7050SOH: Globalisation and Health Assignment Sample 2023

Introduction

Type 2 Diabetes Mellitus (DM) is an inborn failure of metabolic process specified by high glucose level due to deficiency and resistance of insulin (Rodger,1991). Although, the specific reason is not known for type 2 DM, still there are elements of globalization that influence the disease. In fact, patients normally asymptomatic for several years, until an abnormal glucose level is diagnosed in blood or urine. Additionally, the disease shows elevated blood sugar in obese patient and requires insulin in hyper-glycemia patient. However, an early illness of Diabetes causes various difficulties to human disorders and socio-economic impact (ADA,1998). The phenomena have been supported by Schlienger (2013) who states that the complication developed due to this disease causes blindness, organ impairment, kidney failure, gangrene and heart stroke. In contrast, maintaining a healthy lifestyle with a proper routine exercise is the best intervention that impacts the global epidemic health control. This assignment focuses on critical analysis of the global burden related to Diabetes Mellitus and evaluation of the prevention program for type 2 Diabetes Mellitus.

Globalization contributed to increase burden of Type 2 Diabetes Mellitus

The foundation of the severe disaster of type 2 DM is increased in high populated and developing countries, especially in urban areas. Certain globalization factors that drives this disease involves overweight, lack of exercise, smoking, genetic, diet and lifestyle changes (IDF,2011). The other contributing factors such as alcohol, tension and pregnancy diabetes transferred to babies can take part in evocating Type 2 Diabetes. The data finding according to International Diabetes Federation has accounted for 285million population being affected and is predicted to reach the target of 552million by end of 2030. However, the prevalence varies among the countries depending on the population and economic disaster. Furthermore, Asia has a large population and 60% of diabetic patient are seen contributing to high calorie consumption of food and lack of physical exercise where India and China expected to reach 73million and 46million respectively by 2025 (King et al 1998). Earlier, the prevalence rate in China was only 1%, but reached a statistic breakdown of data point to 10% by 2008. In contrast, the prevalence rate of type 2 Diabetes in Western Pacific and Africa is 10.2% and 3.8% consecutively. Similarly, the proportion for the disease is inclined in most of the countries with 70% of people affected in developing countries with less income (IDF,2009).

Apart from this, the data statistics shows a high prevalence rate in 65 years old people which accounts for 1:5 ratio. In 2019, IDA reports that almost 4.2million population died with diabetes and there is high risk of developing 374million population with type 2 DM (IDA,2019). However, the risk of this disease is higher in youth compared to adults. Therefore, early diagnosis and treatment plan is required to decrease their effects in future and government should be compelled to solve the problem by giving primary Care to children suffering with type 2 DM (Rosenbloom et al.1999). Subsequently, the popularity rate of type 2 DM related to childhood obesity has frightened the pandemic health system. In fact, the gestational diabetes developed in pregnant Asian women can lead to type 2 diabetes in their babies in future life. Hence, the diabetes in Asian countries are seen at very young age compared to Western countries despite of low obesity in Asia (Yoon et al.2006). However, the countries having high intake of sugar will have high Type 2 DM prevalence rate (Weeratunga et al.2014).

Insulin is the key factor for aggravating the diabetic disease, which is a hormone constructed in pancreases that operates the sugar level in blood and converts the sugar to glucose formation via food intake. This changes in blood glucose level causes sensitivity of insulin in the body and leads to Type 2 Diabetes. On the other hand, the key factor that contributes to the economic globalization is the Developmental factors. Obesity is a factor that increases with generation who have adapted to the new lifestyle. Simultaneously, the weight gain product to develop obesity includes the uptake of sweet confectionary items and high calorie consumption of food. This causes infection to the metabolic system with the changes in the T cells in human body (Touch et al.2017). The major relevance between obesity and globalization is the movement of different food culture across the countries. The increasing number of obesity in the UK is representation of impact made by food culture. The Asian and African population living in the UK has major prevalence of obesity due to the food culture. For example, the Western style such as KFC burgers and pizza, motivates the intake of fast food and forces to adapt an unhealthy lifestyle. Apart from this, overweight is considered when excess fat is accumulated in the body, which indirectly damages the health system. This excess weight is recorded by Body Mass Index (BMI) in adults and youth. Reducing weight can reduce the risk of cardiac stroke and heart problem including other related disease in kidney, eye and foot.

According to WHO, when BMI is greater than 25 or 30 is defined as excess weight and obesity in adults, whereas in children the age is a factor for obesity to be measured (WHO,2015). However, BMI affects the inequality and changes the economic globalisation. Similarly, there is economic inequality among the countries and BMI is remarkable in high earning countries. The evidence suggested that economic inequality and globalization factors such as poverty and population should be improved to gain good health and reduce obesity globally (Vogli et al. 2011). In simpler words, the globalization’s positive aspects like benefit of healthcare as well as economic aspects needs to be considered for the control of poverty. In contrast, the Genetic factors such as Family and Generation when interfere with the Environmental factors such as Unhealthy Diet and Inactive Lifestyle including Lack of Regular Exercise causes Type 2 DM. Alternatively, the Genetic approach with changes in metabolic function of glucose, pressure, lipid and BMI can lead to Type 2 DM (Doria et al.2008). The imbalance of antioxidant that causes tension and beta cell function becomes worse which indirectly leads to evolution of this disease and involves in infection and arthritis (Ihara et al.1999).

Simultaneously, protein involved in pancreas to convert and regulate the genes is the key factor to supress the production and formation of insulin. On the other hand, High calorie intake related to Diet causes storage of fat accumulation in the muscle. Additionally, the fat accumulated in the abdomen reduces the power of insulin to fight against the body. Conversely, the metabolic hormone such as GLP-1 and GIP receptors reduces the blood sugar level (glucose) to cause deterioration of beta cells in Type 2 DM. Subsequently, the pancreatic factor 7 like 2 in the islets of pancreas causes genetic differences. To elaborate, they target the glucose hormones and leads to sensitivity of insulin in the body (Lyssenko et al.2008). The evidence indicates that the research to find the genetic differences in Type 2 Diabetes was developing and the significant risk factor of genetic was combined with Type 2 DM, still not up to the mark. However, the rising burden of this disease corelates with the environmental factors and the high intake of calories with lack of exercise can create an economic disaster in public health globally. Hence, the combination of exercise with reduction of weight can influence in decreasing the fat accumulation and insulin resistance. Lack of physical exercise is another aggravating factor related to Resting Lifestyle that can lead to resistance of insulin and fat accumulation stored for a longer period on the other hand can cause stimulated fat muscle and increased glucose level in blood (Goodpaster et al.2003). Similarly, Obese patient with can enhance their metabolism by regular exercise and reducing the calorie intake (Solomon et al.2008).

The evidence suggested that physical activities and diet control can change the glucose deposited and metabolic hormone to improve the breakdown of lipid in the muscle and balance the body regulation. However, the growth and modern developmental changes in nourishment and inactive lifestyle with excess weight gain worsens the global epidemic health with the rapid growth of Type 2 Diabetes in poor people and youth generation, especially in developing countries (Hu,2011). According to FDA, the primary cause of death for Type 2 Diabetes was Cigarette Smoking, which is considered as a Modifiable risk factor for this disease. Subsequently, the nicotine content in Tobacco can interfere with the metabolic function of the body, affects the cells and causes stress in oxygen level to aggravate infection in human body. Additionally, Tobacco causes insulin resistance by an impact on beta cell which is formed in pancreas in order to aggravate the risk of Type 2 Diabetes complication related to other disease of heart, kidney and eye. In fact, Smoking changes the regulation of the body with fat deposition. Hence a long-term smoking of cigarette can destroy the beta cell formation and insulin production. Nicotine on the other hand, impairs the lipid function from the tissue by AMP activation (Maddath et al.2017). Although, the risk of heart diseases is related to tobacco smoking, still its correspondence with Type 2 Diabetes need some research. The evidence suggested that cardiac problem with Type 2 Diabetes in female smoking cigarette is at high risk (Al-Delaimy et al.2002). However, the incidence rate increases in current smokers compared to those who do not smoke, particularly those who are chain smokers. The other major impacts of globalization on the increasing burden of obesity includes increased employment and trade activities. The globalization has opened the economies across countries which allowed people to more cross border for jobs. Along with this increased trade activities also created job opportunities in home countries. Increased work opportunities with higher payment has also become a reason of stress which is a major contributor of obesity. The stress due to obesity has impacted the employment related stress and obesity.

Factors that Drive Type 2 Diabetes

The Program Initiated to Preclude the Risk of Type 2 DM and Related Illness

In spite, having a healthy lifestyle, Type 2 DM will have to take some medication either orally or insulin injection to control their blood sugar level (IDA,2019). Long term successful Diabetes prevention of lifestyle changes and some commonly used medication such as Metformin and Sulfonylureas is an advantage to lower the risk or detain the disease (Lancet,2015). In contrast, Prediabetes will develop into Type 2 DM if proper intervention in physical activities, weight loss and diet is not implemented.

Globalization has been a factor that has influenced to the business activities across the world. However, spread of diseases is the negative side or aspects that have been caused by the events of globalization. Although, it can be said that globalization has become an important factor to prevent the diseases its widespread. For example, globalization has influenced over the sharing of technologies and habits which are effective to control the disease. The developing countries as well as the region of Asia and Africa have gained the benefit of globalization in terms of use and sharing of technologies to prevent and treat type 2 diabetes.

Various studies have been implemented in different countries with various outcomes and activities conducted to give instruction about the elevated risk and control of Type 2 Diabetes. Cost and services given by the healthcare provider including IDF, WHO, ADA and CDC recognised organisation have been organized in it. The International Diabetes federation (IDF) was established by various National Diabetes Association and Countries from 1950 onwards to lead a Global Diabetic Community over the world. Subsequently, IDF had a three-step plan to avert the risk of Type 2 DM which is to recognise the risk, calculate the risk and implement intervention to protect and delay the risk (IDF,2015).

To elaborate, numerous scientific theories were considered by IDF to initiate structural lifestyle changes by Diabetes Prevention Program Outcome Study (DPPOS) and Finnish Diabetes Prevention Study (FDPS) to reduce weight, control high calorie intake, improve routine exercise with follow-up of diet restriction (Tuomilento et al.2001). In 2001, the effective study for obstructing and detaining the factor associated with Type 2 DM for National Diabetes Prevention Program was initiated by National Institute of Health (NIH), which in 2012 had a collaborative work with National Institute of Diabetes and Digestive Kidney Disease (NIDDK) and Centre for Disease Control (CDC) to acknowledge the community on prevention, awareness, cost effectiveness of medication and controlling the Type 2 DM epidemic illness.

Earlier, the National Institute of Diabetes and Digestive Kidney Disease (NIDDK) function to study further on Type 2 DM and reduce weight where the National Diabetes Education Program (NDEP) for Universal Approach of prevention and management of Type 2 Diabetes was started in 1997 by a collaborative work with NIH and CDC. Similarly, Diabetes Prevention Recognition Program (DPRP) was accepted by centres for Disease Control and Prevention (CDC). IDF conducted a program in 2004 in UK, for public health awareness related to metabolism, diet, improve the health factors for Type 2 Diabetes including other organisation such as WHO, ADA, NCEP to aim the Heart disease consequence related to Diabetes (Albert et al.2006). On the other hand, the Global Diabetic Plan (2011-2022) was introduced in 2011, to prevent or detain the Type 2 Diabetes risk factor, complications and related illness with cost management of Drug usage, early detection, lifestyle change, and self-awareness campaign (IDF,2011).

Since 2002, the collaborative study of Diabetes Prevention Program (DPP) with National Institute of Diabetes and Digestive Kidney Disease (NIDDK) changed the scenario in precluding Type 2 DM. Subsequently, the lifestyle change intervention performed on Type 2 Diabetic patient for weight reduction and improve routine exercise with healthy diet (NIH,2002). Another program was started in 2016 by National health service (NHS) in England as a continuation to NIH and NICE Guidelines to avert or detain this disease. In the beginning, NDEP only concentrated on blood sugar function because there was a remarkable reduction of Diabetes related illness by DCCT (Diabetes Control and Complication Trial) detection, except the Cardiac disease showed an increase mortality rate in women and slight decrease in men with Diabetes compared to non-Diabetic patient (Gu et al.1999). However, the DCCT and UKPDS findings are crystal clear for early diagnosis and interventions which showed a significant decline in risk of Type 2 Diabetes related illness of eye, nerves and kidney (Stratton et al.2000). The evidence suggested that a further studies and plan on sugar level, tension and metabolic disorder needs to be evaluated with proper diet and routine exercise.

In contrast, Diabetes Prevention Program Outcome Study (DPPOS) is a 10year follow-up program to detain the risk of Type 2 DM by 34%. Subsequently. the follow-up was initiated in 2002 to lower the risk of cardiac problem related to Type 2 Diabetes by cost management of Metformin. To elaborate, DPPOS enhanced the risk of cardiac disease by decreasing the cholesterol and tension level in patient participating in DPP Lifestyle change program. The evidence was not clear about the studies for risk of increasing Type 2 Diabetes, only focusing on Lifestyle changes. However, the study helped to reduce weight and improve physical exercise indirectly lowering the risk of Type 2 Diabetes.

The first unplanned action to prevent Type 2 Diabetes was conducted by Finnish Diabetes Prevention Study (DPS) to bring a lifestyle change for a short and long-term intervention and to improve the metabolic and glucose function. Subsequently, the study was examined in Type 2 Diabetic patient with excess weight gained by high calorie intake and irregular exercise. To elaborate, the member should have a face to face interaction with 3months session. On the other hand, the intervention was continued with a follow-up of almost 3 years which manifested in reduction of incidence rate (Lindstrom et al.2003). the evidence suggested that FDPS Program effectively prevented and detained Type 2 Diabetes. However, the intervention implemented for lifestyle change does not have a standard quality treatment and explanation is inappropriate.

In contrast, the Diabetes Prevention Recognition Program (DPRP) persuade an excellent lifestyle intervention to reduce the incidence rate and health expenses for prevention or detained Type 2 Diabetes and improve the overall illness. Similarly, the organisation contributes a National Diabetic Prevention Program organised in 2010, to change the lifestyle through online services and learning models. In fact, in Finland, the prevention program for Type 2 Diabetes offered a primary health services by American Diabetes Association (ADA) including repayment with moderate lifestyle alternation and weight reduction by numerous visits in healthcare centre. In addition, the DPRP Program conducted by CDC, combined with National DPP to monitor the function in USA. This result showed a constructive shrinkage in risk of Type 2 DM and cardiac disease involving the stoppage of tobacco. However, the economical benefit to all generation could be seen if instruction is properly provided to people below 65 years (Saaristo et al.2010).

The Challenges on Implementing the Program

The global burden of Type 2 Diabetes can be reduced by early detection to lower the risk and delay onset by lifestyle changes with healthy diet. The NDEP with ADA introduced the management of body regulation along with self-management and observation program. Additionally, Healthcare service provided awareness of proper intake of food and regular exercise to reduce weight. Apart from this, usage of Drugs and Counselling to obtain the goal was promoted (Charles et al.2001). In spite, IDF not being a government organisation, collaborated with WHO to enhance the management and education program. Subsequently, IDF implements prevention program to fight the developing burden of global Diabetes. However, concentrating on the environmental factor and developing the health is more beneficial than just conducting an education program (Yach et al.2010). According to CDC, the National Diabetes Data analysis showed a 12.2% finding of people suffering from diabetes in 2015. However, the awareness on community-based intervention, early detection, primary care, regular check-up, education to culture and protocol attained is a global challenge. On the other hand, the goal of NDEP is to lower the risk of Type 2 DM in blindness by 30% within 5 years.

The evidence indicates that the cost management and their impact should be evaluated. Although, Screening is essential for high risk Type 2 Diabetes oral medication and lifestyle intervention included in the program can reduce the delay of risk in patient with no sign and symptom. ADA recommended screening test in pregnant ladies within 14 weeks of gestation (Siu,2015). Additionally, ADA suggested a screening test for Prediabetes to check the plasma glucose level in patient above 40years old. Later, this theory was supported by International organization to detect Type 2 Diabetes and reduce the complication of glycemia, retina, heart disease and metabolic disorders (Colagiuri et al.2011). However, the investigation is inadequate according to WHO.

The factors related with globalization are quite challenging for countries to implement. This is because the developing countries are quite focused on their economic development that they do not want to spend more for on healthcare. Restricted amount of spending creates difficulty to invest and implement the program. Considering socioeconomic factors, it can also be said that the education level of the individuals in developing country is a major factor that restrict in improving the efficacy of initiative. It creates difficulty for the population to understand the benefits and other aspects that can be effective for them to control risk of type 2 diabetes.

The Finish Diabetes Prevention Program (DPS) Program showed an increase in resistance of insulin by reducing weight. Additionally, the lifestyle change intervention decreases the risk of Type 2 DM in people with transitional phase. In fact, Insulin production is shown throughout a long period in prediabetes patient (Uusitupa,2003). Since the program cannot be accessed to poor areas, a computer printout facility will be provided. Due the drastic resting lifestyle changes and weight gain, the FDPS Program conducted have improved the daily routine activities and brought a sustainable development in high risk youth suffering from this disease. Apart from this, targeting the policy on transport and design along with financial support have an impact on reducing the risk. In contrast, the challenge of Diabetes is going to increase by 2030, where the population is increasing related to age and migration of rural areas to urban. Additionally, the people in cities are more prone to increase risk of disease due to less activities performed, fast food, weight and lack of exercise. However, the continuous follow-up of FDPS Program showed a remarkable change in lifestyle and decrease the risk even after counselling has ceased (Lindstrom et al.2006). However, the NDEP strategic plan is carried out by ADA (American Diabetes Association) to enhance the follow-up and practice of healthcare service (ADA,2001). Apart from this, an effective treatment provided by prescribing oral medication such as Metformin showed a cost reduction in healthcare system. To elaborate, Metformin was more productive in lowering the risk of Type 2 Diabetes compared to medical intake of placebo.

Lifestyle Change Program – National Diabetes Prevention Program

In contrast, the National DPP focuses on weight loss and exercise and showed a reduction of 58% likelihood Type 2 Diabetes in prediabetic patient by participating in the lifestyle change program. Additionally, the main purpose of DPP Intervention is to maintain the weight and regular exercise by yoga, aerobics and walking (DPP,2002). According to ADA, the patient is permitted only when they meet the four criteria to link with CDC lifestyle change program. However, the lifestyle change program and the third-party repayment was first initiated by YMCA and UHG respectively to work together on community- based intervention, insurance and healthcare program. Additionally, a pathway program was introduced by American Diabetes Association (ADA). In fact, ADA initiated financial support to scientist for performing various researches on prevention of risk of Type 2 Diabetes. Similarly, ADA critically worked together with NIDDK (National Institute of Diabetes and Digestive Kidney Disease) supported by DPP (Diabetes Prevention Program) showed a reduction of incidence rate of Diabetes by 58% and 31% in Lifestyle changes and Metformin management respectively. To elaborate, the weight loss remarkably reduced the risk of Type 2 Diabetes to almost 16% by attaining the lifestyle change program in which regular exercise has an important role to play (Hamman et al.2006).

However, DPPOS (Diabetes Prevention Program Outcome Study) is a long-drawn follow-up to approach the improvement of Type 2 Diabetes with its complication and risk factor including the related disease of eye, kidney, nerves and heart. Subsequently, there is no significant changes related to age, sex and BMI as reported by DPPOS. The study elaborates on prevention or detained Type 2 Diabetes by continuous oral medication of Metformin for more than 10years. Furthermore, the cost management is effective in routine clinical practice. However, the cost effective with Metformin for adults who are above 65years was less beneficial (Herman et al.2005). In contrast, the challenge faced by DPP was to effectively achieve a fast screening analysis and recognize the high-risk Type 2 Diabetic patient. On the other hand, screening test for Non-Insulin Dependent Diabetes Mellitus (NIDDM) is done to randomly measure the blood sugar level in undiagnosed patient (Engelgau et al.1995). The prevention and lowering the risk of Type 2 Diabetes was carried out by using Metformin. In spite the follow-up program, prevention of Prediabetes with Phenformin or Tolbutamide drug which is carried out under small clinical examination was shown inaccurate (Sartar et al.1980). The Diabetes Prevention Program concentrates on prevention and delaying the risk of Type 2 DM in economically low (LMIC) and developing Countries. However, the DPP Program conducted for lifestyle intervention benefited the detain of the disease in those who continued the oral intake of Metformin which was later accompanied by DPPOS program. Furthermore, Funding for DPPOS was started by NIDDK to check the progress of Metformin in Cardiac and Cancer cases related to Type 2 DM (DPPOS,2012).The evidence suggested that the long-term support of early usage of Metformin over more than 10years have been a key strategy to reduce the incidence rate of Type 2 DM. however, counselling along with medication supports this theory (Lancet,2015).

The Key Strategies is to bring awareness about health illness in public, related to Type 2 Diabetes by reducing weight, decreasing sugar and calorie intake, maintain proper diet and improve the physical exercise. Additionally, proper medical guidelines with fundamental support should be given. To be candid, a proper guidance to policy makers on implementing National Diabetes Program. The increase in weight, improper diet and resting lifestyle can cause global increase in Type 2 Diabetes risk. In contrast, the government, different organization and international agencies joined hand with United Nation System to focus on this key goal and reduce the Global Diabetes illness (Rosenbaum & Lamas,2011). Subsequently, Universal approach supported by all National Diabetes Program from all countries was organised to implement National Diabetes plan or NCD Plan including policy makers, financial supporters and healthcare service helper to withstand the epidemic of Type 2 Diabetes (Albright & Gregg,2013). NDP was conducted by a collaborative work of WHO and IDF from 1986. The evidence suggested that collaborative approach is required to achieve a good Diabetic care, which all countries cannot afford to generate. However, a feedback must be provided by National Diabetes Program to customize the policy.

To conclude, WHO and IDF are working together to target the diet control and routine exercise. It is perfectly summarised by Unwin and Marlin (2004) that lifestyle change is more effectual in precluding or detaining the arrival of Type 2 DM by improving exercise, proper diet, reducing sugar and calorie intake, reducing weight and eradicating smoking. However, the universal collaboration of work within the countries will show a significant decline in risk of this disease and other related illness. In fact, November 14^th is celebrated as World Diabetic Day due to a global collaboration of IDF and WHO. Similarly, NDP has introduced educational program, management guidelines, online approach and practical awareness. In contrast, the economical burden of developing countries creates a barrier to manage this disease due to inadequate food supply. Hence, such countries limit their intervention to initiate prevention by changing the lifestyle and other activities in education aspect and unable to involve the health illness completely (Schwarz et al.2010). The evidence suggested that the government, healthcare providers and other private organization should combine to challenge the screening, monitoring and cost-management intervention program at a wider community range and clinical practice. However, the needs of every individual should be considered to expand the program.

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