Health, Mexico Maternal Diabetes

From: Secretary of Health, Mexico Maternal Health, Gestational Diabetes
Introduction:
Diabetes has become the number one killer in Mexico in the last decade and a half; 14% of all deaths in our country can be attributed to this disorder. Gestational diabetes can be linked to up to one third of those deaths. Gestational diabetes especially impacts those in low-income or rural areas, who lack the access to basic technology like glucometers necessary to diagnose altered blood glucose levels. Older, overweight, hypertensive, diabetic women of color are the most prone to developing gestational diabetes during pregnancy and put themselves at risk for Type 2 diabetes later on in life as well as impaired cognitive abilities for themselves and
their children. This endocrine disorder is the number one cause of Disability Adjusted Life Years (DALYs) in our country, causing about 800,000 DALYs per year, and we spend $180 million per year caring for those who have been afflicted. Mexico must adopt policies that encourage diabetic pregnant women to follow diets and exercise routines. We should also invest $10 million per year towards distributing glucometers to low-income areas in order to diagnose and effectively treat more people with gestational diabetes.

Nature and Magnitude of the Problem: Over the last 2 decades, diabetes mellitus has quietly emerged as an extremely potent killer in Mexico.
Mexico has the third most prominent rate of diabetes of any country in the world, and around a quarter of the patients in the world living with the disorder are in Mexico., Diabetes is a chronic disease where the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. 14% of all deaths in Mexico are attributed to this disorder, and it is believed that, for some age groups, gestational diabetes could be linked to a third of all cases., Gestational diabetes is a form of diabetes mellitus, along with Type 1 and Type 2, that occurs in pregnant females. In 1988, as many as 4.3% of pregnant women in Mexico had gestational diabetes; by 2012, that number had risen 12.9%., Diabetes is linked to weight gain, and as Mexican citizens maintain their unhealthy lifestyles, diabetes rates, especially Type 2 and gestational, will continue to rise. The current lifestyles our citizens are living has accelerated diabetes in overtaking heart disease to become the leading cause of death in Mexico since the year 2000.4 If this obesity trend continues, studies estimate that the number of diabetics in Mexico in 2010 will almost triple by the year
2050.
Affected Population:
Pregnant women and their children constitute the entire affected population for gestational diabetes. Within these labels, however, there are subgroups that can be disproportionately affected. Poor women and women living in rural areas are more likely to remain diabetic through their entire pregnancy. Gestational diabetes, although a chronic disorder that requires long-term care, is relatively simple to control if someone has been diagnosed, but access to the adequate healthcare and technology required to provide this long-term treatment is more difficult to encounter in rural Mexico. Furthermore, the effects of the disease last much longer than the 40 weeks of pregnancy. Some women retain their inability to process insulin after their pregnancy, and face a higher risk to develop gestational diabetes in a subsequent pregnancy. The newborns may also continue into childhood and young adulthood overweight and hypoglycemic, and therefore face an increased risk for associated morbidities, such as cardiovascular disease and seizures.12
Risk Factors:
All gestating women are at risk for gestational diabetes during pregnancy. Associated risk factors that increase a woman’s likelihood of developing the disorder include ethnicity, age, weight, and co-morbidities. Ethnically Hispanic women are, for an unknown reason, 6% more likely to become afflicted with gestational diabetes during pregnancy when compared to Caucasian women. This statistic suggests that the country of Mexico is at a disadvantage and indicates that we should allocate more time and attention to solving this issue. The mother’s age also has an impact on the likelihood of developing gestational diabetes, as older pregnant women are more susceptible to the disease. By the age of 40, a woman is over 30% more likely to develop gestational diabetes. Having previously given birth to a large baby or being overweight can also predispose someone to develop gestational diabetes. Mexico’s obesity epidemic disproportionately affects women and thus excessively contributes to the gestational diabetes crisis, for 37.5% of Mexico’s women are considered obese as opposed to 26.8% of its men. As much as 46% of gestational diabetes cases can be attributed to the mother having a BMI of over 25 kg/m2. Disorders like polycystic ovary syndrome and hypertension also increase a person’s risk for gestational diabetes, and having the disorder in a previous pregnancy can raise a person’s chances of developing it again by more than 30%.,
Health, Economic, and Social Consequences:
The rising rates of gestational diabetes have begun to compound in our country and have led to accumulating costs in our fragile healthcare system.
These increasing rates have been preceded by the eating habits of an increasingly unhealthy Mexican population, and contribute to more long-term diabetic disorders and decreased cognitive ability in both the mother and the child. Having gestational diabetes during a pregnancy can increase a woman’s odds of developing Type 2 diabetes later in life by over 70%. This progression from a nine-month illness to a lifelong chronic disorder drastically reduces a person’s likelihood of adhering to treatment. Poor treatment of diabetes can lead to debilitating outcomes including nerve damage, eye damage, cardiovascular disease, kidney damage, Alzheimer’s disease, and limb amputation. These encumbering sequelae are the primary reason that diabetes contributed to almost 800,000 DALYs in Mexico in 2005, more than any other condition. Diabetes-related conditions are highly cumbersome disabilities, and often remove people from the workforce and diminish their ability to contribute to Mexico’s growing economy. Untreated gestational diabetes has also been proven to reduce the mother cognitive abilities by up to three points on an exam and significantly reduce an infant’s mental and psychomotor development., The sequestering of intellectual capacity by gestational diabetes limits people from living up to their potential and helping the country of
Mexico grow.
Priority Action Steps:
Mexico must implement both short term and long term interventions in order to fend off the growing epidemic of diabetes. Gestational diabetes can be prevented in the same way diabetes can, and Mexico has already taken steps in the right direction. In 2014, Mexico instituted a 10% tax on sugar-sweetened beverages and witnessed their sales fall 6%. Preventative measures such as this sugar tax can go a long way in the long term in preventing the development of Type 2 and gestational diabetes (especially those that bring in revenue for the government), but something must be done regarding the current patients facing these difficulties. One of the largest issues patients with gestational diabetes face is that they continue undiagnosed. We must expand access to technology like glucometers, a tool that can easily recognize altered blood sugar levels in people, to the rural communities of Mexico in order to promote awareness and succeed in diagnosing more women with gestational diabetes. At $30 per unit, Mexico should invest in distributing 10,000 glucometers with test strips per state per year, for a total of $9.6 million. For less than $10 million per year, Mexico can help more women return to the workforce faster and effectively after giving birth, as well as promote cognitive development in its future generations. Mexico currently spends $180 million on care for diabetic patients per year, and this intervention can both lower that cost and increase productivity by distributing glucometers to properly diagnose patients with gestational diabetes.4 Other techniques of managing gestational diabetes can be implemented at no cost, such as starting an ad campaign and setting national guidelines for health professionals to encourage better diets and exercising in diabetic mothers-to-be.,