Diabetes in the Youth: Epidemiology Paper
May 2, 2016
University of Phoenix
NUR/408

Diabetes in the Youth: Epidemiology Paper
Diabetes has become a serious issue in our youth, even though the mortality rates have decreased over the years the rate is still too high. According to the CDC (2012), From 1968–1969 to 2008–2009, the death rate from diabetes among youths under the of 19 decreased 61%, from 2.69 per million to 1.05 per million. The death rate among youths under 10 years of age decreased 78%, from 1.80 per million to 0.39 per million, and the death rate among youths aged 10–19 years decreased 52%, from 3.56 per million to 1.71 per million (Morbidity and Mortality Weekly Report, 2012). The seriousness of these statistics shows that diabetes is disease requiring significant attention in the youth population. Epidemiological studies are needed in order to direct healthcare in the youth population and to provide effective interventions designed to reduce the prevalence and incidence rates of diabetes amongst our youth.
Definition and Purpose of Study
The purpose of epidemiology is to study disease and as a tool of community health it performs this function through a series of steps: 1. Search for determinants – A search for causes and factors that influence public health such as disease or high risk behaviors such as drug use. 2. Study of events- Health-related states or events need to be studied such as chronic diseases, injuries, birth defects, maternal-child health, occupational health, environmental health, and behaviors, i.e., exercise, seat-belt use, etc. 3. Control of disease- Using data from determinants and events, conclusions can be drawn to stop or control the disease. 4. Application of data- The epidemiological data can be applied to community health and can be used to deter, prevent, and educate the community against further issues (UAB, 2012).
The use of epidemiology in this study is to provide vital information in order to define prevention methods for type 2 diabetes in youth. This study is a valuable tool because it provides education and a planned course of action for dealing with the diabetes conflict. For this reason, the epidemiological study of diabetes within the youth population is therefore essential to community and public health because it helps the community and public recognize the issue and develop a resolution or intervene with it.
Methodology
The two methods utilized in this epidemiological study include an experimental and quasiexperimental study. The first study is the HEALTHY study which was conducted across multiple school sites over a 3-year period. Targeting 6th through 8th graders, the study focused on educational, behavioral, and physical activity interventions. Furthermore, factors at the school level affecting the nutrition and health of students as well as family involvement were vital components in the study. The results of the study did not show differences between the intervention and control groups with regard to overweight and obesity prevalence. The lack of significant results in school-based programs targeting overweight and obese children provides a strong rationale to explore other interventions. The second study, The Diabetes Prevention Program (DPP) is an evidence-based intensive lifestyle intervention targeted at preventing or delaying the onset of type 2 diabetes. The study focused on educational modules aimed at healthy eating, physical activity, and individual coaching support. The DPP modification was preferable to the HEALHTY study procedures, because it could be easily incorporated into the existing school curriculum. In addition to that, it included evaluative measures that could be easily performed by school nurses and teachers as opposed to researchers. In the study children from middle school along with high school aged children were given questionnaires regarding diabetes. The purpose of the study was to get the youth to increase the knowledge of food and nutrition; develop healthier eating habits; participate in additional and more rigorous physical activity and set and monitor the progress of healthy weight goals. The information from the study is evaluated in the following ways: 1. Data is gathered from the participants then results are divided according to groups. 2. Participants self-report the data gathered 3. The incidence of a disease is compared to the prevalence 4. The epidemiologist then compares the results of studies to determine the incidence of diabetes, identifies related trends, and suggests ways to control the morbidity and mortality related to the disease.
Both methods of study utilize combine qualitative and quantitative data collection methods. This form of study is vital because it increases the knowledge of diabetes. The quantitative or descriptive epidemiology defines the important areas of question for diabetes study. Sometimes referred to as the who, what, when and why, descriptive epidemiology attempts to define who will contract the disease and when and how. In this study the focus would be on youth with type 2 diabetes. The population at focus was middle school and high school aged children. Other aspects taken into consideration in the studies are age, weight, lifestyle, and diet.
Statistics
* About 208,000 Americans under age 20 are estimated to have diagnosed diabetes, approximately 0.25% of that population. * In 2008—2009, the annual incidencea measure of how often a disease occurs; the number of new cases of a disease among a certain group of people for a certain period of time.X of diagnosed diabetes in youth was estimated at 18,43 with type 1 diabetesa condition characterized by high blood glucose levels caused by a total lack of insulin. Occurs when the body's immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Type 1 diabetes develops most often in young people but can appear in adults. X, 5,089 with type 2 diabetesa condition characterized by high blood glucose levels caused by either a lack of insulin or the body's inability to use insulin efficiently. Type 2 diabetes develops most often in middle-aged and older adults but can appear in young people.X. * Among youth age <10 years, the rate of new cases was 0.8 per 100,000 for type 2 diabetes in 2008–2009. Among youth ages 10 to 19, the rate of new cases of type 2 diabetes was 11.0 per 100,000. * In the United States, as of 2012, 9.3 percent of all adults 20 or over have diabetes. Among adults 65 or over, 25.9 percent have diabetes. In comparison, children 19 and under have a rate of only 0.26 percent.
Epidemiology Triangle
The epidemiology triangle is a vital tool in the study of the disease prevalence and incidence rates. The triangle is defined by three sides including host, agent and environment. In the case of the diabetes study, the host is the youth who are suffering from diabetes. The agent or cause of the disease is easily determined through the use of the triangle to be lack of physical activity and poor health caused from diet and weight gain. (Mozaffarian et al, 2009). The environment is inclusive of conditions which increase the susceptibility of the agent with the host. The environment could include factors such as family history, stress, socioeconomics, living conditions, etc. an individual who may be living in a poverty stricken community is more susceptible to diabetes, due to the lack of choices when buying foods. Healthy food choices are rare in low socioeconomic neighborhoods. The sides of the epidemiological triangle work in this way allowing the epidemiologists to make determination concerning the community. This determination of causes and level of prevalence indicate the need for specific interventions in order to control the disease. These interventions take the form of prevention strategies. There are three levels of prevention, primary, secondary and tertiary prevention.
Primary Prevention
The primary prevention of diabetes is to identify and alter those behaviors that will lead to the development of the disease. For example, eating a proper nutritious diet will help to avoid obesity and diminish the risk of contracting diabetes. Although there is a great deal of evidence from other studies which suggest that diabetes is a result of conditions including environment combined with genetics; this evidence does not reveal itself with the same importance as other factors which increased incidence and prevalence of the disease. Diabetes sets in over a long period of time in individuals living with high risk factors such as poor diet and obesity. By eating a low fat and high fiber diet one can significantly lower the chances of contracting diabetes. This change coupled with an exercise program can lower the risk of diabetes in almost all individuals. (Jones, 2016).
Secondary Prevention
Secondary prevention of diabetes includes testing, regular examinations, and self-monitoring of health. The International Diabetes Federation says if you watch your blood sugar levels when you're first diagnosed, you'll reduce the need for more serious treatment down the road. Seeing a doctor on a regular basis will assist in testing and in raising the awareness of conditions that may be precursors to diabetes. As well, individual awareness and understanding needs to be raised in order to increase secondary prevention. (Jones, 2016).

Tertiary Prevention
Tertiary prevention requires consistent monitoring of blood glucose levels as well as diet monitoring. It focuses on preventing serious complications in diabetics who have had the disease for a long time. Serious complications include anything from glaucoma, to foot problems, skin problems, heart disease. The U.S. Department of Health and Human Services says keeping your blood sugar, blood pressure and cholesterol in the normal range greatly reduces serious complications. Also keeping up with regularly scheduled foot exams, eye exams, and A1C tests. A1C tests measure your blood glucose levels in three-month increments (Jones, 2016)
Conclusion
Even though the results of this study are varied and questionable, I do believe that they cautiously demonstrate the feasibility of employing the modified diabetes prevention program curriculum in adolescent populations in school-based settings. Keeping in mind that the needs of children and adolescents contrast from those of adults, more research should be centered around adolescents and even younger children who are at risk for diabetes. As children and adolescents spend more and more time at school, as they lead an increasingly inactive lifestyle, and as they increase their unhealthy snack and fast food intake, the need for interventions such as the modified diabetes prevention program curriculum presented here will become more pressing. It is vital that epidemiological studies continue to be performed which study the progression of the disease. As depicted in the epidemiological triangle, the disease is largely controllable by implementing lifestyle and diet changes. The HEALTHY study along with the DPP study illustrates that the disease has primary prevention strategies which are much more effective than secondary and tertiary methods.

References
D’Adamo, E., & Caprio, S. (2011). Type 2 Diabetes in Youth: Epidemiology and Pathophysiology. Retrieved from http://care.diabetesjournals.org/content/34/Supplement_2/S161.full
Hingle, M. (2015). Family Focused Community Program to Prevent Type 2 Diabetes in Peripubertal Youth (EPIC Kids). Retrieved from https://clinicaltrials.gov/ct2/show/NCT02421198
Jones, M. (2016). Primary, Secondary & Tertiary Prevention of Diabetes. Retrieved from http://www.ehow.com/way_5664235_primary_-_amp_-tertiary-prevention-diabetes.html
Lori L. Candela, Antonio P. Gutierrez, Janet S. Dufek, LeAnn G. Putney, and John A. Mercer, “Modifying the Diabetes Prevention Program to Adolescents in a School Setting: A Feasibility Study,” ISRN Education, vol. 2012, Article ID 534085, 9 pages, 2012. doi:10.5402/2012/534085
Morbidity and Mortality Weekly Report (MMWR). (2012). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6143a2.htm Mozaffarian, D., Kamineni, A., Carnethon, M., Djoussé, L., Mukamal, K.J., & Siscovic, D. (2009). "Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study". JAMA Internal Medicine 169 (8): 798–807.
UAB. (2012). What is epidemiology? Retrieved from http://www.soph.uab.edu/epi/academics/studenthandbook/what
What is Epidemiology? (2015). Retrieved from http://www.cdc.gov/excite/epidemiology.html