As medical assistant Julie Roddy sits down with a new patient at the Braden Diabetes Center to discuss her diabetic plan, Roddy can’t help but notice that her patient appears in great health, maintains a balanced diet and exercises regularly—practices that would normally deter the development of Type 2 diabetes. However, Roddy’s patient is prediabetic—and so are half of Marin County adults, according to the Marin Independent Journal.
Although Marin remains the healthiest county in California and holds the ninth-lowest obesity rate in America, according to Niche, 50 percent of adults are on the path to developing Type 2 diabetes. Without pre-diabetic intervention, up to 30 percent of adults will develop Type 2 within five years, and as much as 70 percent will develop the disease in their lifetime, according to the American Diabetes Association.
Developing pre-diabetes is usually associated with being overweight, inactive, having high blood pressure and high cholesterol. Although only 15.7 percent of Marin adults are considered overweight or obese, according to Healthy Marin, one in every two adults has pre-diabetes. Fortunately, only two percent of the population has actually been diagnosed—so what is the correlation?
Causes for Development of Pre-diabetes
Prediabetes, also referred to as impaired glucose tolerance, is a condition in which blood glucose levels are higher than normal, but not enough to merit a diabetes diagnosis. Individuals who are prediabetic face a much higher risk of eventually developing Type 2 and cardiovascular disease later in life.
According to the California Center for Public Health Advocacy, 46 percent of adults in California—about 13 million people—have pre-diabetes, while another nine percent—about 2.5 million people—are already diagnosed with the disease.
Type 2 is a form of diabetes that restricts a person’s pancreas from producing enough insulin to maintain normal blood sugar levels. According to the American Diabetes Association, the prevalence of Type 2 diagnosis increased sixfold in the last 100 years. Diabetes risk factors such as obesity and physical inactivity have played a major role in this dramatic increase.
Braden Diabetes Center outpatient dietitian and educator, Katy McDermott, noted that developing prediabetes or Type 2 is not solely related to obesity or physical inactivity. The risk of developing Type 2 or prediabetes also increases with age, and as the average age for residents in Marin County is 46, according to Data USA, the older population is more vulnerable to developing the disease.
“There are several factors that can lead to [diabetes], but a lot of time it is just aging. When we use the term, ‘obese,’ it is based on a Body Mass Index number so you don’t necessarily have to be morbidly obese to still face the risk of developing Type 2 because it doesn’t take that much to affect your health particularly as you are aging,” Roddy said.
Disproportionately Affected Populations
Diabetes disproportionately affects minority populations and the elderly, and its prevalence is likely to increase as minority populations grow and the U.S. population becomes older. According to Avani Bedagkar, a quality improvement manager at Marin County Community Clinics (MCCC), the majority of the clinics’ diabetic and pre-diabetic patients come from lower income neighborhoods pocketing Marin, including parts of San Rafael and Marin City. Bedagkar noted that the prevalence of diabetes among lower income neighborhoods is directly correlated to the inequitable access to resources for poorer neighborhoods.
“In lower socioeconomic classes you have less access to green spaces or safe places to be outside, or even just healthy food to eat. I think that is definitely a leading factor in the higher rates of prediabetes among lower socioeconomic classes in Marin County especially,” Bedagkar said.
The MCCC, with offices in San Rafael and Novato, is the principal provider of medical care to low-income Marin residents. The majority of patients Bedagkar serves rely on Medi-Cal, the Medicaid program in California which provides health coverage to people with low-income and asset levels who meet certain eligibility requirements.
The prevalence of Type 2 diabetes not only increases within lower socioeconomic communities, but is exceedingly higher among minority populations as well. According to a UCLA study, the incidence of pre-diabetes among young adults is 36 percent among Latinos and 38 percent among African-Americans, compared to 29 percent for Caucasians.
Diabetes not only takes a toll on an individual’s personal health, but it can also pose an extreme financial burden especially for struggling families and individuals lacking insurance benefits. According to the Braden Diabetes Center, individuals with diagnosed diabetes incur average medical expenditures of $16,752 per year, an expense 2.3 times higher than the cost of medical care in the absence of diabetes. For Type 1 diabetics, individuals who are insulin dependent and do not receive insurance spend over $1,000 per month on insulin alone, according to the American Diabetes Association.
McDermott noted that alongside the fiscal burdens associated with diabetes, many individuals with prediabetes will not take the necessary steps towards fighting the disease before it fully develops because of an unwillingness to accept their diagnosis.
“Some of our patients might not be willing to seek medical attention because they’ll say, ‘I’m okay, I’m young, I’m fine.’ Access to resources is definitely a concern, but it is also about attitude,” McDermott said. “Type 2 is really preventable, but it is just about a patient’s willingness to make changes to their diet and physical activity. We have a fair amount of patients that live in low socioeconomic areas that say, ‘I don’t have money, I don’t have access to a lot of resources but I am still going to be a role model for my community and for my family.’”
Personal impact: Catie Duys
Diabetes is not only a disease—it is a diagnosis that changes the way an individual lives, thinks and acts, according to senior Catie Duys, a recently diagnosed Type 1 diabetic. Type 1 is a form of diabetes inherited genetically, in which the body stops the production of insulin necessary for survival. Although Type 1 is inherently different from Type 2, both types of diabetes in and of itself requires profound lifestyle and economic changes.
When Duys was diagnosed this past May, she experienced profound psychological shock after learning of her diagnosis. According to Duys, the diagnosis came as a complete surprise as no members of her nuclear or extended family have Type 1, even though the disease is usually hereditary.
“In my mind I was not educated about diabetes at all. I thought that having diabetes and not being born with it meant that I had developed Type 2. I was very confused because I try to eat very healthy and I do yoga and kickboxing and maintain a generally healthy lifestyle. When they eventually told me I had Type 1, it was almost a relief,” Duys said.
Although Duys has learned the rudimentary basics for a diabetic, such as understanding the operation of her insulin pen and the tracking of her blood sugar through a Dexcom—an insulin monitoring device—every day presents a new challenge in coping with and learning from her diabetes.
“Once I learned more about the disease, it struck me that this disease is forever, and it’s really hard to imagine myself as an 80-year-old lady testing her blood sugar level and giving herself insulin for her food. The timeline of the disease was just so broad, and knowing I am going to have it forever is kind of scary,” Duys said.
Although diabetes is the leading cause of death in the United States, according to the American Diabetes Association, Duys noted that many individuals remain uneducated about the disease and make wrongful assumptions usually targeting the Type 2 community.
“People can be really prejudiced towards people that develop Type 2 diabetes because they believe it was their fault that they developed the disease, caused by their diet and their lifestyle choices, but that is definitely not the case all the time,” Duys said. “It is also caused by your socioeconomic status and your location and a lot of things out of your control, like your access to healthy food. People are putting blame on people for this disease when it’s not necessarily their fault.”
Diabetic Services in Marin
To accomodate for the growing number of diabetic and prediabetic residents in Marin, numerous clinics and health care centers have opened practices in and around the county to provide quality diabetic care regardless of race, ethnicity or socioeconomic status. MCCC provide medical, nutritional, behavioral, dental and specialized care for diabetic patients and ensure cost-effective practices for those individuals lacking the economic means to afford a private endocrinologist (diabetes specialist). The clinics offer group classes focused on nutritional or prenatal care as well as stress management with an emphasis on whole-person care. For example, the clinic hosts Health Hubs on Wednesdays at their San Rafael location and Thursdays at their Novato location to provide healthy food for their low income patients.
“Health Hubs are essentially small fairs that our clinic has that offers a free farmers market to families who otherwise might not have access to fresh foods,” Bedagkar said.
MCCC partnered with the Braden Diabetes Center in 2013 to provide a variety of resources for patients across the socioeconomic spectrum. The Braden Center conjunctly offers a wide range of diabetic resources, such as community classes, nutritional health services, seminars, festivals and one-on-one diabetic care. It provides health classes specialized in recognizing prediabetic signs and symptoms and offers personalized resources to individuals at risk of developing Type 2.
According to Bedagkar, prediabetic and diabetic resources have accumulated in the Bay Area over the past 10 years as the prevalence of diabetes has dramatically increased. Bedagkar hopes that future organizations will focus on educating Marin’s youth about the signs of prediabetes and the significance of the disease itself and noted the increasing need for accessible and cost-effective diabetic resources.
“Surprisingly, there are a lot of resources available in Marin and Sonoma counties but it's just the question of accumulating all of them and then finding the right way of disseminating them to our patients in a way that is understandable, digestible and accessible. It is one thing to just be like, ‘Oh yeah, there’s the resource,’ but another is to say, ‘Here is how you can access it,”’ Bedagkar said.