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The following section will discuss the background of diabetes. Diabetes has become a growing concern in adults in the United States with more than 29 million Americans living with diagnosed diabetes and 86 million living with pre-diabetes. Diabetes can be defined as a chronic disease that is caused when the body is unable to produce insulin effectively or use insulin appropriately which causes an increase in a blood sugar. High blood sugar in the blood leads to diabetes which is a root cause of many health problems- kidney diseases such as end-stage renal disease, heart disease such as cardiovascular disorders, nerve damage such as peripheral neuropathy, and eye disease such as retinopathy (Chronic Disease Prevention and Health Promotion, 2016). The data obtained from American Diabetes Association in 2015 shows that 30.3 million Americans have diabetes and is categorized as a 7th leading cause of death (Statistics About Diabetes, 2017). The prevalence of diabetes is projected to increase from 14% to 33% by 2050 as the average age of the US population rises (Caspersen, Thomas, Boseman, Beckles, & Albright, 2012).
Diabetes is sometimes called a silent killer as often it goes undetected due to its signs and symptoms being mistaken for other diseases, patients not experiencing any symptoms or failing to notice warning signs. Some possible indicators of diabetes comprise of extreme thirst, excessive urination, dehydration, increased appetite, and inexplicable weight loss (Riaz, 2009). There are three common types of diabetes: Type 1 diabetes, Type 2 diabetes, and Gestational diabetes. Type 1 diabetes also known as juvenile, insulin-dependent or early-onset diabetes is primarily caused due to the body not being able to produce enough quantity of insulin. The body’s immune system mistakenly attacks and destroys the insulin-making cells in the pancreas causing insulin deficiency. Currently, there is no cure for type 1 diabetes. People with this type of diabetes need to take insulin every day to effectively manage it. This type of diabetes is more common in children and young adults but can emerge at any age. Even though, only about 5 percent of U.S population is affected by type 1 diabetes (Type 1 Diabetes, 2017) according to American Diabetes Association about 1.25 million Americans have been diagnosed with type 1 diabetes and another 40,000 people are estimated to be newly diagnosed each year (Investments in Type 1 Diabetes Research, n.d).
Type 2 diabetes is the most common type of diabetes and is caused due to body’s lack of ability to produce sufficient or effectively use insulin. Insulin hormone produced by the pancreas is essential for glucose to reach blood cells to be converted into energy. Insulin imbalance in the body causes too much glucose to stay in the blood leading to diabetes. Type 2 diabetes is most common in adults ages 45 or older. (Type 2 Diabetes, 2017). According to Center for Disease Control, type 2 diabetes accounts for about 90% to 95% of all diagnosed diabetes cases. Type 2 diabetes can be prevented or delayed by making lifestyle changes such as healthy eating habits and regular physical activities (Chronic Disease Prevention and Health Promotion, 2016).
Gestational diabetes occurs during pregnancy and is sometimes related to the hormonal changes leading to the body producing less insulin. If not managed effectively, gestational diabetes can lead to health problems in both mother and baby. It can be prevented by losing excess weight before pregnancy and being physically active before and during pregnancy. It can be managed by implementing a healthy diet, being physically active and in some cases by taking insulin during pregnancy. In most cases, gestational diabetes is cured after delivery but in some cases, it might be incurable requiring insulin usage for the rest of the life. Individuals who are diagnosed with gestational diabetes are inclined to develop type 2 diabetes later in their lives but can be delayed by maintaining a healthy weight, implementing a healthy diet and being physically active. (Gestational Diabetes, n.d.) According to the article in Medical News Today, 10% to 20% of gestational diabetes patients will require medications to control blood glucose during their pregnancy (Team, 2016).
Worldwide, the incidence of diabetes is on a remarkable rise with the most increase seen in metabolic forms of diabetes, type 2 diabetes. Multiple factors such as predisposing conditions and risk factors are responsible for causing type 2 diabetes. Genetics and family history play a significant role in causing diabetes. According to American Diabetes Association, an individual’s risk of developing diabetes increases by 10% to 25% if both parents have type 1 diabetes, whereas, it increases by 50% if both parents have type 2 diabetes. Leading factors of type 2 diabetes and gestational diabetes are overweight and obesity (Riaz, 2009).
Due to income disparity low-income population is unable to access quality healthcare resulting in higher cases of undiagnosed or untimely diagnosis of diabetes. Income disparity is one of the contributing factors of health disparity. Health disparity can be defined as a gap in the quality of care received by certain population due to various social determinants such as income level, education, insurance coverage, ethnicity etc. In order to deliver high-quality healthcare, this health disparity has to be reduced, if not eliminated and can be achieved by implementing solutions that will cater to the unique requirements of such population. (Approaches for Specific Populations, n.d.)

General Problem Statement
The general problem is diabetes is prevalent in adults in the United States. In 2015, American Diabetes Association considered diabetes as a 7th leading cause of death in the United States. The statistics obtained by American Diabetes Association in 2015 shows that 30.3 million Americans or 9.4% of the U.S population has diabetes. Out of 30.3 million adults with diabetes, 23.1 million have been diagnosed whereas 7.2 million still remain undiagnosed (Statistics About Diabetes, 2017). Also, according to Illinois Department of Public Health, every year approximately 800,000 people of ages 18 years and older are diagnosed with diabetes, with another 500,000 people being unaware of their disease (Diabetes, n.d.).
The prevalence of diabetes in seniors ages 65 and older is at 25.2% or 12.0 million including both diagnosed and undiagnosed. Also, 84.1 million Americans age 18 and older had pre-diabetes in 2015, according to American Diabetes Association. The rates of diagnosed diabetes in adults varies by race/ethnic background with American Indians/ Alaskan Natives at the highest at 15.1 %, 13.8% for Mexican Americans, 12.7% for non-Hispanic blacks, 12.1% for Hispanics, 12.0% for Puerto Ricans, 11.2% for Asians Indians, 9.0 % Cubans, with the lowest being Chinese at 4.3% as per the data obtained from American Diabetes Association. Prevalence of diabetes also varied by education level making socioeconomic factor an indicator for diabetes. This is shown in the statistics obtained from Center of Disease Control according to which 12.6% of adults with less than a high school education had been diagnosed with diabetes in comparison to 9.5% of those with a high school education and 7.2 % of those with more than a high school education (Estimates of Diabetes and Its Burden in the United States, 2017).
The epidemic of diabetes in the United States have been increasing the cost of healthcare which can be attributed to inefficient systems of care, changing demographics and aging population. The Statistics obtained from American Diabetes Association also show that in the United States in 2012, the cost of diagnosed diabetes was $245 billion with $176 billion for direct medical cost and $69 billion in reduced productivity (Cefalu, Petersen, & Ratner, 2014).

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Specific Problem Statement
The specific problem is adult diabetes is prevalent among lower income population in Illinois. Besides lack of physical activity and family history of diabetes, economic status of an individual is also a contributing factor in developing diabetes. Type 2 diabetes though common in all communities in the United States, is 2 to 6 times more prevalent in minority groups such as African-Americans, Hispanic/Latinos and Native-Americans in comparison to other non-minority groups. This is attributed to these populations being closely associated with socioeconomic status and them commonly living in poverty. Low-income African Americans are more susceptible to diabetes and its health problems when compared to their counterparts with higher income levels (Prevalence of Diabetes in African-American Communities: Risk Factors and Prevention as a Social Disease, n.d.) Similarly, the prevalence of diabetes is nearly twice among the U.S Hispanics in comparison to non-Hispanic whites. These poor diabetic outcomes in Hispanics are due to health disparity caused by socioeconomic factors such as low income leading to inadequate medical care increasing their risk of developing other associated disease such as depression (Ell et al., 2009).
Since diabetes affects low-income population, expansion of Medicaid program which provides insurance coverage for low-income population can decrease the health disparity and curb the healthcare spending. With implementation of Affordable Care Act, all individuals up to 138% of poverty are covered under Medicaid plan providing coverage for more low-income populations who were excluded prior to the expansion of Medicaid program (Role of Medicaid for People with Diabetes, 2012). According to Illinois Department of Public Health, 15% of adults with income less than $15,000 have diabetes in comparison to 5.6 percent of adults with income higher than $50,000 (The Burden of Diabetes in Illinois, 2012). The statistics also demonstrate as the income level decreases the dominance of diabetes increases attesting that individuals with high economic status are less susceptible to diabetes. This can be seen in the statistics obtained from Illinois BRFSS which shows that adults with a household income more than $75,000 has 6.0% prevalence of diabetes and tend to go up to 8.4% with income between $50,000-$75,000, 10.5% with income between $35,000-49,000, 12.3% with income between $15,000- $34,000 and highest of 12.7% with income less than $15,000 (Chronic Disease Burden Update, 2013). The expansion of Medicaid program has increased coverage for low-income population in Illinois assisting them in seeking medical care for diseases such as diabetes which require constant monitoring and medication.
Purpose Statement
The purpose of this research is to reduce adult diabetes among lower-income people in Illinois. Since prevalence of both Type I and Type II diabetes is more specific in lower-income population, reduction of income disparities might lead to its decrease. Since reduction of income disparities will increase the access to quality health care for low-income communities, the risk of developing diabetes and its negative outcomes will be greatly reduced (Clark et al., 2011).
According to the studies published by Robert Wood Johnson Foundation, low-income population faces many challenges in management of diabetes such as lack of access to affordable healthy foods, unreliable access to healthcare, restricted transportation, limited access to grocery stores and lack of safe housing. Due to limited income, their diabetes management decisions conflict with other priorities forcing them to make tradeoffs. For example, many individuals are forced to choose home rent over eating a healthful diet. For some individuals routine of diabetic self-care management is too overwhelming as it demands time and knowledge in meal preparation forcing them to choose simpler option of purchasing fast food. Frosch, one of the research scholar of this study recommended that diabetes treatment plan for these individuals should be highly individualized taking into consideration what a patient is able to and willing to do rather than telling them what to do. By developing a collaborative plan of disease management, physicians will be able to achieve higher success rate in curbing diabetes in low-income population (Low-Income Patients Face Added Challenges in Managing Diabetes, 2013). To achieve this type of collaborative care, Improving Diabetes Care and Outcomes program was launched on the south side of Chicago, Illinois. This program focuses on identifying and implementing clinical practice changes which will improve patient care quality in participating clinics (Clark et al., 2011).

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