Disease is often categorized based on two main approaches, whether it is communicable or non-communicable. According to Taylor (2012), a communicable ailment is one that is highly infectious and can spread easily from one person to another, or from animals to human beings. Such diseases are deadly as they result in mass casualties, owing to the high spread rate if they are not adequately managed. Some of the diseases in this category include the flu, common cold, measles, and Ebola.
On the other hand, a non-communicable disease is one which is non-infectious in nature. In this case, these ailments are not distinguished based on the time they take to manifest themselves, as some occur rapidly hence deadly. Some of these include cardiac diseases, all types of cancers, diabetes, HIV/AIDS, amongst others. Taylor indicates that Non-Communicable Diseases (NCD) is responsible for the highest number of deaths in the globe (2012). In this regard, various aspects are identified as the risk factors of this type of disease. This includes a person’s lifestyle, background, and environmental factors which consequently increases chances of one contracting such ailments. This paper will focus on one NCD, diabetes. It will also discuss its epidemiology, the national policies implemented with regards to the disease’s management, as well as the strengths and weaknesses in the identified policies, suggestions and recommendations to strengthen existing policy frameworks.
Diabetes
According to Barnett (2006), diabetes is a disease that is represented by a higher glucose level than compared to normal levels. As a result, it causes ailments such as eye problems, kidney failure, and nerve complications. The development of this ailment is caused by the improper insulin production and/or management. In this case, once food is ingested, it is broken down to produce sugar that is distributed to body organs for provision of energy. The pancreas, an organ near the stomach is responsible for the production of a hormone called insulin. Therefore, the sugar or glucose produced is transported using the insulin. In this regard, if the insulin does not transport the sugar, or is inadequate, sugar is going to accumulate in the body, hence causing diabetes.
Diabetes is categorized into three categories, namely, type 1, type 2, and gestational diabetes. Type 1 is caused by the destruction of insulin-producing cells of the pancreas by the body’s immune system. As a result, the lack of production of this vital element causes organ failure owing to the lack of energy provided by glucose. Therefore, this leads to sugar accumulation, causing diabetes. For this reason, individuals suffering from this type are subjected to insulin injections on a daily basis.
Type 2 is the most common form of diabetes, as it affects approximately 90% of the population. In this case, the pancreas produces an insufficient amount of insulin leading to deficiency of energy by body organs. In other instances, the body resists the insulin produced and hence uses it inadequately. In this regard, people suffering from type 2 diabetes are required to take pills or insulin in order to treat and manage the ailment.
Gestational diabetes mostly affects pregnant women and increases the woman’s chance of developing diabetes, mostly type 2. In addition, the child is also exposed to higher risks of becoming overweight and subsequent development of type 2 diabetes.
According to current clinical management, there is no sure way of distinguishing type 1 and 2 diabetes. This situation leads to inadequate medical support and relevant and direct assistance in management of the disease. The prevailing situation is dependent on the predominant method of establishment of glucose levels. However, this approach is misleading and not fool-proof as some unique situations are experienced in which case the beta-cells that are used in the determination of type 2 diabetes, are available in type 1 diabetes situations. Therefore, such situations lead to misdiagnosis hence the involvement of wrong treatment options. For instance, individuals who in the actual sense suffer from type 2 diabetes but are diagnosed as type 1 are forced to use insulin injections, a treatment they would have avoided through taking pills or a change in diet or making better lifestyle decisions such as reduction of one’s weight.
However, studies are being carried out with regards to this situation, in order to improve patient experience and better clinical management by medical practitioners. For instance, researchers from Yale University have proposed a genetic measurement instrument that can distinguish between type 1 and type 2 diabetes.
Epidemiology
According to Berger (2005), Oman is classified as one of the top countries in the Middle Eastern and North American (MENA) countries. The country has low child and adult mortality rates at 3.2 per 1000 people. However, diabetes mellitus is identified to be one of the leading causes of premature mortality in the country. In this regard, approximately 9% of adult hospital admissions and 12% of Oman’s hospital bed occupancy are related to diabetes mellitus. These statistics indicate a high prevalence of the disease in the country.
The international scene has also seen an unprecedented rise in the number of diabetes cases in the recent past. According to the Center for Disease Control and Prevention (CDC), diabetes is has been identified as a national disaster. This is because of the startling statistics which indicates of the increasing number of individuals diagnosed with diabetes. Even though the rate of new cases has reduced since 2009, the number of diabetic patients remains a cause for worry.
In this regard, according to Taylor (2012), approximately 29 million people in the US were diagnosed with the ailment in 2014, with 7 million remaining undiagnosed. In addition, a total of 12.1 million visits to the Emergency Department (ED) were identified as diabetes-related cases from the ages of 18 years and above, which signified approximately 9% of total ED cases. In comparison, the Sultanate of Oman the disease is attributed to approximately 75% of all hospital deaths in the country. The high figures related to the disease translate to increased revenue expenditure on the disease. In this case, the US spends approximately $130 billion annually on diagnosis, treatment, and research on the disease (Taylor 2012). This amount illustrates the severity of the issue as the government and Non-Profit Organizations establish better management practices and subsequent effective and complete treatment.
According to (Sonken, Fox, and Judd 2003), women are identified by a higher rate of diabetes than compared to their male counterparts. However, that rate of diabetes as related to weight gain is equally prevalent between the two genders. In this case, this is attributed to lifestyle choices as identified in type 2 diabetes, in which case is mostly associated with weight gain. In addition, this diabetes type is common than compared to type 1 diabetes.
As identified above, various risk conditions exist in the prevalence of the disease. The risk factors associated with type 1 include, family history, in which case incidences of the disease in the family structure increases the risk of development of the disease. In addition, factors such as race and childhood infection also contribute greatly in the prevalence of the disease.
On the other hand, the risk factors associated with type 2 diabetes are further categorized as either modifiable or non-modifiable. According to Poretsky (2008), modifiable factors are identified as lifestyle risk factors. These are concerned with the determination of Body Mass Index (BMI), poor lifestyle choices as evidenced in nutrition decisions and lack of inactivity, stress, hypertension, smoking and alcohol-use, amongst others. The consideration of the above factors increases the prevalence rate of the disease. However, the determination of one’s BMI is connected to diabetes type 2 development. Moreover, body fat distribution and an increased waist-to-hip ratio also increase prevalence.
On the other hand, non-modifiable factors are represented by those which cannot be changed as a result of their virtue. In this regard, non-modifiable factors for type 2 diabetes include race, family history that explain genetic predisposition, and age. In addition, psychosocial factors in diabetes development are also responsible for its prevalence. In this regard, aspects such as depression, high stress levels, and an overall poor mental predisposition factor heavily in the development of type 2 diabetes.
In terms of mortality, diabetes was identified as one of the leading causes of death in the year 2005, with direct reference to the ailment, as well as, diabetes-related complications. In addition, the contribution of death features greatly in the determination of the cause of death. In this case, individuals below the age of forty-five are more likely to die prematurely than compared to those who do not have the disease. Moreover, two-thirds of those suffering from type 2 diabetes succumb to heart disease and stroke. In this case, cardiovascular mortality is approximately two to four times greater than compared to those who do not have diabetes.
Diabetes Policies
Owing to the economic burden associated with diabetes management and treatment, national policies have been implemented in light of this situation. In this regard, various policies, revolving around research, treatment, and management of the disease have been enacted by virtue of the increased in budget allocation. Berger indicates that the year 1995 saw the total expenditure on the disease increased by approximately 64% in 2005 (2015). These figures illustrate the severity of the issue that has adverse implications on the nation’s health and consequently, finances.
Various research findings carried out over the years have proven a positive correlation between weight gain and prevalence of diabetes. As indicated above, the higher the increase in weight, the higher the risk of prevalence of diabetes. As a result, various federal interventions have been introduced in schools, owing to the accreditation of obesity to young children as a result of unhealthy food choices. In this case, various programs that advocate for healthy school food have been introduced in the United States to encourage children take proper and nutritious diets (Brown 2008). For instance, some projects, such as that driven by the First Lady of the United States, has encourage healthy eating practices and advocated for the introduction of an exercise regime in a bid to control the rate of obesity among young people. This direction is also supported by the World Health Organization in its Global Strategy on Diet, Physical Activity, and Health (Bagchi and Sreejayan 2012). Such initiatives should be introduced in Oman in a bid to reduce the prevalence of the disease in the country.
National policies have supported various advocacy groups focused on issues surrounding diabetes. One of these is the National Diabetes Prevention and Control Program (NDPCP) that has received increased support from the legislature. In this case, the government has provided for funding of the National Diabetes Program. This has been done in order to establish a framework that would make diabetes-prevention programs more widespread and accessible to many individuals.
The Oman government has played a pivotal role in reducing the diabetic level among its citizens. Government initiative such as easy access to diabetic medication is integral in the reduction of the high mortality rates. Currently, all citizens get free diabetic medications for free of charge and also in Oman recently got a new endocrine center which take care for all diabetic patients.
Strengths and Weaknesses
As indicated above, a variety of laws and regulations at the national level exists in the management and administration of treatment of diabetes. In this case, proper medical assistance is provided for individuals, especially children, suffering from the disease. In addition, the support for programs that advocate for lifestyle changes have also helped in management of the prevalent rates of diabetes. In this regard, such initiatives have received government funding for advocacy purposes, as well as information-sharing with the public.
However, national policies in Oman are relatively weak when it comes to policy surrounding healthcare. Comprehensive care is not administered to all individuals on the basis of age and other factors. As a result, such obstacles prevent proper management and treatment of diabetes on the basis of an insufficient healthcare cover.
As a recommendation, the Sultanate of Oman should introduce initiatives that focus on prevention and control in order to avert a potentially damaging situation in Oman.
In conclusion, diabetes is one of the leading causes of death in Oman, with direct reference to the ailment, as well as, diabetes-related complications. In addition, the contribution of death features greatly in the determination of the cause of death. This is as a result of relatively weak national policies in Oman when it comes to policy surrounding healthcare. Comprehensive care needs to be administered to all individuals in order to ensure the disease rate is reduced and subsequently curb in the long run.
References
Al Mandhari A, Al Zakwani I, El Shafie O, Al Shafee M & Woodhouse N (2009). Quality of diabetes care: a cross sectional observational study in Oman. Sultan Qaboos University Med J 9: 32-36.
Al Moosa S, Allin S, Jemiai N, Al-Lawati J & Mossialos E (2006). Diabetes and urbanisation in the Omani population: an analysis of national survey data. Popul Health Metr 4: 5-9.
Al-Futaisi A, Al-Zakwani I, Almahrezi A, Al-Hajri R, Al-Hashmi L, Al-Muniri A & Farooqui M (2006). Prevalence and predictors of microalbuminuria in patients with type 2 diabetes mellitus: A cross-sectional observational study in Oman. Diabetes Res Clin Pract 72 (20): 212-215.
Al-Lawati J, Al Riyami A, Mohammed A & Jousilahti P (2002). Increasing prevalence of diabetes mellitus in Oman. Diabet. Med 19(11): 954–957.
Bagchi, D., & Sreejayan, N. (2012). Nutritional and therapeutic interventions for diabetes and metabolic syndrome. Amsterdam, Elsevier/Academic Press.
Barnett, A. H. (2006). Diabetes: best practice & research compendium. Edinburgh, Elsevier.
Berger, S. (2015). Infectious diseases of Oman. Los Angeles, Gideon Informatics.
Brown, R. M. (2008). Diabetes: good food choices .Laguna Beach, CA, Basic Health Publications.
Khandekar R, Al Lawati J, Mohammed A& Al Raisi A (2003). Diabetic retinopathy in Oman: a hospital based study. Br J Ophthalmol 87(9): 1061–1064.
Ministry of Health Oman (2005). Communicable Diseases Control in The Sultanate of Oman. Oman.
Poretsky, L. (2009). Principles of diabetes mellitus. New York, Springer.
Sonken, P. H., Fox, C., & Judd, S. (2003). Diabetes at your fingertips. London, Class.
Taylor, N. (2012). Health education in context: an international perspective on health education in schools and local communities. Rotterdam, Sense Publishers.
