There are a couple of things that determine the health in general. The ‘Force Field Model of Health’ identifies four determinants of health which are; heredity, medical services, environment, and lifestyle [Figure 1] (1).
Figure 1: Force Field Model of Health (Source: Blum, 1983)
Based on Blum’s framework, a literature review identified several determinants responsible for the development and burden of diabetes. The summarized findings are presented in table 2.
|Table 2: Determinants of developing diabetes and disease burdens|
|Heredity||The determinants include, family history (2), high body weight and BMI (3). high blood pressure (IDF, 2017), age (3), obesity (4), gestational diabetes, and several genetic factors like KCNQ1, TCF7L2, KCNJ11 (5), HLA-DR3-DQ2 and/or HLA-DR4-DQ8 haplotypes (6). Some of the genetic factors are modifiable and some are not (7, 8).|
|Environment||The determinants include, living in high altitude (9), PM2.5 air pollution (10), noise pollution, public transport, green space (11), income and wealth (IDF, 2017), quality of social contact (12).|
|Lifestyle||The determinants include, level of physical activity, sedentary behaviour (3), alcohol consumption (3), eating processed meat, drinking sugar-sweetened beverages (3), smoking (8).|
|Medical care services||The determinants include, lack of access to healthcare services, and quality of services (IDF, 2017; WHO, 2016).|
A recent meta-analytical study classified the risk factors of T2D into six different aspects (3). Another study classified the risk factors of T1D into three broad categories [Figure: 2] (4).
Figure 2: Determinants of T1D (Source: Rewers & Ludvigsson, 2016)
Combining all of these factors, author has constructed a broader classification of diabetes risk factors which is illustrated below (Figure 3).
Figure 3: Risk factors of diabetes (Source: Author’s construct)
To summarize this chapter it is evident, there are a lot of factors which are playing role as the determinant of diabetes. Some of these are modifiable and some are not. In both categories, frameworks are needed to treat, manage and prevent diabetes.
- Blum HL. Expanding health care horizon: from a general systems concept of health to a national health policy. 2nd ed: Third Party Pub Co.; 1983.
- Frier BM, Fisher M. Diabetes Mellitus. In: Colledge NR, Walker BR, Ralston SH, Davidson S, editors. Davidson’s principles and practice of medicine. 21st ed. / the editors, Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston ; illustrated by Robert Britton. ed. Edinburgh ;: Churchill Livingstone/Elsevier; 2010. p. 795-840.
- Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLOS ONE. 2018;13(3):e0194127.
- Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. The Lancet. 2016;387(10035):2340-8.
- Wu Y, Ding Y, Tanaka Y, Zhang W. Risk Factors Contributing to Type 2 Diabetes and Recent Advances in the Treatment and Prevention. International Journal of Medical Sciences. 2014;11(11):1185-200.
- Pociot F, Lernmark Å. Genetic risk factors for type 1 diabetes. The Lancet. 2016;387(10035):2331-9.
- Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. The Review of Diabetic Studies : RDS. 2012;9(1):6-22.
- Piccolo RS, Subramanian SV, Pearce N, Florez JC, McKinlay JB. Relative Contributions of Socioeconomic, Local Environmental, Psychosocial, Lifestyle/Behavioral, Biophysiological, and Ancestral Factors to Racial/Ethnic Disparities in Type 2 Diabetes. Diabetes Care. 2016;39(7):1208-17.
- Lin BY, Genden K, Shen W, Wu PS, Yang WC, Hung HF, et al. The prevalence of obesity and metabolic syndrome in Tibetan immigrants living in high altitude areas in Ladakh, India. Obesity research & clinical practice. 2018;12(4):365-71.
- Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The 2016 global and national burden of diabetes mellitus attributable to PM2·5 air pollution. The Lancet Planetary Health. 2018;2(7):e301-e12.
- Dendup T, Feng X, Clingan S, Astell-Burt T. Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review. International Journal of Environmental Research and Public Health. 2018;15(1):78.
- Feng X, Astell-Burt T. Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a longitudinal study. BMJ Open Diabetes Research & Care. 2017;5(1).