In its “National Diabetes Statistics Report 2020,” the US Centers for Disease Control and Prevention’s Division of Diabetes Translation details the most updated “state of the disease” in America. The CDC aims to use the report’s information to improve diabetes prevention and management strategies available in this country.

According to the report, which analyzed health data through 2018, 34.2 million Americans, or just over one in 10 individuals, have diabetes. Further, 88 million American adults, approximately one in three, have prediabetes. Unfortunately, most people with prediabetes are unaware they have it.

Diabetes is a chronic, or long-lasting, disease that affects how your body turns the food you eat into fuel your body can use for energy. When you eat food, most of it is broken down into a sugar called glucose that is then released into your bloodstream.

When you eat, your glucose level increases, and that signals your pancreas to release a hormone called insulin. Insulin serves as the “key” to unlock your body’s cells and allow glucose to enter. The cells can then use the sugar for energy. Diabetes occurs when there isn’t enough insulin or your body doesn’t use it efficiently, and the glucose in your blood becomes too high.

There are two main types of diabetes: type 1 and type 2.

Approximately 5 to 10 percent of people with diabetes have type 1 diabetes, which is typically diagnosed in children and teens. With type 1 diabetes, your own immune system attacks the specialized insulin-creating cells in the pancreas called islet cells. Normally, islet cells produce the exact amount of insulin necessary to normalize the glucose level in your blood.

With type 2 diabetes, the more common type, you still produce insulin but it’s inadequate for your body’s needs. Generally, the release of insulin from your pancreas is defective and, as a result, the amount is insufficient. Type 2 diabetes occurs most often in people over 30 years old, and its incidence increases with age. It is sometimes referred to as adult-onset diabetes.

Prediabetes is when your blood sugar is higher than it should be but not high enough for your doctor to diagnose diabetes. Almost all people with type 2 diabetes had prediabetes first.

Symptoms of diabetes include: increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue, irritability, blurred vision, slow-healing sores and frequent infections,. Abdominal pain, itchy skin and tingling or numbness in the feet or toes may also occur. Symptoms vary depending on the level of glucose in your blood.

The onset of type 2 diabetes is typically slower than that of type 1 diabetes, and the symptoms may be less noticeable. Or you may overlook the symptoms or attribute them to another condition or to simply getting older. But if you notice symptoms, see your health care provider to be tested for prediabetes or diabetes.

Type 1 diabetes is treated using injections of insulin or wearing an insulin pump. The injected insulin performs the same function as the insulin normally made by the islet cells of your pancreas. It serves as the key to allow glucose to enter your cells for use as energy.

Treatment for type 2 diabetes generally begins with lifestyle modification, such as altering your diet, increasing your exercise and losing weight. If your glucose level remains high, you may be instructed to use medications that help your body use insulin more efficiently. It may be necessary to use insulin injections to manage your blood glucose.

If you cannot adequately control the glucose level in your blood, you may develop chronic complications of diabetes. These arise due to blood vessel damage caused by consistently high blood glucose and can affect your eyes, kidneys, nerves and heart. These complications include diabetic retinopathy, diabetic neuropathy, erectile dysfunction and coronary artery disease.

Currently, there is no cure for diabetes, so the aim of treatment is to manage the disease and prevent complications. Management involves controlling your blood glucose, and that requires consistent monitoring. You must test your blood glucose level throughout the day to be sure it is not too high or too low. Both extremes can have serious consequences.

One way to test your glucose level at home is to use a fingerstick to obtain a drop of blood that you place on a meter that calculates your glucose level. There are also monitors that you wear on your body, called continuous glucose monitors (CGMs). CGMs use sensors to measure your glucose level. They provide continuous, dynamic glucose information every five minutes.

If you notice symptoms of diabetes, visit your doctor for testing. If you test positive for diabetes or if you’ve had diabetes for a while, follow your doctor’s recommendations for controlling your blood glucose and managing your condition. And most of all, monitor, monitor, monitor.

One of the biggest problems that health care providers have to deal with pertains to health literacy, which is a person’s ability to understand health care information and navigate the health care system. Currently, health literacy in the United States is woefully deficient.

So what exactly is health literacy?

There are many definitions out there, but the concept behind them is essentially the same. An example comes from the American Medical Association Foundation, which defines health literacy as: “the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment.”

The Center for Health Care Strategies puts it more simply. In their definition, health literacy refers to “the skills necessary for an individual to participate in the health care system and maintain good health.” The skills they identify are reading and writing, calculating numbers, communicating with health care professionals, and using health technology such as electronic diabetes monitors.

The Network for the National Library of Medicine agrees that health literacy involves using a certain set of skills. The network suggests that “health literacy requires a complex group of reading, listening, analytical and decision-making skills, as well as the ability to apply these skills to health situations.”

According to the US Centers for Disease Control and Prevention (CDC), anyone who needs health information and services also needs health literacy skills. You can use those skills to find appropriate information and services, communicate your needs and preferences, and respond to the information and services.

Health literacy skills also enable you to understand the choices, consequences, and context of the information you receive. With such understanding, you can make decisions based on which information and services match your needs and preferences.

But there’s a big problem. An estimated 90 million Americans, nearly 36 percent, have low health literacy. And it affects certain populations more than others.

For example, Hispanic adults have lower health literacy skills overall than any other ethnic or racial group. Low health literacy is also more common in people who speak another language or speak English as a second language, as well as in older people, people with lower socioeconomic status or education, and people who are uninsured or on Medicare or Medicaid.

It’s imperative that we improve health literacy in this country because low health literacy is having a negative effect on how Americans use the health care system and on overall health outcomes. And as a result of increased use of services and poor outcomes, low health literacy is making an enormous impact on the nation’s health care costs.

The authors of a report titled “Low Health Literacy: Implications for National Health Policy” estimate the impact of low health literacy on the nation’s economy to be between $106 billion and $238 billion annually. That amount, the authors point out, represents between 7 percent and 17 percent of all personal health care expenditures.

To achieve optimal health, you must be an active participant in your health care. But people with low literacy often don’t have the skills necessary to clearly describe their symptoms to their health care provider, or fully understand their diagnosis and follow the instructions for their treatment. Many are simply unable to play an active role in their care.

And that affects the way they use the health care system. Many avoid going to the doctor, and when they have a health concern, they go to the emergency room for care instead. Studies show that people with low health literacy are 2.3 times more likely to visit the emergency room. And with that comes an associated increase in hospital admissions.

Health literacy affects overall health and mortality as well. Low health literacy has been linked to increased frequency of depression, physical limitations, and chronic diseases such as heart disease, stroke, diabetes, and asthma.

Making matters worse, people with low health literacy often have little understanding of their chronic disease. And because they are less engaged in their health care, they are less likely to use preventive services or follow instructions for managing their chronic disease. As a result, people with low health literacy have a much higher risk of complications and death.

Health care providers, health educators, and patients all have roles to play if we’re going to boost health literacy in America. Patients must be willing to engage with their providers and listen to what they say. Providers and educators can do their part by following these Four Simple Strategies for Improving Your Patients’ Health Literacy:

• Use plain language in both verbal and written communication
• Use visual aids
• Recommend and use technology – Research shows that nearly 90 percent of Americans use the internet and 81 percent own a smartphone. Using these technologies can be a good way for providers to get their message to patients.
• Use effective teaching methods – Some techniques include talking slowly, asking open-ended questions, and asking patients to repeat instructions given to them.

Why is health literacy important? It’s important because it allows you to make good decisions about your health. Health literacy also enables you to get appropriate medical care, take your medications correctly, and manage chronic diseases. And most importantly, it helps you lead a healthy lifestyle so you can live a full and healthy life.