A chronic disease has characteristics that effects the quality of life for that individual. The characteristics are problems with sleep, depression, stress, distress about having the disease, how to cope with the illness, and lack social support from family and society. If you have a chronic disease it will have these same effecting qualities that Type 2 diabetes has. The illness will be hard to manage and leads to disease severity further down the line. Remember, with any physical ailment there is a psychological and social component that creates more hardship and must be dealt with along with medications. Let’s look at the facts about type 2 diabetes.
Diabetes Type 2 Facts
30.3 million people (9.4%) US
84.1 million pre-diabetic (CDC 2015).
78 million people were considered obese
347 million people worldwide.
Seventh leading cause of death in 2015
Costs roughly $245 billion US
Average health care cost newly diagnosed diabetic over their lifetime is $85,200 53% of that cost will be used for treating complications
Type 2 diabetes is estimated to reach 642 million by the year 2040
Risk factors of obesity, smoking, and physical inactivity
1) Recent studies on the characteristics of chronic disease:
Stress – factors include job loss, divorce, death of loved one, daily deadlines, traffic, family, and having to manage an illness
- Individuals under stress may not follow daily routine of self-care that entails eating healthy, exercising, and taking medication consistently.
- Individuals may drink alcohol to cope and may not check their blood sugar levels
- Stress creates a biological change in the body by producing chemicals that place more sugar into the blood stream. The stress and blood sugar level connection will remain out of control if coping strategies are not employed
- Managing blood sugar levels with several blood prick checks a day as well as dietary changes and increase of physical activities add to the stress of having the illness.
- Stress factors of oral medication or insulin injections
- The fear (perceived fear) of future comorbidities and developing poor physical conditions
Coping – thoughts and behaviors used to manage the emotional and logistical demands of situations that are judged as stressful
- Diabetic females have a harder time coping with diet where diabetic men were more aware of diet changes.
- Stress and coping skills will affect self-care management. Patients are required to handle 95% of their own care which is a heavy burden.
- The heavy burden of self-care creates fear or perceived stress.
Distress – connected to certain stressors and is a reaction to chronic health condition
- Types of distress: emotional burden, regimen distress, interpersonal distress, and physician distress.
- Emotional burden of self-management, fear of complications, and possible loss of function.
- Emotional distress is a response to the patients’ perception of health threats versus coping resources
- Emotional distress was expressed as angry, frustration, denial, anxious, and mostly depression.
- Diabetes distress (DD) can create psychological pressure that produce sleeplessness, depression, and anxiety
- Found to be 10-15% higher in people with diabetes. Treating individuals with both conditions remains difficult and anti-depressant can affect blood sugar control
- Negative effect on adherence to medications, dietary measures, quality of life, and rate of mortality.
- Depressive symptoms and inflammation have been shown in recently diagnosed type 2.
- Patients reporting more depression symptoms had more diabetes-related stress and negative appraisal of the illness
- Biopsychosocial risk factors for depression with type 2 are: occupation, marital status, social support, diabetes complications, and negative life events in the past 6 months.
- Psychological conditions such as depression and anxiety have been connected to poor glycemic control or elevated blood sugars caused by lack of self-care and poor coping skills.
- Connection between sleep problems and inflammatory disease risk
- Poor quality of sleep related to duration
- Depression and sleep coincide (Sleep Foundation)
- Sleep disturbances increase hunger hormone and risk for obesity and type 2
- Type 2 have sleep problems impacting glycemic control
- Both short and long duration has significant increase risk of type 2 (Diabetes Care)
- Diabetes and heart failure have same sleep problems.
- Poor sleep quality attributes to arterial thickening in type 2
Social Support – Plays an important role in self-management
- Improvement in self-care, quality of life, and increased disease knowledge.
- Females received support through friends and family, whereas males received support through their spouse.
- Females reported more stress from friends’ interaction.
- Family unit is a means of support for the diabetic’s lifestyle change and adherence.
- Negative beliefs toward family situations affected diabetic self-care.
- Supportive spouse but not controlling had a better relationship in coping with this illness.
- Martial adjustment, family coping, and positive support resulted in good adherence behavior even when negative beliefs about medication were present.
- Negative or conflicting support coupled with negative beliefs about medication lead to nonadherence
2) How is the quality of life affected by chronic disease characteristics?
Quality of Life
- Defined by physical, mental/cogitative, psychological, and social (equates to the biopsychosocial model).
- Diabetic factors that modify quality of life were age, sex, occupation, marital status, years with diabetes type 2, comorbidities, and depression.
- Perceived stress greatly affected QoL outcomes and researchers suggested that interventions include this psychosocial factor.
3) Why is the biopsychosocial approach a valid model for understanding chronic disease?
Diabetes is hard to self-manage and has three basic concepts that hinder adherence: the individual does not feel he is ill, self-regulation requires a routine out from normal life flow, and self-efficacy or confidence that one can control outcome is lacking. This is the biopsychosocial model of health. Notice how all three globes intermingle creating mental health in the middle.
Now let’s look at the same model with how the factors affect illness. These factors are hard to cope with just on a daily without having an illness too.
The Biopsychosocial Model of Risk Factors
4) The importance of taking care of yourself and improving your quality of life.
- Non-adherence to self-care is a serious problem raising the cost of medical care.
- Good self-care behaviors are the most important undertaking for a diabetic.
- Devotion and obedience are required in maintaining dietary changes, exercise, medication, and monitoring blood sugar levels.
- Stress of lifestyle change is showing responsible for nonadherence that leads to comorbidity conditions and future complications.
- Stress related variables to consider socioeconomics, living conditions, health care systems, family adjustments, and partner’s support.
- Learn coping mechanisms and obtain social support.
- Challenge your belief about the use of medication.
Outlook on future interventions
General advice is always diet, exercise, and proper sleep. National Diabetes and Prevention Program (NDPP) developed yearlong behavior change program to improve eating habits and lose weight. CDC, American Diabetes Assn, American Medical Assn, joined Ad Council public service funny videos on prediabetes (you tube) or go to prediabetes.org
I would like to see a comprehensive educational and intervention approach developed for the diabetic to understand the full scope of this disease including psychosocial factors. Attitudes and beliefs about having the disease should be discussed. Annual checkups on everyone for diabetes should include HbA1c and other markers to catch it early as possible. Take the pre-diabetic test to check yourself:
Are you a man? Give yourself 1point
Family history of diabetes? Give yourself 1 point
Do you have high blood pressure? Give yourself 1 point
Are you inactive? Give yourself 1 point
Are you over 40-50-60? Give yourself 1-2-3-points respectively
Are you overweight? Give yourself point: Somewhat 1 moderately 2 and very 3
Score 5 or more means you are in prediabetes status. Please have your HbA1c blood work done by your physician.
To Your Heath,