Diabetes - Women in Maine

Maine

Diabetes interrupts the body's ability to use insulin, a hormone that converts food into energy for the body. People with diabetes are more likely to have an accumulation of glucose (i.e., food broken down into sugar) in the blood, which can lead to serious health problems like heart disease, vision loss and kidney disease. Diabetes was the eighth-leading cause of death in 2020 among women ages 18-44 in the United States. There are three types of diabetes:

• Type 2 diabetes occurs when the body cannot use insulin appropriately to regulate blood sugar levels. Approximately 90-95% of diabetes cases are Type 2.
• Type 1 diabetes is thought to be caused by an autoimmune reaction that prevents the body from making insulin. Approximately 5-10% of diabetes cases are Type 1.
• Gestational diabetes develops in pregnant women who have never had diabetes. It can increase the risk of developing Type 2 diabetes later in life for both women and children.

Additionally, prediabetes is a diagnosis that reflects an increased risk of developing Type 2 diabetes, heart disease and stroke. 

For women of reproductive age, diabetes increases the risk of adverse pregnancy outcomes. Compared with women without diabetes, women with any type of diabetes during pregnancy are at increased risk of preeclampsia, preterm delivery, miscarriage and stillbirth. 

Approximately 1 in 4 Americans with diabetes cannot afford the amount of insulin prescribed by their doctors, making insulin underuse common. Increasing insulin prices are raising the overall costs of health care spending on diabetes. In 2017, the total direct and indirect costs of diabetes in the United States were estimated at $327 billion. Individual costs vary; however, excess medical expenditures associated with diabetes increased from $8,417 to $9,601 per person between 2012 and 2017. 

According to America’s Health Rankings data, the prevalence of diabetes is higher among: 

• Women ages 35-44 compared with those ages 25-34 and 18-24.
• American Indian/Alaska Native, Black and Hispanic women compared with white women. 
• Women with less than a high school education compared with those with a college degree.
• Women with an annual household income less than $25,000 compared with women with an annual income of $75,000 or more.
• Women living in non-metropolitan areas compared with those in metropolitan areas.

Additional risk factors for developing diabetes include obesity or overweight and a family history of Type 1 or 2 diabetes.

Prediabetes and Type 2 diabetes are largely preventable. Interventions that promote maintaining a healthy weight and diet and increasing moderate-intensity physical activity can prevent Type 2 diabetes and reduce the overall burden of the disease. To reduce the risk of gestational diabetes, the Community Preventive Services Task Force recommends lifestyle interventions like exercise classes, education and counseling for diet and physical activity.

For those living with diabetes, complications can be prevented through adherence to medications, lifestyle changes and health care interventions. The recently passed Inflation Reduction Act caps the cost of insulin for Medicare beneficiaries by law, which will make it possible for millions of individuals to access life-saving medication and improve adherence. President Biden has stated a goal to extend this benefit to all Americans. 

For women of reproductive age with preexisting diabetes, managing the condition prior to conception and during the first trimester is critical to reduce the risk of adverse outcomes for both infant and mother. Research shows that diabetes-related complications during pregnancy may be prevented with a healthy diet, regular physical activity and medication modifications.

The Centers for Disease Control and Prevention’s National Diabetes Prevention Program offers resources to support lifestyle changes and prevent or delay diabetes.

Healthy People 2030 has several diabetes-related objectives, including:

• Reducing the number of new diabetes cases diagnosed yearly. 
• Reducing the death rate among those with diabetes.

American Diabetes Association Professional Practice Committee. “3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Medical Care in Diabetes—2022.” Diabetes Care 45, no. Supplement_1 (January 1, 2022): S39–45. https://doi.org/10.2337/dc22-S003.

Centers for Disease Control and Prevention. “National Diabetes Statistics Report 2020.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html.

Galaviz, Karla I., K. M. Venkat Narayan, Felipe Lobelo, and Mary Beth Weber. “Lifestyle and the Prevention of Type 2 Diabetes: A Status Report.” American Journal of Lifestyle Medicine 12, no. 1 (January 2018): 4–20. https://doi.org/10.1177/1559827615619159.

Luo, Jing, and Walid F. Gellad. “Origins of the Crisis in Insulin Affordability and Practical Advice for Clinicians on Using Human Insulin.” Current Diabetes Reports 20, no. 1 (January 2020): 2. https://doi.org/10.1007/s11892-020-1286-3.

Negrato, Carlos Antonio, Rosiane Mattar, and Marilia B. Gomes. “Adverse Pregnancy Outcomes in Women with Diabetes.” Diabetology & Metabolic Syndrome 4, no. 1 (December 2012): 41. https://doi.org/10.1186/1758-5996-4-41.