Global Nutrition and Food Security: Type 2 Diabetes

This paper examines the causes, epidemiology, and major food sources of type 2 diabetes. It also discusses the risk groups and determinants of the disease and critically analyzes two programs intended to address it. The programs focus on lifestyle modification and community engagement.

Running head: Type 2 Diabetes 1
Global Nutrition and Food Security: Type 2 Diabetes
Name of Student
Institution

Type 2 Diabetes 2
Introduction
Type 2 diabetes is a critical and common chronic illness caused by an intricate inheritance-
environment interface in addition to other risk factors such as sedentary lifestyle and obesity.
It is characterized by a chronic hyperglycaemic condition due to the deficient action of
insulin. The disorder alongside its complications comprises of a common global public health
matter that impacts almost every developing and developed nation, with high mortality and
morbidity rate. This paper seeks to consider type 2 diabetes with regard to its etiology and
epidemiology, the primary food sources that cause it alongside the groups at risk of infection
and the corresponding determinants. This paper will also critically examine two programs
intended to address the disease.
Etiology
The primary causes of type 2 diabetes include an amalgamation of genetic factors associated
to compromised insulin secretion and insulin resistance alongside environmental factors such
as a lifestyle of physical inactivity, obesity, depression, anxiety, overeating, and aging.
Genetic Factors
There is a clear association between type 2 diabetes with a family history of diabetes. The
substantive involvement of genetic factors in the development of type 2 diabetes was
confirmed by the considerably higher concordance rate between monozygotic twins than in
the dizygotic twins (Drong, Lindgren, & McCarthy, 2012). The association of genetic
abnormality in the molecules associated with the system of glucose metabolism regulation
has been the assumption of pathogenesis. Genetic defects have been identified in the
assessment of candidate genes aimed at secretion of pancreatic beta cells via glucose-
stimulated insulin, and the molecules consisting of the molecular mechanism for the action of
insulin. The KCNQ1 gene mutation has been associated with the abnormality in the secretion

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of insulin as an essential gene that is disease- susceptible in Japanese and the ethnic
communities in Asia (Unoki et al., 2008).
Environmental Factors
Examples of independent risk factors of pathogenesis include smoking, drinking alcohol,
obesity, aging and inadequate intake of energy among others. Physical inactivity leads to
obesity especially visceral fat obesity and is complemented with a drop in muscle mass,
triggers insulin resistance, and is closely linked with the speedy increase in the incidence of
the disease among aged patients. Alterations in food energy sources, especially increased
consumption of fat, low intake of starch, use of large amounts of simple sugars, and the
consumption of foods with little fiber leads to obese cases and contributes to declining of
glucose tolerance. Obesity is one of the leading dietary factors that contribute to type 2
diabetes. For example, even low cases of obesity such as a BMI of less than 25 poses a five
times risk of developing diabetes, especially when accompanied by the rise in visceral fat
mass (Ozougwu, Obimba, Belonwu, & Unakalamba, 2013).
Epidemiology
According to the Global burden of diabetes (2011) in 2011, approximately 366 million people
were diagnosed with diabetes mellitus, and it is estimated to reach 522 million people by
2030. There is an alarming increase in the diagnosed cases of diabetes across the globe with
80% of diabetic patients residing in low and middle-income countries. 4.6 million deaths in
2011 were caused by diabetes mellitus (Global burden of diabetes, 2011). 439 million people
are expected to have type 2 diabetes by the year 2030 (Chamnan et al., 2010). The prevalence
of type 2 diabetes varies significantly based on the geographical location due to risk factors
such as lifestyle and environment (Chen, Magliano, & Zimmet, 2012).

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A critical review of the existing literature indicates minimal data on the incidence of type 2
diabetes in Africa. However, the few existing studies that assess the epidemiology trends of
type 2 diabetes in Africa show a significant increase in its incidence both in rural and urban
settings, and equally impacting both genders (Guariguata et al., 2014). Type 2 diabetes
records the highest disease burden in Africa with less than 10% of cases being recorded as
type 1 diabetes. According to the 2011 report by Centre for Disease Control (CDC),
approximately 25.8 million people in the US were affected by diabetes mellitus in 2011 with
95% of them being diagnosed with type 2 diabetes (Department of Health and Human
Services, 2011). Shaw, Sicree, & Zimmet (2010) predicts the frequent occurrence of type 2
diabetes to increase in the next twenty years in the developing countries particularly in adults
of 45 and 64 years.
Major Food Sources
Different studies have examined the strong association between food choices and the relative
risk of developing type 2 diabetes. Bauer et al. (2013) surveyed dietary patterns among
diabetic patients using Netherland as a case study and found out that a diet full of junk food
such as fries, chips, and soft drinks increased the risk of type 2 diabetes seven times.
Highly processed carbohydrates
Highly processed carbohydrates especially those sourced from the white flour, white rice, and
white sugar are the leading food categories that cause diabetes. This is because these foods
comprise of whole grains that have been stripped of vital fiber in addition to health vitamins
and minerals. The 2010 study by Nanri et al. (2010) on Japanese men and women found out
that the intake of heavily processed carbohydrates predisposed them to the risk of developing
diabetes type 2 by 1.65 when paralleled to those who consumed whole foods.
Sugar-Sweetened Drinks

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Sweetened soft drinks such as sweet the teas and sodas have been associated with an
increased risk of developing type 2 diabetes according to the 2010 study by Malik et al.
(2010). The outcomes of the research indicated that there was a high risk of 26% of
developing type 2 diabetes in individuals that consumed one to two sugary drinks each day
compared to those that had less than one in a month.
Risk Groups and Determinants
Age
The risk for type diabetes increases with age. Adults aged 45 and above have a 25% risk of
being diagnosed with type 2 diabetes (Wu, Ding, Tanaka, & Zhang, 2014).
Race
Studies have shown that type 2 diabetes is more prevalent in African Americans, Asian
Americans, Latinos, and Native Americans (Wu, Ding, Tanaka, & Zhang, 2014).
Family History
Individuals with a family history (especially first degree relatives) of type 2 diabetes are more
prone to type 2 diabetes. Monozygotic twins have a concordance of 100% and 25% in those
with cases of family history of type 2 diabetes (Wu, Ding, Tanaka, & Zhang, 2014).
Programs to Address Type 2 Diabetes
A community-Based Diabetes Prevention Programme in Sydney
Colagiuri et al. (2010) observe that this programme is based on the fact that type 2 diabetes
can be detected early and prevented. It focuses on populations that are at risk of developing
the disease or have been diagnosed with it. The objectives of this programme include:

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1. To improve early identification of populations prone to developing diabetes and to
recommend a prevention aid
2. To increase the initial diagnosis of diabetic patients and to offer control and support
3. To offer expert knowledge to care providers to improve the quality of diabetes care
services in the community
Programme Interventions
To effectively realize the objectives mentioned above, this programme will implement
various services to the community members. During planning the community leaders who
form part of the stakeholders are to be consulted about multiple community traditions and
culture, and the prioritized needs of the community. The community members will first be
screened using the AUSDRISK tool (Chen et al., 2010) to determine the prevalence of the
disease in the community. Then those that will be positive to the test will be enlisted in the
lifestyle intervention workshop which will be aimed at promoting lifestyle changes regarding
healthy eating and increased physical activity. The lifestyle modification program forms the
central part of the programme.
The objective of the lifestyle intervention programs include:
• Spending a minimum of 30 minutes each day on average to intense physical activity in
addition to aerobic exercises. Alternatively, additional days per seek alongside strength
training twice a week.
• Less than 30% reduction in the consumption of energy from total fat, and less than 10%
from saturated fat
• 15g/1000 kcal intake of fiber or more
• 5% reduction of body weight within one year.

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The primary intervention on lifestyle will take six weeks and includes weight management,
providing healthy eating guidelines, reduction and elimination of tobacco, involvement in
regular physical activity (measured using Physical Activity Scale for the Elderly (PASE)
tool), and adequate sleep. These parameters have been found to foster the prevention and
management of type 2 diabetes.
Critical Analysis
The screening and lifestyle intervention programme is useful because it approaches the
burden of type 2 diabetes from a preventive perspective. Additionally, the lifestyle
intervention for patients diagnosed with type 2 diabetes is easy and can be self-replicated at
home after training. This ensures that minimal cost is incurred in the treatment of a disease in
a population that is already burdened with disease.
The approach has also factored in the aspect of community engagement and involvement.
The work of the trainers is to offer expert skills and guidelines on interventions such as
weight management and physical activity. Ackermann et al. (2008) observed that the
involvement of community leaders during planning ensures that the community participates
in decision making and that the programme meets their needs. Furthermore, the cultural
relevance of the programme was ascertained through the involvement of the community
leaders. This approach involved the normal activities of any culture such as eating. Thus it
ensured that it did not violate any significant cultural practices. The evaluation framework for
physical activity using the Physical Activity Scale for the Elderly (PASE) ascertained its
reliability and validity (Copeland & Esliger, 2009).
The High-Risk Approach to Prevention of Diabetes

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The objective of this programme is to reduce the modifiable risk factors of type 2 diabetes in
high-risk adults using a community-based lifestyle change approach tailored to the Malaysian
Culture (Ibrahim et al., 2016). The high-risk approach takes 12 months, and it involves five
steps. The first step consists of the identification of individuals who are at high risk of
developing type 2 diabetes using the Finnish Type 2 Diabetes Risk Assessment Form
(Buijsse, Simmons, Griffin, & Schulze, 2011). The individual that is regarded to be at high
risk of type 2 diabetes proceeds to the second step which involves the measurement of the
risk for the development of type 2 diabetes. The presence or absence of IGT or IFG in blood
glucose will be determined alongside the assessment of other risk factors for diabetes such as
genetics, body weight, etc. The third step involves the intervention to lower the risk using
lifestyle modification programs to lose weight through the average restriction of calorie,
increased physical activity among others. Phase four consists of the implementation of the
intervention using the group-based approach. The last step entails the analysis of the
outcomes regarding long-term (after 12 months) and short-term (after six months).
The eligible subjects to the study must meet the inclusion criteria. They must be living or
working within the community during the period of the study, and have to be aged between
18 to 65 years. The participants have to be at risk of type 2 diabetes and be able to read and
comprehend English language or Bahasa Malaysia.
Critical Analysis
The use of lifestyle modification as an approach to prevent the escalation of type 2 diabetes
has been ascertained by several studies (Hu, 2011; Li et al., 2008). This intervention makes
the programme more effective because of programs such as weight loss increase insulin
resistance in the short term (Hu, 2011; Li et al., 2008). Furthermore, physical activity is
significant in maintaining weight loss, and increases insulin sensitivity and is recommended

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by IDF. The survey of individuals to be included in the programme involved the use of
Finnish Type 2 Diabetes Risk Assessment Form. This tool gathers demographic and
socioeconomic data, state of activity, quality of life, and the present medications.
Moreover, the Finnish survey tool is recommended within the physical activity aim of the
Sydney Diabetes Prevention Program (SDPP), and it includes strength training during
exercise lessons which increases insulin sensitivity (Copeland & Esliger, 2009)
Studies have ascertained the effectiveness of lifestyle changes in across different ethnic
groups of varying cultures. For instance, studies on diabetes prevention and management in
Sydney (Colagiuri et al., 2010) and India (Balagopal, Kamalamma, & Misra, 2008) have
confirmed this assertion.
Furthermore, the inclusion criteria further ensured community engagement. For instance,
those eligible for the study must have been residents of the community during the period of
study. The evaluation framework is reliable since it consists of elements of behavioral change
that are founded on socio-cognitive theories 23 and stages of change 22. The intervention
outcomes are assessed after every six months to ascertain the progress and make any
necessary adjustments, thus ensuring the reliability of the programme. The programme is also
sustainable because it is based on simple steps or activities of lifestyle changes which can
easily be carried out at home even after the termination of the programme.
Conclusion
Type 2 diabetes is amongst diet-related conditions that are on the increase across the globe. It
is primarily as a result of a chronic hyperglycaemic state caused by the deficient action of
insulin. The risk factors of the condition include environmental and genetic factors.

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Individuals from a family with a history of diabetic cases are at high risk of developing
diabetes type 2.
On the other hand, a sedentary lifestyle, obese cases, aging, overeating are some of the
environmental factors that predispose people to type 2 diabetes. Additionally, African
Americans, Asian Americans, Latinos, and Native Americans are more prone to the disease
than other ethnic groups. Over 366 million were diagnosed with the disease in 2011, and it is
estimated to reach 522 million by 2030. This overwhelming increase is attributed to foods
such as highly processed carbohydrates and sugar-sweetened drinks. Examples of programs
to effectively prevent and manage type 2 diabetes include a community-Based Diabetes
Prevention Programme and the High-Risk Approach to Prevention of Diabetes.

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