CHALLENGES OF TYPE 2 DIABETES AND ROLE OF HEALTH CARE SOCIAL WORK: A Neglected Area of Practice
DeCoster, Vaughn A., Health and Social Work
Across the world, diabetes mellitus is one of the most prevalent and serious chronic diseases. In the United States alone, almost 16 million people suffer from diabetes, which costs many of them their eyesight, kidney function, lower limbs, or life itself, and costs the U.S. health care system billions of dollars. Currently, social work involvement with this chronic disease appears limited; however, social workers have the potential to make remarkable differences in the lives of people coping with diabetes. To facilitate involvement, this article outlines the basic aspects of Type 2 diabetes mellitus, its biopsychosocial challenges, and the roles health care social workers that may be assumed in assisting adult patients and their families.
Diabetes mellitus is one of the most prevalent and serious chronic diseases facing the U.S. health care system. According to the Centers for Disease Control and Prevention (CDC) (1998), diabetes affects 15.7 million people in the United States, 10.3 million of who have been diagnosed and 5.4 million of who are unaware that they have this disease. The American Diabetes Association (ADA) (1998) estimates that in 1997 alone medical care for diabetes cost $44.1 billion dollars. Diabetes exacts an equally devastating physical toll; it is the leading cause of blindness, end-stage renal disease, noninjury-related lower limb amputations, and cardiac disease, and it is the seventh leading cause of death in this country (CDC, 1998). Currently, social work involvement with this chronic disease is limited. For instance, as of 1998, social work clinicians made up less than 1 percent (n = 57) of the professionals listed with the American Association of Diabetes Educators, the principal organization of diabetes professional s. As a topic of research, a review of the social work literature identified 13 articles on diabetes-related topics (see Table 1). Although there are probably many social workers treating and researching diabetes, their involvement seems inconspicuous. Considering the ability of diabetes and its treatment to challenge an individual's biopsychosocial functioning, social workers have the potential to make remarkable differences in the lives of people coping with this disease. Nevertheless, according to Sidell (1997), mental health professionals "typically receive little training specifically designed to help them assist people with chronic illnesses" (p. 10).
To assist people with diabetes, social workers first need to understand the disease, how it challenges patients, and then ways to become involved. This article outlines the basic aspects of Type 2 diabetes, its incessant challenges, and several interventions health care social workers may use to assist adults with this chronic disease.
Diabetes mellitus is a cluster of endocrine diseases characterized by the body's complete or partial inability to absorb glucose, the principal source of energy, from digested foods into cells (Harris, 1995b). Unabsorbed glucose accumulates in the bloodstream, eventually exceeding physiologically tolerable levels, damaging blood vessels and capillaries. According to the National Institutes of Health (NIH) (1995), diabetic complications include blindness, renal failure, peripheral neuropathy, and peripheral vascular disease. People with diabetes are also at greater risk of cardiac disease, strokes, amputations, retinopathy, cataracts, glaucoma, and gestational complications compared with people of similar age without diabetes (CDC, 1998; NIH, 1995).
Distinguishing Type 2 from Type 1 Diabetes
There are primarily two forms of diabetes. In Type 1 diabetes, formerly called "insulin-dependent diabetes mellitus," the pancreas produces very little or no insulin, necessitating an injected supply of insulin. …