Executive research and investment on the primary prevention

Executive Summary

As the burden of Type 2 Diabetes
Mellitus (T2DM) is rising in the United States, Bench to Bedside would like to
primarily address concerns regarding improving secondary screening methods and
how to best identify those at risk for developing T2DM in time to prevent
further disease progression. According to Katherine Taber and Barry Dickinson’s
research, more than twenty-nine million people in the U.S. have T2DM, eight
million are undiagnosed, and eight-six million people in the US exhibit signs
of prediabetes. Because citizens may not be educated on important factors for
prevention of T2DM such as personal diet and health, exercise, noticing the
signs and symptoms, and deciding what to do when symptoms arise, the rates of
diabetes are increasing and treatment options are being introduced late into
the progression of patients with T2DM. Bench to Bedside is recommending new
approaches to the secondary screening methods in order to decrease the rate of
T2DM, as well as considering options for further research and investment on the
primary prevention T2DM as well as filling in the gaps of screening trends.

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Potential policy options include but are not limited to: easier and more
frequent access to screening, investment in further genetic research, awareness
on healthier diet and exercise, access to affordable healthcare, and education
on noticing the symptoms, the signs, and taking action for treatment options.

Problem Statement

To simply put it, diabetes is when the
blood sugar levels rise higher than normal. To be more specific, Type 2
Diabetes is when your body experiences insulin resistance–in other words, your
body is not using insulin properly. The pancreas produces extra insulin to
compensate for the lack of insulin in the first place–however, over time your
pancreas is not able to keep up with compensation, and in turn is not able to
produce enough insulin to keep blood glucose at normal levels.1 Certain
risk factors for T2DM include cardiovascular disease, stroke, neuropathy,
retinopathy, periodontal disease, foot ulcers, and in some extreme cases,
amputations.1 Along with external factors, there are also genetic
factors that play a role in T2DM. According to Taber and Dickinson, there are
sixty-five genetic variations–these variations impair the function of beta
cells, which in turn affects insulin secretion, rather than directly affecting
insulin action.

Current screening methods for T2DM
include risk assessment questionnaires, biochemical tests, and combinations of
both. Of the biochemical tests, there are blood glucose/ urine glucose
measurements, and blood HbA1c/ blood fructosamine measurements. According to
the WHO, each screening tests requires a threshold that defines high risk.

These screening tests are usually followed by diagnostic tests such as fasting
plasma glucose or an oral glucose tolerance test in order to implement the
diagnosis.3

            It is
crucial for the general population to know the certain signs and symptoms of
T2DM so that early detection can be possible to prevent long term harmful
effects. By the time the patient is screened, they will have had full on T2DM
rather than when they could have gotten screened during the pre-diabetic stage.

Diabetes can be prevented if the patient attends to the right diet, exercise,
and makes the right lifestyle choices—which can only be done by knowing the
facts.  

             Although external factors such as the patients’
diet and exercise can account for decreasing the risk of diabetes, there is
still a chance of a patient having T2DM due to genes Contribution of genetic
factors to diabetes risk, onset, and progression is estimated to be as high as
forty percent (which varies by person, of course).2 Family history
also contributes to the risk factors–for example, individuals who have one or
more first-degree relatives diagnosed with T2DM, the risk for the patient is
estimated to increase by approximately two to six times.2

            To resolve
the problem of primary prevention and secondary screenings, Bench to Bedside is
advocating for promoting education on T2DM as well as investing into research
on genetic counseling for those who carry the gene. However, a few implications
include time for further research. Going into further research that requires
further detail significantly requires more time. Along with time, comes
monetary expense into increased screenings and research, as well as citizen’s
health care benefits and access to insurance. This is where the essential
question is asked, what are the opportunity costs, and are those opportunity
costs worth the complexity of the problem at hand?

Evidence and Potential Solutions

To put this dilemma into perspective,
Bench to Bedside is also strongly recommending investment in an effort to
advocate for translational research into genetic risk scores and T2DM risk
assessment and prevention in the clinical setting. There are several factors to
consider biologically, environmentally, behaviorally, and socio-economically. Environmental
factors include healthy dietary habits and access to food. Behavioral and
socio-economic factors include exercise habits, taking action for screening,
knowledge of the first sign of symptoms, and having the budget/ability to
purchase healthy groceries as well as access to healthcare financially,
respectively. Moreover, genetic markers passed through family members and
epigenetics play a significant role. Although only one to two percent of
diabetes cases are monogenic (resulting from mutations in a single gene), a
huge variety of gene variants contribute to an increased risk for T2DM.2According
the WHO, continuation of discovering genetic variants that increase the risk
for diabetes leads to the hypothesis that genetic information beyond family
history could enhance current secondary screening methods and improve risk
assessment tools3. Therefore, investing time and money can benefit
very largely when keeping in mind the opportunity costs at stake. To explain
further, opportunity costs include possibly investing more time into
discovering different genetic variants rather than solely focusing on the
tertiary treatment premises, and monetary expenses for the research that could
also take away from screening methods. By doing this, preventative measures are
taking place to reduce the need for drastic tertiary treatments which could
save time and money for the patient and their family.

Recommendations                                                                                   

In light of recommendations, the most
crucial point to consider is the complexity of whether the system carries out
screening, follow-up, and diagnostic testing the efficiently manage detected
cases of diabetes.3 This can only be done by spreading awareness for
patients and citizens to actively seek screening—especially when they are at
risk because they carry the gene. To argue, investing in research can and will
be categorized as a primary preventative method–in that Bench to Bedside is
preventing citizens from having a high risk of T2DM/discovering they have T2DM
when it’s far too late by advancing in the discovery of genetic variants in a clinical
setting as well as working on how to educate citizens on how they, themselves,
can practice primary prevention what to do when they notice symptoms. With that
being said, the more research efforts put into genetic risk scores and
prevention in a clinical setting, the more secondary screening methods can be
worked on as well, such as requiring schools and workplaces to conduct a
bi-annual screening. In doing this, hundreds of thousands of cases can be
detect earlier.