Understanding Diabetes

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Diabetes is a chronic disease that’s triggered by either lack of the pancreas to produce enough insulin or the inability of the body to use the insulin produced, which results in lack of regulation of blood glucose in the body.

Types of diabetes

There are two types of diabetes. Diabetes 1 and diabetes 2.

Diabetes 1 occurs when the body’s immune system responsible for fighting infection attacks and destroys the insulin producing Beta cells of the pancreas. Scientists tend to think that diabetes 1 is caused by genes and environmental factors such as viruses that have the capability to trigger the disease 

Diabetes 2 has its onset on several factors which include being overweight, not having enough exercise, and to larger extent genetics. Having regular blood tests and check-ups with a healthcare provider is advised because it helps detect the disease at an early stage. Other causes of this type of diabetes include insulin resistance, genetic mutations, hormonal diseases and damage to or removal of the pancreas.

Diabetes Prevention 

Most of the measures that can be taken to prevent the prevalence of diabetes are practical. They comprise:

-Losing extra weight which reduced the risk of getting the disease

-Exercising regularly 

-Eating healthy plant foods that provide vitamins, minerals and carbohydrates 

-Skipping fad diets and generally making healthier choices in life

Diabetes in the USA 

As per 2021,29.7 million people of all ages, which translates to 8.9% of the US population had diagnosed diabetes.353, 000 children and adolescents younger had diagnosed diabetes.

Diabetes is the 7th leading cause of death in the US. Poorly controlled or treated diabetes can also lead to leg or foot amputations, vision loss or kidney damage. People who don’t have diabetes should be advised to take precautions by eating healthily, being actively involved in physical activity, and taking measures to lose weight in order to keep the risks of contracting the disease at bay.

Diabetes Prevention Policy in the US in Relation to the Affordable Care Act(ACA)

Type 2 diabetes has apparently become a major health problem in the US. It affects 12% of adults. It has added health as well as economic burden to the US populace.

It’s preventable because it’s largely a socially and environmentally provoked condition. The main cause of this disease is obesity, dietary composition and physical inactivity. It’s advisable that people adopt healthier lifestyles which subsequently reduce highly elevated blood glucose levels.

Over 86 million Americans, or one out of three adults are classified as having prediabetes. This means that their blood sugar level is higher than normal though not high enough to be considered diabetic.

Research has shown that about 5-10% predisposed people develop diabetes each year whereas 70% are bound to develop it during their lifetime. Diabetes mostly affects the poor, and to some extent racial and ethnic minorities.

The US Diabetes Prevention Program (DPP) has demonstrated intensive lifestyle intervention focused on achieving 7% weight loss and 150 minutes per week of moderate training can halve the risk.

OPP and other trials also found that Metformin, a medication that’s often used to treat diabetes, is also effective in preventing diabetes. The benefits of Metformin compounded by lifestyle intervention can be witnessed within 3-6 months and can last for as long as a decade. But these are not the only methods and so they aren’t enough to prevent diabetes.

Policies, Systems and Environmental changes (PSE) are also advocated for since they are essential elements of a long-term agenda to prevent chronic diseases like diabetes. Policies and Environmental changes work on the principle of making healthy behavior accessible and desirable while trying to ensure that unhealthy behavior is more difficult, inaccessible or even prohibited.

System level intervention aims to improve the functioning of an agency or organization while ensuring that service delivery to the community is realized. The Patient Protection and Affordable Care Act represents a collection of PSE interventions that are aimed at scaling down diabetes nationally.

The ACA targets multiple levels of influence, an approach that is widely advocated for by public health authorities tasked with tackling Diabetes Prevention.

This initiative can only work when individuals are made aware, motivated and supported toward self-care. Recommendations for raising individual awareness of diabetes risk require testing of blood glucose or hemoglobin AIC within the health system.

Under these circumstances, ACA tries to enable access to prepared and proactive personnel and services that enables risk assessment, raising of awareness and enhancing access to supportive interventions at individual, system and community levels so as to achieve its set goals.

Affordable Care Act, Insurance Coverage and Diabetes Prevention 

Access to healthcare includes availability, organization, financing, utilization and satisfaction. Many chronic diseases such as diabetes have a tendency to disproportionately affect certain population subgroups such as racial ethnic minorities and those up against socio-economic hurdles.

Some ACA provisions were put in place to ensure that these disadvantaged groups get equitable access to health insurance coverage and a patient based medical care that enables them to receive preventive services at either a low or no cost.

ACA aimed at expanding insurance coverage to all eligible Americans who had lacked it previously. After its implementation, the US Department of Health and Human Services reported a 35% decrease in the number of the uninsured between 2012 and 2015.

The establishment of the marketplace by the ACA allows individuals to purchase Private Qualifying Health Insurance Plans independent of the employer. A report indicated that there was a 23% increase in the identification of diabetes in the states where Medicare was expanded. This was an encouraging statistic in the fight against diabetes. 

However, although medication treatment for diabetes also took an upward trajectory, no significant effect on glycosylated hemoglobin levels was recorded. 

The ACA also mandates coverage of all the US preventive services task force A or B recommendations that do not advocate for cost sharing, by Medicare and all grandfathered commercial health plans.

It’s also stipulated that Medicaid plans that are destined for groups targeted by new coverage expansions must also do so without cost sharing and if they comply with the requirements, the federal government pays the state for an additional 1% of the cost of each service.

With health insurance and access to a usual source of health care providing coverage for a minimum set of evidence-based preventive services, the ACA stands a chance to improve the detection of prediabetes which can create awareness and prevention of the development of type 2 diabetes.

Conclusion

The adoption of the Affordable Care Act expanded insurance for low-income Americans and took two main forms; Medicare expansion in several states and subsidized private health insurance that was managed through insurance exchanges available in all the states with deep subsidies for persons with incomes from 138% to 250% of the federal poverty limit.

The decline in new diabetes cases is associated with improved access to many preventive care services and medications provided for by the ACA.

But the selected are doing the ACA a disservice due to their underestimation of the presumed improvement in the health services for low-income patients of the academic centers before the implementation of ACA.

This handicaps these patients who have to face a different level of improvement when accessing care in comparison with those who were completely isolated from the healthcare system before the policy took effect. This glaring gap needs to be addressed.

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