious burden among African American youth aged <10 years, and African
American adolescents are impacted substantially by both type 1 and type 2 diabetes
(Mayer-Davis, 2009).
In the report on physical activity-induced improvements in markers of insulin
resistance in overweight, obese children, and adolescents, they reported that when
children engage in physical activity alone, without dietary intervention, can have a
positive, and significant impact on insulin resistance risk and potentially prevent the
development of type-2 diabetes in overweight and obese youth. The studies reviewed
provide support for the future interventions to shift the focus from reducing obesity to
increasing physical activity for the prevention of type-2 diabetes in obese youth
(Tompkins, Moran, Preedom, & Brock, 2011). This report makes excellent sense. When
children exercise they lose weight and the chances of them not developing type-2
diabetes.
The next report I read was about reducing obesity and related chronic disease risk in
children and youth: a synthesis of evidence with 'best practice' recommendations. The
evidence reviewed indicates that current programs lead to short-term improvements in
outcomes relating to obesity and chronic disease prevention with no adverse effects
noted. This supports the continuation and further development of programs currently
directed at children and youth, as further evidence for best practice accumulates. In this

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synthesis, schools were found to be a critical setting for programming where health
status indicators, such as body composition, chronic disease risk factors and fitness,
can all be positively impacted. Engagement in physical activity emerged as a critical
intervention in obesity prevention and reduction programs. While many programs in the
review had the potential to integrate chronic disease prevention, few did; therefore
efforts could be directed towards better integration of chronic disease prevention
programs to minimize duplication and optimize resources. Programs require sustained
long-term resources to facilitate comprehensive evaluation that will ascertain if longterm impact such as sustained normal weight is maintained. Furthermore, involving
stakeholders in program design, implementation and evaluation could be crucial to the
success of interventions, helping to ensure that need is met. A number of
methodological issues related to the assessment of obesity intervention and prevention
programs were identified and offer insight into how research protocols can be enhanced
to strengthen evidence for obesity interventions. (Flynn, NcNeil, & Maloff, 2006) Again
this report also suggested that physical activity is the best way to prevent diabetes in
the youth.
The next report I researched was Translating the diabetes prevention program for
Northern Plains Indian youth through community-based participatory research methods.
There perspectives of factors that encouraged or were barriers to healthy diet and
exercise behaviors in AI youth. They focused on diet and exercise to control and fight
diabetes. This was the best one. They not only addressed one issue they addressed

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both issues when it can to diabetes.(Brown, Harris, Harris, Parker, Ricci, & Noonan,
2010).
The next paper I researched was an effective lifestyle intervention in overweight
children: One-year follow-up after the randomized controlled trial on "Obeldicks light".
This study was aimed at obese children. Obeldicks light is based on physical activity
training, nutrition education, and behavior counseling for overweight children and their
parents. This was very good that they were looking at treating the children and stopping
diabetes by attacking the disease in three directions. After 12 months they concluded
that the children lost weight and overall fat mass, reducing their chances at getting
diabetes (Schaefer, Winkel, E, Kolip, & Reinehr, 2011).
The next paper I researched was Healthy outcomes for Teens project: diabetes
prevention through distributed interactive learning. The paper studied the assessment
of distributed interactive learning via web-based modules and grounded in schema and
social cognitive theory would increase knowledge about diabetes prevention in
adolescents from three middle schools to a greater extent than the control group and
examined whether the school environment used to convey the education had an effect.
They concluded that distributed interactive learning was more effective than its passive
counterpart, and more structured delivery enhanced knowledge, as did opportunities to
self-regulate learning. Attention to these process components will facilitate effective
interventions by educators in schools (Castelli, Goss, Schere, & Chapman-Novakofski,
2011).

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The five different methods that Ive researched told the different ways we can
prevent adolescent diabetes. The first two articles I read were about how we can add
more physical exercise to combat diabetes. The exercise cuts down on the fat and
creates less chance of diabetes developing. These would be primary interventions. The
next report I found about the research completed on the Indian reservation. This would
be an example of a secondary intervention. The next report was about how the child
could change their lifestyles. Lifestyle changes could be an example of secondary. The
final report I found was about a program called Obeldicks light. This addressed all
three ways we could start the fight with child hood obesity. This is a prime example of
primary intervention. The last was about presenting materials to children through web
based learning about diabetes and how to prevent it at an early age. This would be an
example of tertiary intervention.
The various interventions that were discussed in this paper, regarding stopping
diabetes before it starts, looks at all the different ways we as parents can use to help
our children. There was one intervention that addressed the three main ways we could
do something about stopping diabetes. The paper addressed proper diets, exercise,
and counseling. Children need someone to talk to other than their parents or friends
especially if they are overweight and trying to lose weight. The other papers were all
addressing one form or another to stop diabetes. The impact of these papers on the
youth today if they were implemented throughout the United States would decrease the
number of diabetic cases seen each year in the Doctors offices. The entire youth of
today could live longer and healthier if diabetes was stopped before it started.

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Works Cited
Bell, R. A. (2009). Diabetes in Non-Hispanic White Youth. Diabetes Care, S102-S111.

Brown, B., Harris, K., Harris, J., Parker, M., Ricci, C., & Noonan, C. (2010, Nov). Translating the diabetes
prevention program for Northern Plains Indian youth through community-based participatory
research methods. Retrieved April 30, 2011, from PubMed.Gov:
http://www.ncbi.nlm.nih.gov/pubmed/20944056

Castelli, D., Goss, D., Schere, J., & Chapman-Novakofski, K. (2011, Mar 13). Healthy outcomes for teens
project: diabetes prevention through distributed interactive learning. Retrieved April 30, 2011,
from PubMed.gov.

Flynn, M., NcNeil, D., & Maloff, B. (2006, Feb 07). and related chronic disease risk in children and youth:
a synthesis of evidence with 'best practice' recommendations. Retrieved April 30, 2011, from
PubMed.Gov: http://www.ncbi.nlm.nih.gov/pubmed/16371076

Lawrence, J. M. (2009). Diabetes in Hispanic American Youth. Diabetes Care, S123S132.

Mayer-Davis, E. J. (2009). Diabetes in African American Youth. Diabetes Care, S112-S122.

Schaefer, A., Winkel, K., E, F., Kolip, P., & Reinehr, T. (2011, April 20). An effective lifestyle intervention in
overweight children: One-year follow-up after the randomized controlled trial on "Obeldicks
light". Retrieved April 30, 2011, from PubMed.Gov:
http://www.ncbi.nlm.nih.gov/pubmed/21514017

Tompkins, C., Moran, K., Preedom, S., & Brock, D. (2011, April 26). Physical Activity-Induced
Improvements in Markers of Insulin Resistance in Overweight and Obese Children and

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Adolescents. Retrieved April 30, 2011, from PubMed.gov:

http://www.ncbi.nlm.nih.gov/pubmed/21521161

YourDiabetesinfo.org. (2008, Aug). Overview of Diabetes in Children and Adolescents. Retrieved April 30,
2011, from NIH.GOV: http://www.ndep.nih.gov/media/Youth_FactSheet.pdf