The lack of self-management of people with

type 2 diabetes mellitus in the United States

2.Findings and discussion

2.1 The current situation of type 2 diabetes mellitus in the United States

Currently,according to the American Diabetes Association, approximately 26 million Americans have

diabetes . Among the patients with diabetes,there are an estimated 24 million Americans (85% of the
patients)struggling with the type 2 diabetes mellitus(T2DM),up more than 3 million people since 2005.
Figures from the 2007 National Diabetes Fact Sheet (the most recent year for which data is available)
shows that 23.6 million children and adults in the United States—7.8% of the population—have diabetes,
including 17.9 diagnosed million people, undiagnosed 5.7 million people and pre-diabetes 57 million people.
Furthermore, there are 1.6 million new cases of diabetes each year. Here are some charts and graghs indicating
the current situation of diabetes mellitus in America. The figures is quite alarming. A new analysis conducted
by UnitedHealth Group's Center for Health Reform and Modernization points out more than half of all
Americans will have diabetes or prediabetes by the year 2020.
2.2 The lack of self-management of people with type 2 diabetes mellitus in

the United States

 2.2 Complications of T2DM in the United States
About 85% of patients with diabetes are Type 2 diabetes .Type 2 diabetes is
more common in African Americans, Latinos,Native Americans, and Asian
Americans, Native Hawaiians and other Pacific Islanders, as well as the aged
population.
Type 2 diabetes, formerly known as on-insulin dependent diabetes mellitus, is a
serious and progressive disease. It is chronic innature and has no known cure. It is the
fourth most common cause of death in most developed countries (UK Prospective
Diabetes Study Group 1998a).
In type 2 diabetes, either the body does not produce enough insulin or the cells
ignore the insulin. Insulin is necessary for the body to be able to use glucose for
energy. When you eat food, the body breaks down all of the sugars and starches into
glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from
the blood into the cells. When glucose builds up in the blood instead of going into
cells, it can lead to diabetes complications.(American Diabetes Association).
Based on the estimated data from Centers for Disease Control and Prevention
(CDC), the outpatient database of the Indian Health Service (IHS), the U.S. Renal
Data System of the National Institutes of Health (NIH), the U.S. Census Bureau,
People with Diabetes Mellitus(DM) are more likely to have heart disease death rates
two to four times higher than adults without diabetes.Besides the high risk of the
cardiovascular disease ,people with DM are more likely having the blindness(12,000
to 24,000 new cases of blindness each year) ,kidney disease(In 2005,178,689 people
with diabetes began treatment for end_stage kidney disease in the United States and
Puerto Rico) ,nervous system disease(about 60-70 percent of people with diabetes
have mild to severe forms of nervous system damage),amputations(in 2004,about
71,000 nontraumatic lower limb amputations were performed in people with
diabetes),dental disease(almost one-third of people with diabetes have severe
periodontitis than those without diabetes) and complications of pregnancy etc.

2.3 Diabetes Costs in the United States

Recent study investigators points that ten percent of the total health care
spending by the end of the decade at an annual cost of almost$500 billion which up
from an estimated $194 million in 2010.The study by UnitedHealth Centre for Health
Reform and Modernization offers solutions designed to improve health and life
expectancy, while also saving up to $250 billion over the next 10 years(November
23rd,2010 CNN health).

2.4 Solutions for the control of complications of T2DM

 2.41 Trends of future----the medical care programme
The most recent report by UnitedHealth suggests that the next decades of years
the strategies to fight against the DM should focus on early intervention programme to
prevent prediabetes, instituting stronger medication programmes and educating
Americans on lifestyle changes they can make to control DM.Simon Stevens, executive
vice president,United Health Group,and chairman of the UnitedHealth Centre for Health
Reform and Modernization."Making a major impact on the prediabetes and diabetes
epidemic will require health plans to engage consumers in new ways, while working to
scale nationally some of the most promising preventive care models.Done right,the
human and economic benifits for the nation could be substantial."Many research
demonstrated that given the proper education and medications, people with T2DM can
efficiently control their complications of DM.

2.42 The self-management skills for people with T2DM in the

United States

Frequent physician visits do not assure that persons diagnosed with DM follow care
recommendations.Health care providers may fail to abide by the DM care
recommendations either by not providing particular services or failing to stress the
importance of diabetes self-management to their patients (Sloan et al. 2004; Keating et al.
2007).The research from Health Research and Educational Trust(Frank A. Sloan, Norma A.
Padro ´ n, and Alyssa C. Platt),set the values of each statement to investigate whether the
patients will follow the recommendations and manage to control the DM by his own .From
the result of the study nearly half of individuals (46 percent) reported having control over
events in their lives and almost the same percentage(42 percent) reported that they think
about the future and do not live one day at a time.On average,respondents assigned a
probability of living about 10 more years at 0.36, and most individuals fell into the highest
(59 percent, the omitted reference group) or lowest (30 percent) risk tolerance
categories.Not reflected in the percentage distribution of persons by risk tolerance is a
sizable number of missing values(53 percent).The result is far from perfect which indicated
us should consider more factors to implement a more feasible care programme.
DISCUSSION:

In order to develop a comprehensive care programme for people with T2DM, Individual plan
perspetive accounting for many factors( such as age ,years of shooling,income,race etc) should be
the good way for patients to control the T2DM.The status of health
indicators( nurses,psychologists,physicians) need to be identify to find a proper programme and
framework suitable to the patients with T2DM.
The estimates on diabetes in this fact sheet were derived from various data systems of the Centers for
Disease Control and Prevention (CDC), the outpatient database of the Indian Health Service (IHS), the
U.S. Renal Data System of the National Institutes of Health (NIH), the U.S. Census Bureau, and
published studies. Estimates of the total number of people with diabetes and the prevalence of diabetes
in 2007 were derived using 2003–2006 National Health and Nutrition Examination Survey (NHANES),
2004–2006 National Health Interview Survey (NHIS), 2005 IHS data, and 2007 resident population
estimates