Analyzing a Research Article

For my last blog of this semester, I will be analyzing a research article that contains a common theme with my other blogs - Diabetes. My article, "14-Year Diabetes Incidence: The Role of Socioeconomic Status", caught my attention for two reasons. First of all, it is relevant to the material I have learned in my Kinesiology 140 class. A large gap in socioeconomic status results in an overall lower heath status of the overall population; individuals with lower incomes have a higher chance of obtaining diabetes and other health implications. Secondly, it also provides insight to my own experience; this article allows me to depict whether my father's diabetic condition is related to socioeconomic status.

The following information was obtained from the article, "14-Year Diabetes Incidence: The Role of Socioeconomic Status, composed by Ross, Nancy A; Gilmour, Heather; Dasgupta, Kaberi (2010).

Methods:

This study was conducted on 5,547 women and 6,786 men aged 18 or older, who did not have diabetes in 1994/1995. Subjects were followed to determine if household income and education level were associated with an increased risk of diagnosis or death from diabetes by the year of 2008/2009. The data used for this study was Statistic Canada's National Population Health Survey (NPHS). Excluding people on Indian Reserves, territories, Canadian Forces and some remote areas, the household component of the NPHS covers the population living in private houses in 10 provinces in 1994/1995.

Using the year 1994/1995 as a reference point, the researchers applied three models. Model 1 was adjusted for income, education and lengths between observations. Model 2 was adjusted for variables included in Model 1 and the addition of age. Lastly, Model 3 was adjusted for all the variables previously with the inclusion of cultural background, Body Mass Index (BMI), and number the number of secondary risky behaviour factors. Secondary risky behaviour factors include: heavy drinking, smoking and physical inactivity. For all these models, the researchers separated the data into three categories: income and education for men, for women, and for both sexes.

BMI Chart
Retrieved from: http://www.spudart.org/blogs/randomthoughts_archives/A2007053

Results:

Among the people aged 18 and over who were free from diabetes in the 1994/1995 period, 877 people were diagnosed with diabetes by 2008/2009 and 23 (12 men, 11 women) of them died. Although men in this study were more likely than women to live in high income households and be postsecondary graduates, they were also more likely to be overweight/obese and report 2-3 incidents of secondary behaviour risk factors.

Discussion:

From this study, it shows that there is a consistent association between low income and incidents of diabetes when compared with the higher income individuals. Previous cross-sectional have also found an association between socioeconomic status and diabetes prevalence. Thus, this study adds onto previous studies and affirms a clear association between low-income and incident of diabetes. The take home message from this study is that individuals in the lower spectrum of society's socioeconomic status have a higher risk of being diagnosed with diabetes. A limitation to this study is that BMIs were based on reported height and weight. As a result, the calculations tend to yield lower estimates of obesity and could potentially underestimate the association between obesity and Type 2 Diabetes.

In conclusion, socioeconomic status is associated with diabetes. Further studies should be conducted to increase the amount of data available and to inform individuals of these statistics. It is essential for the public to be more aware of this topic and to help reduce inequities through various means.

References:

Ross, Nancy A; Gilmour, Heather; Dasgupta, Kaberi. (2010). 14-year diabetes incidence: The   

          role of socio-economic status. Health Reports, (21)3, 17-28. Retrieved from  

          http://search.proquest.com.proxy.lib.sfu.ca/docview/904161014?accountid=13800

Insulin Sliding Scale - Is it good? Is it bad? 

Today, we will be discussing about a controversial approach in diabetic therapy - The Insulin Sliding Scale. The Insulin Sliding Scale is a set of procedure used by doctors to determine the amount of insulin required at a specific glucose level, and to provide dosage according to glucose tests (3). The insulin given in this process are fast- or rapid-acting and is given when glucose levels are particularly high (4). Administered to patients who has hyperglycemia or high blood sugar, this scale is used primarily in a health institution setting rather than daily use for patients at home (3).

Insulin Chart for Diabetes
http://www.safehavenpch.com/speciality-care/diabetes-management/ 

Since the scale has been around for 80 years and many physicians and therapists still continue to use this method, it may seem to have made a breakthrough in the realm of diabetic therapy (3). The higher the glucose reading from the test, the greater the amount of insulin that should be given (3) - this seems to make sense right? What actually occurs is that the use of this method has not proven to stabilize a patients blood glucose level but rather causes patient’s glucose level to become out of control (3).

An argument against this method is it does not manage the blood glucose level, but rather “chases” it (1). Since a blood test is required before hand to determine the amount of dosage, the patient will already be at that specific level of blood sugar; the dose will simply comply with the amount of blood sugar at that time (3). Another perspective for opposing this procedure is that doctors may use this to reduce their own botheration (1). The doctors will not be continually called while a patient is in the hospital, as the nurse would be able to apply the scale to administer insulin (1).

Despite all the arguments made against the Insulin Sliding Scale, this practice continues to prosper in academic medical centers and community hospitals (2). The scale is a “Historical Practice Habit” (4). Thus, breaking these habits and practices would require a lengthy amount of time because it is deeply entrenched (4). Alternatively, the process is convenient and straightforward; nurses will be able to administer insulin while doctors handle other more severe cases (2). 

My perspective on this Insulin Sliding Scale is quite gray; It depends on the standard of living and whether funding is sufficient in a specific location. For example, if funding for health care is high and the cost is low, I agree to removing this procedure from hospitals and other health institutions. More doctors would be readily available to attend to patients  On the other hand, if funding for health care is low and costs are high, then there are fewer options for institutions. There is no perfect solution; whatever we gain for ease, we pay for it in terms of costs.

Sources Cited:

1) DiabetesLife (n.d.) Insulin Scale - What’s the Whole Controversy About? Retrieved from:
        http://www.diabitieslife.com/diabetes/diabetes-basics/treatment-of-diabetes/insulin-sliding-scale.htm

2) Hirsch, B. I. (2009). Sliding Scale Insulin - Time to Stop Sliding. Retrieved from:

http://jama.ama-assn.org.proxy.lib.sfu.ca/content/301/2/213.full 

3) Insulin Sliding Scale (n.d.). Insulin Sliding Scale - A Controversial Approach Diabetic Therapy. 

        Retrieved from: http://www.insulinslidingscale.net 

4)  Miller, D. (2011). Why Won’t the Sliding Scale Go Away?. Canadian Diabetic Association. 

        Retrieved from: http://www.diabetes.ca/documents/for-professionals/CJD--Sept_2011--D.Miller_.pdf