Executive SummaryAs the burden of Type 2 DiabetesMellitus (T2DM) is rising in the United States, Bench to Bedside would like toprimarily address concerns regarding improving secondary screening methods andhow to best identify those at risk for developing T2DM in time to preventfurther disease progression. According to Katherine Taber and Barry Dickinson’sresearch, more than twenty-nine million people in the U.S.
have T2DM, eightmillion are undiagnosed, and eight-six million people in the US exhibit signsof prediabetes. Because citizens may not be educated on important factors forprevention of T2DM such as personal diet and health, exercise, noticing thesigns and symptoms, and deciding what to do when symptoms arise, the rates ofdiabetes are increasing and treatment options are being introduced late intothe progression of patients with T2DM. Bench to Bedside is recommending newapproaches to the secondary screening methods in order to decrease the rate ofT2DM, as well as considering options for further research and investment on theprimary prevention T2DM as well as filling in the gaps of screening trends.Potential policy options include but are not limited to: easier and morefrequent access to screening, investment in further genetic research, awarenesson healthier diet and exercise, access to affordable healthcare, and educationon noticing the symptoms, the signs, and taking action for treatment options.Problem StatementTo simply put it, diabetes is when theblood sugar levels rise higher than normal. To be more specific, Type 2Diabetes is when your body experiences insulin resistance–in other words, yourbody is not using insulin properly. The pancreas produces extra insulin tocompensate for the lack of insulin in the first place–however, over time yourpancreas is not able to keep up with compensation, and in turn is not able toproduce enough insulin to keep blood glucose at normal levels.1 Certainrisk 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 geneticfactors that play a role in T2DM. According to Taber and Dickinson, there aresixty-five genetic variations–these variations impair the function of betacells, which in turn affects insulin secretion, rather than directly affectinginsulin action. Current screening methods for T2DMinclude risk assessment questionnaires, biochemical tests, and combinations ofboth. Of the biochemical tests, there are blood glucose/ urine glucosemeasurements, and blood HbA1c/ blood fructosamine measurements.
According tothe WHO, each screening tests requires a threshold that defines high risk.These screening tests are usually followed by diagnostic tests such as fastingplasma glucose or an oral glucose tolerance test in order to implement thediagnosis.3 It iscrucial for the general population to know the certain signs and symptoms ofT2DM so that early detection can be possible to prevent long term harmfuleffects. By the time the patient is screened, they will have had full on T2DMrather 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 thefacts. Although external factors such as the patients’diet and exercise can account for decreasing the risk of diabetes, there isstill a chance of a patient having T2DM due to genes Contribution of geneticfactors to diabetes risk, onset, and progression is estimated to be as high asforty percent (which varies by person, of course).2 Family historyalso contributes to the risk factors–for example, individuals who have one ormore first-degree relatives diagnosed with T2DM, the risk for the patient isestimated to increase by approximately two to six times.2 To resolvethe problem of primary prevention and secondary screenings, Bench to Bedside isadvocating for promoting education on T2DM as well as investing into researchon genetic counseling for those who carry the gene. However, a few implicationsinclude time for further research.
Going into further research that requiresfurther detail significantly requires more time. Along with time, comesmonetary expense into increased screenings and research, as well as citizen’shealth care benefits and access to insurance. This is where the essentialquestion is asked, what are the opportunity costs, and are those opportunitycosts worth the complexity of the problem at hand?Evidence and Potential SolutionsTo put this dilemma into perspective,Bench to Bedside is also strongly recommending investment in an effort toadvocate for translational research into genetic risk scores and T2DM riskassessment and prevention in the clinical setting. There are several factors toconsider biologically, environmentally, behaviorally, and socio-economically. Environmentalfactors include healthy dietary habits and access to food.
Behavioral andsocio-economic factors include exercise habits, taking action for screening,knowledge of the first sign of symptoms, and having the budget/ability topurchase healthy groceries as well as access to healthcare financially,respectively. Moreover, genetic markers passed through family members andepigenetics play a significant role. Although only one to two percent ofdiabetes cases are monogenic (resulting from mutations in a single gene), ahuge variety of gene variants contribute to an increased risk for T2DM.2Accordingthe WHO, continuation of discovering genetic variants that increase the riskfor diabetes leads to the hypothesis that genetic information beyond familyhistory could enhance current secondary screening methods and improve riskassessment tools3.
Therefore, investing time and money can benefitvery largely when keeping in mind the opportunity costs at stake. To explainfurther, opportunity costs include possibly investing more time intodiscovering different genetic variants rather than solely focusing on thetertiary treatment premises, and monetary expenses for the research that couldalso take away from screening methods. By doing this, preventative measures aretaking place to reduce the need for drastic tertiary treatments which couldsave time and money for the patient and their family. Recommendations In light of recommendations, the mostcrucial point to consider is the complexity of whether the system carries outscreening, follow-up, and diagnostic testing the efficiently manage detectedcases of diabetes.3 This can only be done by spreading awareness forpatients and citizens to actively seek screening—especially when they are atrisk because they carry the gene. To argue, investing in research can and willbe categorized as a primary preventative method–in that Bench to Bedside ispreventing citizens from having a high risk of T2DM/discovering they have T2DMwhen it’s far too late by advancing in the discovery of genetic variants in a clinicalsetting 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 thatbeing said, the more research efforts put into genetic risk scores andprevention in a clinical setting, the more secondary screening methods can beworked on as well, such as requiring schools and workplaces to conduct abi-annual screening.
In doing this, hundreds of thousands of cases can bedetect earlier.