Diabetes - Women in Hawaii

Hawaii

Diabetes is a chronic health condition that interrupts the body's ability to use insulin, a hormone that allows sugars to enter cells and be used for energy. People with diabetes have an accumulation of sugar in their bloodstream, which can lead to serious health problems like heart disease, vision loss and kidney disease. Diabetes was the eighth-leading cause of death in the United States in 2022. 

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 may be diagnosed when blood sugar levels are elevated but not high enough for a Type 2 diabetes diagnosis. Prediabetes can lead to 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 who do not have diabetes, women with any type of diabetes during pregnancy are at increased risk of preeclampsia, preterm delivery, miscarriage and stillbirth. 

In 2022, the total direct and indirect costs of diabetes in the U.S. were estimated at $413 billion. Individual costs vary; however, average excess medical expenditures associated with diabetes increased from $10,179 to $12,022 per person between 2012 and 2022.

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

• Women ages 35-44 compared with those ages 18-34.
• Black, multiracial and Hispanic women compared with Asian and white women. 
• Women with less than a high school education compared with those who have a college degree.
• Women with an annual household income less than $25,000 compared with women who have incomes of $75,000 or more.
• Women who have difficulty with self-care compared with women without a disability.

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

Prediabetes and Type 2 diabetes are largely preventable through lifestyle changes. 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 prescribed medications, lifestyle changes and health care interventions. The recently passed Inflation Reduction Act caps the cost of insulin for Medicare beneficiaries by law, making it possible for millions more to access life-saving medication and improve adherence. 

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 and 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.

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.

Kochanek, Kenneth, Sherry L. Murphy, Jiaquan Xu, and Elizabeth Arias. “Mortality in the United States, 2022.” NCHS Data Brief No. 492. Hyattsville, MD: National Center for Health Statistics, March 2024. https://doi.org/10.15620/cdc:135850.

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.