Category: Diabetes

Diabetes has become a typical malady among individuals everywhere the globe these days. To combat the wide unfold wings of polygenic disease, many modes of treatments have come back up. however {diabetes|polygenic disorder|polygenic malady} isn’t simply one disease. It comes in an exceedingly package of its many forms. Of them the foremost deadly one is Diabetic acidosis.

Diabetic acidosis is additionally called DKA. Diabetic acidosis isn’t triggered by itself. it’s a consequence for associate degree another polygenic disease. once diabetes goes untreated, it takes the form of Diabetic acidosis. If not taken care of properly, DKA will prove fatal to your life.

In a nut shell, polygenic disease acidosis will be coupled to associate degree impaired aldohexose cycle that begins with the deficiency of the internal secretion accelerator in your body. If your polygenic disease goes unknown you’ll suffer from this condition. And though you’re aware of your diabetic condition however still not taking any correct medication, then no body will stop you to fall within the lure of diabetic acidosis. this manner of polygenic disease is such a lot dangerous that if unbroken unnoticed the morality rate will be high as one hundred pc.

It has been found that diabetic acidosis chiefly happens with kind one polygenic disease. the rationale being the very fact that it’s associated with the current internal secretion disorder. On the opposite hand, it’s less common in kind two polygenic disease patients as a result of kind two polygenic disease is said to the cells inability to internal secretion and to not the shortage of it.

Despite having high quantity of aldohexose within the blood, the liver in your body can behave in an exceedingly manner as if your body is starving of aldohexose. during this case the liver are going to be forced to supply another form of fuel to satisfy the metabolic functions of your body. As a result the liver are going to be forced to use the body’s triglycerides to supply aldohexose. This aldohexose that may be made are going to be utilized by the brain to hold on the functions. during this whole method, organic compound bodies ar made as a by-product that facilitate to method the fatty acids.

But like every malady, diabetic acidosis will have a treatment to that. The treatment chiefly consists of the association method. association lowers the diffusion property of the blood whereas commutation the lost electrolytes in it. within the method, internal secretion is additionally replaced which ends within the production of aldohexose and atomic number 19 within the cells.

But still, hindrance is healthier than cure. If you maintain a correct record of your aldohexose levels within the bloodArticle Submission, the possibilities of you full of this malady remains bleak.

Noncommunicable diseases (NCDs) are the most common reasons for death worldwide according to world health organization statistic the deaths related to (NCDs) is equal to or more than the total number of deaths that related to other reasons, and NCD responsible for forty-one million deaths out of fifty-seven million deaths occurred worldwide, that means NCD accounts for almost 23 of all deaths globally(1). Diabetes is one of the four main NCDs and alone accounting for around 1.6 million deaths in 2016(2). Diabetes mellitus, more simply called diabetes, is a chronic condition that occurs when there are raised levels of glucose in the blood because the body cannot produce any or enough of the hormone insulin or use insulin effectively(3).

The interaction between several genetic and environmental factors Overweight and obesity are major contributors to the development of insulin resistance. When β cells have not longer able to secrete sufficient insulin to overcome insulin resistance, impaired glucose tolerance progresses to type-2 diabetes after many years of uncontrolled diabetes complication occur ether macro or microvascular which lead to blindness and renal failure and eventually death(4). The symptoms of DM include: polyphagia, polyurea, polydipsia, blurred of vision, unexplained weight loss, numbness or tingling sensation in extremity, fatigue and delayed wound healing. The symptom of DM develop slowly over the years or can develop in just a few weeks or months and can be severe depend in the Type of DM(5).

There are three main types of diabetes, type 1 diabetes, type 2 diabetes and gestational diabetes (GDM)(6). There are also some fewer common types of diabetes which include monogenic diabetes and secondary diabetes. Monogenic diabetes is the result of a single genetic mutation in an autosomal dominant gene rather than the contributions of multiple genes and environmental factors as seen in type 1 and type 2 diabetes. Examples of monogenic diabetes include conditions like neonatal diabetes mellitus and maturity-onset diabetes of the young (MODY). Secondary diabetes arises as a complication of other diseases such as hormone disturbances (e.g., Cushing’s disease or acromegaly), diseases of the pancreas (e.g., pancreatitis) or as a result of drugs (e.g., corticosteroids)(6).

Type 1 diabetes is caused by an autoimmune reaction where the body’s immune system attacks the insulin-producing beta cells in the islets of the pancreas gland. As a result, the body produces none to very little insulin with a relative or absolute deficiency of insulin. The causes of this destructive process are not fully understood, but a combination of genetic susceptibility and environmental triggers such as viral infection, toxins or some dietary factors have been implicated(7).

Type 2 diabetes is the most common type of diabetes and is the result of inadequate production of insulin and an inability of the body to respond fully to insulin, defined as insulin resistance. During a state of insulin resistance, insulin is ineffective and therefore initially prompts an increase in insulin production to reduce rising glucose levels but over time a state of relative inadequate production of insulin can develop(8). Type 2 diabetes is most commonly seen in older adults, but it is increasingly seen in children, adolescents and younger adults due to rising levels of obesity, physical inactivity and poor diet(9).

GDM is a type of diabetes that affects pregnant women usually during the second and third trimesters of pregnancy though it can occur at any time during pregnancy. In some women, diabetes may be diagnosed in the first trimester of pregnancy, but in most such cases diabetes likely existed before pregnancy but was undiagnosed and usually disappears after giving birth. It occurs if your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet the extra needs in pregnancy(10).

Diabetic patients may develop complication over time if they do not stick to their treatment regimen comparing to the general population, and this complication is divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). Microvascular complications include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections leading to amputation). Macrovascular complications include cardiovascular diseases such as heart attacks, strokes(11).

The International Diabetes Federation (IDF) estimated the total number of adult diabetics (aged between 20 and 79 years) all over the world at around 425 million and expected to reach 629 in 2045. With the western Pacific is the highest region of the diabetic patient followed by south-east region and together they have more than half of diabetic patient, China alone has more than 100 million diabetes, and it’s the highest country in the diabetic patient. While the Africa region had the lowest prevalence in 2017.

In 2017, approximately 38.7 (27.1-51.4) million people, or 9.6% (6.7-12.7) of adults aged 20-79 years are living with diabetes in MENA. About 49.1% of these are undiagnosed. Countries with the highest age-adjusted comparative diabetes prevalence in MENA are Saudi Arabia (17.7%), Egypt (17.3%) and UAE (17.3%), The countries with the largest number of adults aged 20-79 years with diabetes are Egypt (8.2 (4.4-9.4) million), Pakistan (7.5 (5.3-10.9) million) and Iran (5.0 (3.9-6.6) million)(12)

From 1980 to 2014, worldwide age-standardized adult diabetes prevalence in men increased from 4·3% (95% CrI 2·4–7·0) to 9·0% (7·2–11·1) and crude adult prevalence increased from 3·6% (2·0–5·9) to 8·8% (7·0–10·8). In women, age-standardized adult diabetes prevalence increased from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) and crude adult prevalence increased from 4·7% (2·7–7·4) to 8·2% (6·6–9·9)(13).

In the same years. In the Middle East, adult diabetes prevalence in men increased from 5.9% to 13.7%(14). The prevalence of type 2 diabetes mellitus in the kingdom of Saudi Arabia according to the literature published increased from 3% in 1982 to 32% in 2015, The predicted prevalence will be 35.37% in 2020, 40.8% in 2025 and 45.8% in the year 2030(15).

Despite the human burden characterized by premature mortality and lower quality of life due to diabetes-related complications, diabetes also imposes a significant economic impact for countries, healthcare systems, and above all, for individuals with diabetes and their families. The healthcare expenditure on diabetes increased from 232 billion USD worldwide in 2006, to 727 billion USD in 2017 a threefold increase for those aged 20-79 years(16)

In the MENA total, the health expenditure on diabetes reached 20.5 billion USD in the region in 2017. By 2045, the total expenditure on diabetes is estimated to reach USD 37.1 billion. The largest expenditures were observed in Saudi Arabia with ID 13.1 billion, Iran ID 8.6 billion and Egypt ID 7.9 billion. The smallest expenditure was found in Armenia with 0,09 billion. The highest mean expenditure per person with diabetes was in Qatar and Saudi Arabia with ID 6,602 and ID 5,186(16).

Diagnosis of DM

diabetes was defined according to the American Diabetes Association criteria, either as fasting blood sugar level 126 mg/dL (7 mmol/L) or higher (after 8–12 hours of fasting) or random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes, or A reading of more than 200 mg/dL (11.1 mmol/L) after two hours OGTT), or Hemoglobin A1C (HA1C a plasma glucose level of 6.5 percent or higher) on two separate tests indicates diabetes(17).

Global strategy for prevention and control of DM

The Sustainable Development Goals (SDGs), adopted by the UN in September 2015, aim to achieve, through national commitments, a reduction in premature mortality from NCDs by one-third, ensure access to quality essential healthcare services and to provide safe, effective, quality and affordable essential medicines for all by 2030(18).

IDF also implement three priority objectives set out in the IDF Global Diabetes Plan 2011-2021(19):

• To improve health outcomes for people with diabetes.
• To prevent the development of type 2 diabetes.
• To prevent discrimination against people with diabetes.

National Health Program of DM in Saudi Arabia

20 Specialized Centers: the aim is kept on delivering the optimum health services for diabetics, working on enhancing the health awareness of each diabetic or anyone vulnerable to develop the disease, and providing the best health and education services.

Anti-diabetes Education National Program: It aims to have the healthcare officials participate in applying it and increasing the general awareness for all the Saudi community segments on diabetes through positive communal participation.

National Campaign for Diabetes Control: The campaign focuses on reinforcing and disseminating the general health awareness and limiting the disease spread(20).

Conclusion

Diabetes is a growing public health problem, and the number of people with diabetes has increased threefold between 2000 and 2017 mainly in developing countries. Economic development and increasing urbanization leading to more sedentary lifestyles and higher consumption of unhealthy foods linked to obesity are behind the rapid increase in diabetes prevalence. Diabetes also imposes a significant economic impact for countries, healthcare systems, and above all, for individuals with diabetes and their families.

References

1. Noncommunicable diseases [Internet]. 1 June 2018. [cited 2019 Feb 5]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases
2. The top 10 causes of death [Internet]. 24 May 2018. [cited 2019 Feb 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
3. WHO | Diabetes mellitus. WHO [Internet]. 2010 [cited 2019 Feb 5]; Available from: https://www.who.int/mediacentre/factsheets/fs138/en/
4. Skyler JS, Bakris GL, Bonifacio E, Darsow T, Eckel RH, Groop L, et al. Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis. Immunol Metab Endocrinol [Internet]. 2017 [cited 2019 Feb 5];66:10–2. Available from: http://www.diabetesjournals
5. Symptoms | Basics | Diabetes | CDC [Internet]. July 25, 2017. [cited 2019 Feb 5]. Available from: https://www.cdc.gov/diabetes/basics/symptoms.html

Introduction

Periodontitis, which is a common chronic disease of the tooth-supporting structures, is caused by bacterial deposits accumulating on the surface of the tooth [Moghadam>>>1,2], leading to local oral inflammation. Local oral inflammatory process may induce systemic inflammation which could also aggravate systemic diseases including cardiovascular diseases, pulmonary diseases, rheumatoid arthritis and diabetes mellitus [Moghadam>>>3]. Diabetes mellitus (DM), a metabolic disorder characterized by hyperglycemia, is a complex disease with various systemic and oral complications [Moghadam>>>5]. Periodontal diseases take the sixth position in the most common complications of DM [Moghdam>>>10,11,12]. Several research studies demonstrated the bidirectional relationship between DM and periodontal diseases, which could aggravate periodontitis. Subsequently, periodontitis could negatively impact the control of the diabetic state [Moghdam>>>6]. Such relationship has become a recent focus of attention among healthcare providers due to the substantial evidence supporting the two-way relationship between DM and periodontal diseases; DM increases the risk of periodontitis while periodontitis negatively affect glycemic control [Shanmukappa>>>2].

The recent rise in patients being diagnosed with diabetes is not solely a genetic shift, but also an environmental one as a result of certain lifestyle habits. The international Diabetes Federation plans on preventing type II diabetes based on controlling and enhancing those modifiable risk factors. They can be divided into two groups: individuals at high risk of developing type II DM and the entire population similarly with the periodontal diseases [Shanmukappa>>3]. For proper management of DM as well as periodontitis, patients themselves are the most determining factor. Lack of information of the bi-directional relationship between DM and periodontal diseases is one of the main reasons for non-compliance to healthy lifestyle modifications. Better compliance comes with informing and positively reinforcing those patients. In that instance, individuals who have the knowledge and awareness of such relationship and are highly susceptible to periodontal diseases tend to go to dentists on a regular basis [Shanmukappa>>>4]. Adequate health education attempts to modify behaviors by altering individuals’ knowledge, beliefs, and attitudes about health matter.

Awareness of diabetic patients of the bidirectional relationship between DM and periodontal diseases is very limited in Sweden, where 83% of patients with diabetes were unaware of such link [Bahammam>>>15]. Another study conducted in Jordan revealed that 48% of diabetic patients were aware that diabetes increases the susceptibility to develop periodontal diseases and oral health complications [Bahammam>>>19]. Recently, a study conducted in Abha, Saudi Arabia, pointed out the deficient awareness of dental health knowledge among diabetic patients were 52.3% of patients were unaware of the existence of such link [Bahammam>>.21]. Therefore, we conducted this survey study to gather baseline information on awareness, practices, and source of diabetes-related information of patients with DM at three outpatient clinics in Saudi Arabia as regards periodontal and oral health in order to enhance dental health education for the targeted population.

Methods

This study is a cross-sectional descriptive survey study. We recruited individuals with confirmed diagnosis of diabetes who were receiving the regular care at the outpatient diabetes clinics of three healthcare settings: King Khalid Hospital, Hail Hospital, and Salamat Hospital in Hail City, Saudi Arabia. The majority of patients attending these outpatient clinics are Saudis from a mixture of urban and rural communities. The study was conducted from August to December 2018. Patients with diabetes were required to fulfill the following conditions in order to be eligible for inclusion into the study: the presence of at least one natural tooth in the patient’s mouth and a period of at least six months have passed since the diagnosis of diabetes. Diabetic patients with obvious physical or mental health problems were excluded from this study. Eligible participants of all age groups and both genders were included. The study protocol was reviewed and approved by the ethics committee, Institutional Review Board (IRB), of each corresponding study center.

Patients who were willing to participate in the study were instructed to write an informed consent. Afterwards, they were asked to complete a self-reported questionnaire during waiting for their appointments at the outpatient clinic. Oral and written instructions were provided to each participants with assurances of confidentiality. Completed questionnaires were collected from participants prior to leaving the clinic.

We thoroughly reviewed the literature of the association between DM and periodontal diseases in order to design a well-structured questionnaire. The development of the questionnaire was based on the previously published study of Allen et al. [REFERENCE]. The questionnaire was subdivided into six categories. The first category of the survey evaluated participants’ sociodemographic characteristics. The second one assessed patients’ medical history including type of diabetes. The third category aimed to assess patients’ general health and practices followed to maintain oral hygiene as well as the frequency to visit dentists, and brushing frequency. The fourth category addressed awareness of participants about diabetes and its types. The fifth part assessed the two-way relationship between periodontal health problems and diabetes. On the last part of the questionnaire, the six part, participants were questioned about the sources of diabetes information. There was a complete anonymity of all of the data gathered in the study.

Statistical Analysis

Data were collected and entered into Microsoft Excel Sheet. Data analysis was performed using Statistical Package of Social Science (SPSS-Version 22). Categorical variables were expressed as numbers and percentages.

Results

Sociodemographic characteristics of the study participants

A total of 186 registered diabetic patients agreed to participate in this survey study, completed the self-administered questionnaire and were eligible for inclusion into the final analysis. Of those, 81 patients were males while 105 patients were females. The highest percentage of respondent were in age group of fifth to sixth decade of life (43.6%).

Medical history

Most of the study participants were diagnosed with type I diabetes mellitus (39%) and 34% had a diagnosis of type II diabetes. On the other hand, 27% of participants did not know their type of diabetes mellitus. Data regarding the time since diagnosis of diabetes, family history of diabetes, and the type of hypoglycemic medication taken, were not available to be investigated.

General and oral health-related awareness and practices

The analysis reveals that participants’ responses indicated inadequate health-related practices in our surveyed population. The majority of the respondents (62%) visit the dentist only if needed followed by those who never visited a dentist. On the other hand, a very limited percentage of respondents visit dentists on a regular basis. and not on a regular basis (Figure 1). Furthermore, upon assessing oral hygiene practices performed by participants to maintain the healthiness of their teeth, we found that 43% brushed their teeth once a day.Figure 1. Frequency of visiting dentists in patients with diabetes mellitus participants’ awareness of the association between periodontal diseases and diabetes

The majority of respondents were familiar with the oral problems associated with the high blood sugar level due to diabetic state, as 52.7% reported that they know that a relation between diabetes and gum diseases exist. However, 42% of study population did not know about the existence of such relation.

Sources of diabetes-related information

All of the 186 participants, who finished the diabetes awareness assessment questionnaire, completed the data regarding the sources they had their information from. As shown in Figure 2, The majority of participants reported that they ‘do not know’ about the association between diabetes and periodontal health problems in the first place. On the other hand, only 17% reported that they knew about the association from relatives. Following relatives in order, equal percentage of participants gained their information from newspaper, schools, and services from ministry of health (MOH), respectively. Television, Internet and experience was reported the least.

Discussion

Periodontal diseases are considered the six main complication of DM, which proves that patients with diabetes are more susceptible to such diseases [Moghdam>>>>10,11,12]. Adequate knowledge and information about the association between periodontal diseases and diabetes is essential [Moghdam>>>13]. Patients with diabetes should have regular recall program visits due to the insufficient care provided to those patients. Therefore, consultation with a dentist is crucial to enhance oral health promotion [Moghdam>>>14,15]. It is clear that the knowledge and attitude of each individual in healthcare is important in order to provide information about health promotion and practices to prevent periodontal diseases.

The results of the present study show that most of the respondents did not care about their dental healthiness, as only a minority of the population went to dentists on a regular basis. On the other hand, more than half of them went to dentists only when his help was required. The low compliance with regular dental visits shown in this study goes in line with other studies. A study conducted in Jeddah in 2015 reported that only 12.6% of their survey population visited their dentists regularly [Bahammam]. Another previous research conducted on female Saudi adults showed that only 8% of female patients with diabetes visited their dentists on a regular basis [Bahammam>>>20]. Similarly, a study conducted in Jordan reached the same conclusion about this findings [[Bahammam>>>19]. On the other hand, our results regarding dental visit compliance is much lower than that reported in other research conducted in Western countries [[Bahammam>>>15,28] (39% and 43%, respectively). Such differences between our results could be attributed to the difference in the examined population. Moreover, age could play a role in such difference, as most of our population was between the 5th and 6th decade of life; thus, visiting dentists on a regular basis would not be a possible option for them. Based on the above observations, diabetic patients should visit dentists regularly to reinforce and promote dental health in those populations and to inform them about the best health practices to prevent periodontal diseases.

Upon assessing dental care practices in the present study, we found that 43% brushed their teeth once daily, which indicates that oral hygiene measures are not adequately followed in this population. Similar findings of inadequacy of maintaining oral hygiene measures in diabetic populations were reported in the literature [Bahmmam+ Bahammam>>>19,30,31]. Even though brushing once a day has shown to be linked with better oral health-related quality of life (OHRQL) in comparison with less frequent brushing [Sadeghi], we recommend following proper oral hygiene methods in addition to proper education of these measures in order to enhance periodontal health and prevent gingival diseases in this high-risk population.

Individuals continue to neglect dental health, however, seek medical care whenever required. However, it is not realized that often poor periodontal health can be an underlying cause for a deteriorating systemic health of those individuals. In such instances, physicians and medical professionals’ knowledge of the relationship between periodontal health and general health comes to the rescue of the patients.

As for awareness of the relationship between diabetes and periodontal diseases, only 53% were aware that diabetes would be associated with gum problems. This finding indicates that our population was less aware as regards the connection between diabetes and gum problems. Multiple studies conducted in Saudi Arabia and other countries reported similar findings, showing that the knowledge of such association is still lacking [Bahammam + Bahmmam>>>20,28,32,33]. This could be the results of the low educational level of those patients. In this study, a considerable percentage of respondents did not even know what type of diabetes they had, reflecting the low educational background and knowledge of those patients.

Going in line with the findings of Bahammam et al [Reference], relatives were the most common source of information about the association of diabetes and periodontal health, followed by services from MOH, school programs, newspaper, TV, and internet respectively. These results indicate that information obtained by patients with diabetes came from informal sources lacking a scientific basis. Therefore, we suggest that dental health education containing accurate and updated information is required to be available through educational program for diabetic patients. That being said, regardless of the sources of information, limited knowledge and awareness of the two-way relationship between diabetes and periodontal health problems was evident in our study.

Research in the area of diabetes health education in Saudi Arabia remains limited. Therefore, our findings point out the importance of conducting further research to identify barriers to awareness and compliance of diabetic patients in maintaining regular dentist visits as well as the background knowledge of healthcare providers and dentists as regards the association between diabetes and periodontal diseases.

This study has several limitations. The findings obtained from the self-administered questionnaire is not supported due to the lack of objective clinical data for assessment. The fact that our population was based on patients presenting at the outpatient clinics make our study liable for bias and not representative of the whole diabetic population. Finally, the fact that our study is based on self-administered questionnaires increases the risk of recall bias due to the possibility that participants would give socially acceptable responses to questions pertaining to oral health behavior.

Conclusion

Almost half of our population lack the knowledge of the relationship between periodontal health problems and diabetes. They also follow inadequate health practices in terms of oral healthiness in addition to neglecting the regular visits to dentists. These findings conclude that awareness of the burden of diabetes on periodontal health remains neglected in Saudi Arabia and that further investigations are warranted.

Introduction

Reports indicate that 30.3 million people are diabetic worldwide as of 2017 and it is estimated that 23.1 million are in early stages of diagnosis. According to the Center for Disease Control and Prevention(CDC) report, about 28.8% of the world population suffer hidden diabetes (1). The prevalence of diabetes is estimated as 6% in the Iranian population, and it is estimated that about 4 million individuals are affected(2).

Diabetes is associated with serious complications and injuries, and several studies suggest that the rate of diabetic complications will increase in the near future and it will occur at younger ages of life (3, 4). Therefore, it is necessary for diabetic patients to control their blood glucose level to have a normal life and avoid unnecessary treatment costs. To achieve this goal, educating diabetics and healthy individuals to lower the risk of developing diabetes (5) and mainly increasing knowledge, awareness and attitude, acquiring necessary skills, enhancing coping with the disease, performing the required care, accelerating improvement and recovery, and minimizing the complications is absolutely necessary. (6-9).Today, educating people with emerging technological advances and multimedia, encourages them to learn and develop an understanding of the disease, and adapt to the new information (10). Therefore, considering the high prevalence of diabetes in the world and its grave unwanted consequences, it is necessary to benefit from new educational technologies and instruments.

One of these technologies is gamification, which as an effective educational tool that enhances the quality of education, creates motivation and enthusiasm, and develops a feeling of competition in the target population. (11). It has the potential to transform knowledge and educational content into personal knowledge to enable users to solve problems in an active or interactive manner (12). It should be mentioned that in addition to gamification, there are other tools such as a serious game (to combine aspects of both serious concept such as teaching, learning, communication, or further information with less entertainment.)(13), an educational game (For teaching the basic and certain subjects with enjoyment and pleasure)(14) game-based learning (to encourage learners to participate in learning while playing, and make the leaning process more interesting by adding fun)(15), that are used as tools to improve the learning process. These tools have their own specific features, but all of them have one purpose of “Increasing the level of learning along with increasing motivation and entertainment. In this systematized review, papers regarding diabetes using one of these three tools of gamification, serious game, and educational game were appraised.

Materials and Methods

The databases of PubMed, Ovid, Cochrane, Scopus, Web of Science, ProQuest, Springer, Embase, and Science Direct were searched from the very beginning to February 2018 to retrieve publications related to diabetes and games, using an advanced search query. The search operators included Boolean operators (AND, OR and NOT), parenthesis, and truncation. The keywords to retrieve the papers, were selected from Medical Subject Headings (MeSH) and National Library of Medicine (NLM) thesaurus, and were as follows: ‘diabetes mellitus, diabetes mellitus-type1, diabetes mellitus-type2, gamification, Digital game, Video game, Game(s), Simulation, Computer-assisted gaming, Serious Game(s), Educational game(s), Role-playing game(s), Real-world game(s), massively multi player online game, role play simulation, storytelling game’

An example of the search strategy is as follows: ((‘diabetes mellitus, type1’ OR ‘diabetes mellitus, type2’) AND ( ‘gamifications’ OR ‘serious games’ OR ‘educational games’ OR ‘video games’ OR ‘digital games’ OR ‘Simulation’ OR ‘Computer-assisted gaming’ OR ‘Serious Game(s)’ OR ‘Educational game(s)’ OR ‘Role-playing game(s)’ OR ‘Real-world game(s)’ OR ‘massively multi player online’ OR ‘role play simulation’ OR ‘storytelling game’ ))

The inclusion criteria were: full texts of original research articles, English language, with no time limit that was related to diabetes gamifications (serious games, educational games). Moreover, researchers excluded duplicates while assessing the retrieved studies. Papers were reviewed and appraised by at least two independent researchers and inconsistencies were assessed and resolved, if there were any. The data retrieved from the papers included: title, name(s) of author(s), publication place and year, research sample or population, type of study, objectives and research questions, and type of game. In addition, findings and results of each study were summarized and recorded in predesigned forms. The Critical Appraisal Skills Program checklist (CASP) was applied to assess quality of the papers. The entire process of retrieving and reviewing studies are specified in the flowchart below

It could be concluded from this table that all games were designed to educate, teach skills and make behavior improvement for diabetics and they are less attended to train healthcare providers or healthy people. According to the title or game features, some games are considered as educational game such as the diabetes escape room, Escape from DIAB, Nanoswarm and Packy & Marlon or some of them are serious games such as Mobigame, L’Affaire Birman, InsuOnline and Balance which means that all types of games were retrieved based on the purpose of the research. Most of these games are mobile-based; however, some of them were designed for game consoles or game boards. Assessment of learning theories used in these gamifications showed that self-determination theory was frequently applied in games such as Virtual coach, robot, Escape from DIAB and Diab. Classification of games according to Bloom’s Taxonomy of Behavioral Objectives showed that most gamifications could be classified under cognitive domain (application and knowledge levels); in this regard exergames consider psychomotor activity and could be classified under this domain. Considering effectiveness of games, the retrieved data indicated that gamification in each platform and genre could meet the participants’ needs and encourage their participation.

The target population of the gamifications was from different age groups including children, diabetic patients, and healthy people and the games were designed for medical students and residents, or students of other related medical majors. There was a marked variation in the type of diabetes and many gamifications encompassed both types. Physical activity and nutrition (14 papers) were the most frequent diabetic subthemes in diabetes gamifications.

Discussion

Gamification is one of the learning methods that has been much considered in the recent years(16, 17). According to Gee, the purpose of gamification is to create a problem-solving environment that can be integrated with continuous education and enjoyment for improving learning process(18). So in this review, the features, educational aspects and effectiveness of gamification (serious, educational games) in diabetes (both types) were investigated.

In this systematized review, 1795 papers were retrieved from eight databases from April to May 2017. After discarding unrelated papers that did not match purposes of this study, 35 papers remained that met the study criteria. At first, all bibliographic information of these papers were retrieved.

Assessment of characteristics and commonalities among diabetes gamifications showed that they were designed as digital games, exergames requiring sensors and motion detectors, and board games. They are all problem-solving games that use the task and goal method in gamification, to deliver teaching and learning indirectly, so that learners learn through missions, tasks, victories and failures. (19, 20). Considering game design, all the related games, except the games for teaching physical skills (exergames), use multiple-choice questions to convey game concepts. (21-23).

Considering underpinning learning theories to develop a gamification is crucial (24). These theories promote learning and improve skills such as problem solving and critical thinking (25-27). In this research, all diabetes gamifications aimed at teaching a skill or concept, changing a behavior or habit positively, or enhancing disease management in the target population and most of them benefited from one or more implicit underpinning learning theories.

Gamification targets knowledge and skills and transfers them to the learner through elements such as repetition, feedback, and entertainment. When the learner becomes skillful, knowledge and skills related to that concept become persistent in the memory so that the learner can focus on perception and implementation of the information. On the other hand, gamification has positive effects on motivation and decision-making capabilities, because the player faces challenges that untimely enhance learning through decision-making, discovery, and trial and error (16, 28, 29). This scientific background is the backbone of the effectiveness of gamifications (30-32). It is also consistent with the results of this study since the target populations of diabetes gamifications could successfully receive and implement the required knowledge and skills. However, it should be noted that retention of information learned through gamification was not assessed in these studies.

Considering diabetes gamification developing team, it is revealed that in addition to the field professionals, an expert technical team, including game design experts, programmers, concept designers, art designers, graphic designer, character designer, and sound designers must be among the game production team members, because identification of the technical, artistic and aesthetic aspects of the game is of paramount importance besides mastery over the gamification topic and field, which is also associated with heavy financial costs. On the other hand, use of several advanced technologies, software, and hardware increases the costs of gamification production and are highly challenging. (33-35).

The research findings indicate that all studies confirm the effectiveness of gamification in the user’s training, and of course encourage other researchers in other clinical fields to develop gamifications or serious games, especially in the disciplines where understanding and learning are tedious and challenging. Since health is a matter of life and death and treatment is a costly process, gamification can improve public health and decrease treatment costs through training healthy individuals to manage and enhance their health literacy or providing disease management training for high-risk groups and patients by creating fun and entertainment. Finally, it is suggested that in the future studies on gamifications, application of learning theories in gamifications and serious games be focus of attention.

References

1. Prevention CfDCa. National Diabetes Statistics Report, 2017: Centers for Disease Control and Prevention (CDC( Available from: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf .[Accessed Feb 2017]
2. Vares Z, Zandi M, Baghaei P, Alavi N, Ajorpaz N. Quality of life and related factors in diabetic patients attending a diabetes center in Kashan. Nurs Res. 2010;5(17):14-22.
3. Praet SF, LJ VL. Optimizing the therapeutic benefits of exercise in type 2 diabetes. Journal of Applied Physiology. 2007;103(4):1113-20.
4. Bajpeyi S, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Hickner RC, et al. Effect of exercise intensity and volume on persistence of insulin sensitivity during training cessation. Journal of Applied Physiology. 2009;106(4):1079-85.
5. Smeltzer B. Text Book of Medical-Surgical Nursing. 6th ed ed. Philadelphia: J. B. Lipincott; 2002.
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Many people with diabetes wonder, rightly, if they can consume honey and enjoy this ‘nectar of the Gods’. Honey is mostly composed of sugars and so it is important to control your consumption when you are diabetic. Among the sugars, however, honey is one of the most interesting. His qualities make him an ally to know .

What is diabetes ?

Diabetes is a chronic disease that can have serious consequences if it is poorly managed (cardiovascular diseases,Apparatus that can measure blood sugar levels: people with diabetes must pay attention to the amount of honey they consume.ocular disorders, neuropathies, …). It can not be cured, however, it can be treated and controlled . This is a lack or lack of use of insulin that regulates the level of sugar in our blood. There are several types of diabetes whose origins and treatments are different. As a rule, people with diabetes should be extremely vigilant about the carbohydrate intake of their diet .

However, all honeys contain up to 82% of sugars (glucose, fructose, sucrose, …) . Generally, about 5% sucrose is found and the balance is half glucose and fructose. However, honey is not contraindicated! The problem is a question of quantity …

Excessive consumption of honey is therefore not recommended for people with diabetes , just like all other sugars. Similarly, this recommendation can be applied to overweight people. It must be consumed with great care and included in the daily ration of carbohydrates and calories consumed . Nevertheless, in view of its nutritional qualities and its health benefits , it is a food not to be neglected. Honey is a complex and nutritionally interesting food

The glycemic index of honey

This is the ability of a food to raise blood sugar in the blood. The glycemic index of honey is lower than that of refined sugar . However, it varies according to its origin and the fructose / glucose ratio. Indeed, it is lower if the honey is high in fructose (overall, it is the case of liquid honeys such as acacia honey ). It is therefore important to choose your honey to enjoy this property.

In general, we all have an interest in sweetening our food with honey . In addition, it is possible to replace sugar with honey in cooking recipes to lower their glycemic index.

The qualities and virtues of honey

In addition, honey is a food consumed for at least 12000 years by men. It is appreciated for its taste as well as nutritional and therapeutic qualities .

It is a complex food that is far from containing only sugars. Indeed, it contains amino acids, minerals, vitamins in quantity, some fatty acids, enzymes and many other substances (flavonoids, esters, alcohols, pollen grains and pigments). Nutritionally speaking, it is an interesting food.

In addition, all honeys have therapeutic virtues used by individuals and doctors. They have potent antiseptic activity and anti-inflammatory and antioxidant properties (read our article on the virtues of honey ).

Abstract

Diabetes Mellitus is a condition that millions of people around the world suffer from. The hallmark of this disease is an insulin insufficiency. For decades researchers have sought to find and improve treatment methods for this disease, using various methods of insulin delivery. This article outlines some of the major techniques used over the past several years.

Introduction

Over the past several years, the prevalence of Diabetes Mellitus has been increasing worldwide, becoming one of the world’s most common non-communicable diseases. As of 2011, the International Diabetes Federation Reported that 366 million people worldwide suffer from this condition and the number is expected to grow to 552 million by the year 2030. These high occurrence rates are what have made diabetes one of the most common Most of the cases contributing to the increase in prevalence of Diabetes Mellitus are Type 2, but the number of type 1 cases are increasing as well.

Diabetes Mellitus (T1DM) occurs when a patient is unable to produce an adequate amount of insulin, a peptide hormone that helps to lower blood glucose levels. Insulin is composed of two polypeptide chains connected by disulfide bridges between cysteine molecules. Human insulin is made in its inactive form (preproinsulin) and must be converted to an active form before it can be used by the body (Figure 1). In a healthy individual, insulin is released continuously in small quantities to reduce glucose output by the liver by directly inhibiting gluconeogenesis (glucose production) and glycogenolysis (breakdown of glycogen into glucose monomers). The indirect effects of insulin include inhibition of glucagon secretion, lipolysis of fat, and proteolysis in muscles. The quantity of insulin released increases after one consumes a meal in order to maintain euglycemia, or normal blood glucose concentration. Insulin is released from beta cells in the pancreas that each contain 10,000 to 13,000 secretory granules that each contain around 106 molecules of insulin.

Because of the insulin deficiency associated with T1DM, one of the most crucial aspects of treatment is the administration of insulin to maintain proper blood glucose levels and avoid hyper- and hypoglycemia. Insulin therapy was first used in 1922 by Banting and Best. In the early stages of insulin therapy development, insulin derived from bovine and porcine pancreases was used, resulting in high rates of immunological reactions, lipodystrophy, and unpredictable insulin absorption. These issues led to further research on purification of insulin, resulting in the various long and short acting insulins used today. Currently, research has shifted to focus on exogenous insulin secretion that mimics that of the pancreas in order to achieve tight glycemic control while avoiding hypoglycemia.

Insulin Therapy Today

Two of the most common methods of insulin therapy for T1DM today include Multiple Daily Injections (MDI) and continuous subcutaneous infusion using an external pump (CSII). Even with these effective methods, there is still a significant morbidity rate associated with T1DM. This can be attributed to patients having poor adherence to their insulin and glucose monitoring regime. Many factors affect this lack of cooperation with treatment, including pain of injections, cost, ability to self-administer injections, weight gain, and the psychological burden. Because of this failure of patients to adhere to their treatment plan, many researchers are focused on developing new insulin delivery methods. Currently, the highest priority has been placed on developing an artificial pancreas and delivery methods for adolescents with diabetes.

Non-Invasive Delivery

When insulin therapy was first introduced, the hormone was administered intramuscularly. This could be painful for patients, and this method has since been replaced by subcutaneous injections which are just as effective while causing significantly less trauma to the patient. Over time, several innovative approaches to insulin delivery have been suggested, including: transdermal, intranasal, oral, and pulmonary (Figure__) . Each of these methods have undergone various testing and have their own sets of pros and cons in clinical applications.

Transdermal

One of the biggest hurdles to overcome when developing transdermal methods of insulin delivery is physical and immunological barriers the skin presents. The skin is composed of three layers, the epidermis, dermis, and subcutaneous tissue. The epidermis is mainly composed of the stratum corneum, a thick layer of dead cells that serves to protect the underlying layers. The dermis is the middle section that contains blood vessels, hair follicles, sweat glands, and nerves. The innermost layer, the subcutaneous tissue, serves as a thermal insulator and energy storer. In order for insulin injections to reach the subcutaneous tissue, the needle must pass through the dermis, which is the reason pain is felt from these injections.

Many transdermal methods of delivery today use various methods of enhancing skin penetration to eliminate the need for needles that cause pain upon injection. There are four main penetration enhancing methods: increased drug solubility, optimization of the formula, increased diffusion coefficients, and provision of additional driving force. Each of these methods functions to increase skin permeability by creating nanometer-scale disruptions in the stratum corneum layer without disrupting the viable epidermis.

Ionophoresis has been researched as a potential method for increasing skin permeability to insulin. In this method, low level electric currents are used to disrupt the stratum corneum. An experiment was performed on hairless mice TALK ABOUT IT. Results of this experiment indicated that the type of insulin used mattered in its effectiveness, as the human analog of insulin produced a more significant change in blood glucose concentrations. This method has potential to meet basal insulin requirements, but not ???. Similarly, low frequency ultrasound was also shown to increase skin permeability, however the rate was not rapid enough to make it a feasible option for insulin administration.

Another method of bypassing the skin barrier is using transfersomes. These lipid vesicles are small enough to fit through pores much smaller than themselves. They can transport insulin with 50% of the bioavailability of subcutaneous injections, making them one of the better candidates for insulin delivery. This high bioavailability could meet the daily basal insulin needs of patients with type 1 diabetes.

One route of transdermal delivery that has received a lot of attention is the use of microneedles to create tiny holes in the skin for thin insulin to pass through. In 1998, the Prausnitz Lab at Georgia Institue of Technology first reported the creation of microneedles. These needles were able to pass through the dermal layer without stimulating the dermal nerves. This is a major SOMETHING because it helps eliminate the painful injections associated with MDI.

There are several different applications of microneedles in insulin delivery. Microneedles can be used to create holes in the skin where insulin can then been applied. They can also be coated in insulin that is absorbed upon application or the microneedles can be created from polymers that dissolve upon puncturing the skin. A final method of use would be to inject the insulin directly through the hollow microneedles into the skin.

Microneedle injection of insulin provides the treatment benefits of subcutaneously injected insulin through a painless, minimally invasive route. In multiple studies using microneedles, patients have reported the insertion as painless, more specifically “Significantly less painful than a 26-gauge hypodermic needle,” the size used for subcutaneous injections. They have also been shown to have better controlled distribution of insulin with lower variability. It is very likely that patients will have better compliance with their insulin regimen when using microneedles because needle anxiety and social difficulties associated with multiple injections can be eliminated.

Intranasal

Nasal delivery of drugs has been commonly used route in the past for molecules much smaller in size than insulin. Because insulin is a fairly large molecule, it has difficulty crossing the membrane in the nose. Absorption of nasally administered insulin is rapid and takes around 15 minutes to begin working. This is attractive because it closely mimics in the timeline of endogenously secreted insulin during a meal. Although, when administered nasally, the insulin reaches systemic circulation with a relatively low bioavailability ranging from 8-15% and is influenced by several factors, including dose, timing, frequency, and variable mucous production of the nasal mucosa. Because of this low bioavailability, permeability enhancers are incorporated into the formula of insulin administered. However in trials, lecithin, an enhancer, was associated with nasal irritation, 100% of patients reported nasal irritation due to the bile salt enhancers, adn 25-50% of patients reported irritation with laureth-9.

A study was conducted with 31 participants diagnosed with T1DM who received intranasal insulin therapy. Results of the study showed that the intranasal dose required to reach a certain level of glycemic control was 20 times that of subcutaneous administration. In addition, the concentration of insulin in the blood both increased and decreased more rapidly when given nasally vs subcutaneously.

These results indicate that the low bioavailability and high irritation rates make intranasal administration a poor alternative to subcutaneous delivery; however, when the two methods are combined, the results are promising. A 6 month, 16 T1DM patient study was performed using a gelified insulin combined with promoters. The study found that when combined with twice daily NPH injections, three preprandial nasal doses of insulin were equally as effective as three preprandial subcutaneous insulin injections. Although this route of nasal administration does appear more effective than that in the previous study, four participants had to quit the study do to treatment related side effects.

Although intranasal administration of insulin has potential as an alternative form of drug delivery, many obstacles must be overcome before it is a viable option, making it an unattractive option for most researchers.

Pulmonary

Pulmonary delivery of insulin is an appealing option for a wide array of reasons. The large surface area of the lungs allows for rapid absorption and the close proximity of air and blood compartments facilitate transfer of the insulin into the bloodstream. There are no peptidases in the the lungs, thus eliminating the issue of insulin breakdown before reaching the bloodstream. Pulmonary delivery also bypasses the first-pass metabolism of insulin. The delivery of insulin deep in the lungs is influenced by the particle size, particle speed, and ventilatory parameters. The efficiency of this method is measured by the “fraction of dose delivered from device, fraction deposited on alveolar region, and bioavailability of fraction absorbed.”

The first approved inhalable insulin formula, Exubera, was approved if 2006. It consisted of a dry-powder formulation that was administered in 1mg and 3mg doses using an inhaler. Exubera was successful at significantly reducing post-prandial blood glucose and A1c levels. However, it was removed from the market in 2007 due to low cost-effectiveness.

Pharmacokinetics studies revealed that the total exposure to insulin was comparable between inhaled and subcutaneously injected insulin, however the exposure time was much shorter for inhaled insulin. Another concern with this delivery route is that insulin is a growth factor and thus deposition of insulin in the alveoli could cause problems with pulmonary function.

Results of studies performed on inhaled insulin have proven that it is as clinically effective as short-acting injected insulin and tolerated well by T1DM patients. It is not currently a popular choice for course of treatment, however, due to its limited bioavailability leading to higher costs. The expenses and questions regarding safety and efficacy led many sponsors to end research endeavors into pulmonary insulin delivery systems.

Conclusion

While there is still much debate over which method of insulin delivery is most efficient and most plausible, there is still a great deal of research to be done on each method to improve efficacy. However, it is becoming apparent that the end-goal of research in insulin delivery is to develop an artificial pancreas, making disease management easier for all T1DM patients.

References

1. 1. Shah, R., Patel M., Maahs D., Shah V. Insulin Delivery Methods: Past, Present and Future. International Journal of Pharmaceutical Investigation. 2016 Jan-Mar;6(1):1-9.
2. 2. Hultstrom, M., MD, PhD, Roxhed, N., PhD, & Nordquist, L., PhD. Intradermal Insulin Delivery: A Promising Future for Diabetes Management. Journal of Diabetes Science and Technology. 2014; 453-457.

Diabetes can be easily prevented and controlled with the change in lifestyle. Modifying the lifestyle is the cornerstone for diabetes management and cure. These modifications in lifestyle involves various non-pharmacologic therapies and include a prescription for it, are regular exercises, yoga, healthy and mindful eating and stress management.

Regular Exercises- Exercise is a prevailing way in the direction of refining the physical fitness and keep a check on long-term glycemic control. Plainly controlling blood glucose through change of eating regimen and way of life ought to be a pillar of diabetes treatment. Standard exercise has been appeared to improve blood glucose control, diminish cardiovascular hazard factors, add to weight reduction, and improve prosperity. With expanded physical action, the choice of pre-and post-practice feast or potentially snacks end up the basics. A cautious appraisal of an individual ought to be made by a doctor while consolidating an activity program in the administration. Exercise projects ought to be individualized by individual limit and disabilities. People with diabetes must wear fitting footwear for exercise.

Proof from the Diabetes Prevention Program and the Finnish Diabetes Prevention Study directed in patients with prediabetes demonstrates that proper way of life change, including physical action, can prompt diminished occurrence of T2D by practically 58%. Studies have demonstrated that obstruction preparing and high-impact practice are powerful in improving the metabolic profile of grown-ups with T2D. Specifically, directed opposition preparing (limit of 10 reiterations for >3 days out of every week) has been appeared to prompt noteworthy improvement in insulin affectability and estimations of A1C lipids, and truncal and fringe subcutaneous fat tissue in Asian Indians with T2D. Extra physical movement >60 minutes of the day would be useful in keeping up a decent glycemic profile for patients with T2D. It has been accounted for that kids and young people with T1D should total at least 30 to an hour of moderate-power physical movement day by day.

Yoga- Yoga is a conventional and restorative Indian practice that advances physical and psychological well-being. A yoga-based way of life adjustment program can lessen blood glucose, A1C TGs, all out cholesterol, and extremely low-thickness lipoprotein. Careful eating and yoga have medical advantages on glycemic control in pregnant ladies with gestational diabetes in certain investigations. Yogic activities have upgraded the cancer prevention agent barrier instrument in individuals with diabetes by diminishing oxidative pressure.

Mindful food consumption habits benefit people promote familiarity with both inner and outside triggers to eating, converge programmed eating, and eat in response of the characteristic physiological signs of craving and satiety, but not due to divert mind and consuming extra food that I not required by the body at all. Mindful consumption interventions have been operative in facilitating enhancement in dysregulated ingestion and dietary forms. With continuous practice over time, eating mindfully can intersect habitual eating activities and provide better regulation of diet choice. Additional study is required to determine the long-standing effect of mindful intake programs.

The idea of mindfulness has concerned significant attention in behavioral remedy, weightiness regulation, and diabetes management. In year 2012, 34% of Indian adults used a complementary fitness tactic, and meditation was among the highest five most commonly used tactics. Research among individuals suffering from diabetes has found that a mindfulness approach enhanced depression indicators, nervousness, well-being, diabetes-related agony, and health-related quality of lifecycle. Along these lines, significant research suggests that mindfulness mediations give potential to get to keep an eye on dysregulated eating and the psychological bleakness related with medical ailment, also for relieving pressure and upgrading mental prosperity. With careful utilization of mindfulness, in explicit, may improve eating habits by increasing eating of foods grown from the ground, dropping consumption of energy thick foods, and lessening the consistency or seriousness of overwhelming and non-required eating.

What is Type 1 diabetes? How does it affect the body’s natural homeostasis? Are there ways to prevent and even get treatment? As your reading this research paper on Type 1 diabetes you will see multiple factors on how this disease can cause and even play in effect on other organs in the body such as the heart, pancreas, and even the kidneys. Let’s begin with discussing what Type 1 diabetes is. Type 1 diabetes is an auto immune disease, which in layman terms, is an abnormal or undesirable disease where the bodies own immune system attacks healthy cells. Which in this case, these cells are beta cells located in the pancreas which helps the body make and produce insulin. People that have Type 1 diabetes have to physically inject themselves with manufactured insulin to even stay alive.

So, where does this process begin? Type 1 diabetes is one of many current diseases that is still being studied across the world to understand the main factors that caused it. Some things we do know is that this particular disease is lifelong. This means most people will most likely deal with this disease for their entire life. Type 1 diabetes can be diagnosed at any age, but in most cases found in children, teens and young adults. That being said, this disease plays an important role on how it impacts multiple organs that are operating within the body’s natural system. One being the heart. Due to this being a long-term disease, it will begin to cause issues with the blood flow and the transportation of important nutrients and oxygen through out the body. This causes grave damage to blood vessels of the heart, which can cause macrovascular disease. Not only that it can lead to the clotting and build up in the arteries and blood vessels, which could easily cause a heart attack or even bring on coronary heart disease.

Another organ that is severely affected by this disease is the pancreas. Type 1 diabetes is a disease that prevents the pancreas from making or creating little to no insulin in which the body needs to survive. This also affects the homeostasis of the human body. One other organ that Type 1 diabetes affects is the kidneys. Due to Type 1 diabetes slowing the transportation of good nutrients and heavily damaging blood vessels, this can also be a leading cause for kidney disease. This causes the kidneys not to filter blood in the proper way that it should and causing individuals over a long period of time substantial kidney and body damage.

On average, due to this disease being long-term, homeostasis for an individual’s body climate is made a lot tougher. The reason being is that the body is producing little to no insulin because this is an autoimmune disease that attacks insulin producing beta cells. These beta cells help regulate the body’s natural sugar levels. During this time, the body cannot regulate its own sugar levels. So, what happens when the body can’t regulate its sugar levels? The blood vessels and other major organs start to develop and even obtain other catastrophic diseases that can lead to major health problems and even death.

How is Type 1 diabetes diagnosed? Most people have symptoms that begin to develop that are signs that you need to be seen and checked out by a doctor. Most doctors if they see or feel that you are exhibiting signs of this disease, they will make you take a “A1C test”. This test will provide doctors with the average level of glucose over the last three months to determine if the symptoms being exhibited may be found true that you or an individual may have diabetes. Some of the leading symptoms that most people see are, increased or excessive thirst, blurred vision, mood changes, and even frequent urination. Other symptoms may include, bed wetting, extreme hunger, and a fruity or sweet smell to an individual breath.

Currently, the exact cause as to why people get Type 1 diabetes is unknown. What is known is that this disease can be seen as an auto immune disease. Where the body’s own immune system which is meant to fight and defend the body against bacteria and harmful viruses. Somehow turns is sights on beta cells which are meant to help the pancreas produce insulin to help regulate the human body’s blood sugar levels. In turn due to the immune system attacking these cells homeostasis is thrown completely out of sequence and out of normal regulation.

Next, quick and mandatory treatment is needed when you are first diagnosed with this disease. Most doctors upon diagnoses will recommend you have weekly checkups until they can find the right dosage of insulin to help you regulate your body. As your blood sugar levels begin to regulate you will have lesser visits and more annual checkups. Your doctor may provide you with some healthy and alternative steps that may help you regulate and maintain good care to your body while dealing with this disease. It would be good for you to go and try to see a nutritionist so that you can be given an appropriate diet that may help you along the way. Most doctors will also recommend exercise which in turn helps the body stay in a healthy physical condition to handle and combat the disease as well.

In closing, Type 1 diabetes in simple terms is described as an auto immune disease where the body’s on immune system attack insulin producing beta cells located in the pancreas. Which in turn, causes the pancreas to be heavily damaged, making the pancreas to produce little to no insulin. With out insulin an individual with this disease can not survive. The disease is also a leading factor to other organs such as the heart, pancreas, and kidney developing major and climatic issues in the long-term. Symptoms a person may exhibit or have, could be blurred vision, extreme hunger, and even bed wetting. Most doctors test for this using a A1C test, which shows the doctor the average past three months blood sugar levels. Doctors upon giving you this diagnosis will recommend you diet, and exercise and have annual checkups to make sure the disease is being handled correctly. Type 1 diabetes again can be regulated and taken care of but will be dealt with on a long-term scale meaning a life time.

References

1. Type 1 diabetes: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved from https://medlineplus.gov/ency/article/000305.htm
2. Dresden, D. (n.d.). Effects of diabetes on the body and organs. Retrieved from https://www.medicalnewstoday.com/articles/317483.php
3. Department of Health & Human Services. (2015, January 31). Diabetes – long-term effects. Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-long-term-effects
4. Type 1 Diabetes Symptoms. (n.d.). Retrieved from https://www.endocrineweb.com/conditions/type-1-diabetes/type-1-diabetes-symptoms

Chronic illness today is sometimes referred to as a pandemic due to the increasing prevalence of such illnesses (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2014). Some examples of illnesses that can become chronic are heart failure, kidney disease, cancer and diabetes (Lewis et al., 2014). This paper will focus on type II diabetes (DMII). DMII manifests as a result of insulin resistance, inadequate insulin synthesis due to morphological changes in pancreatic beta cells, changes in adipokine production and increased glucose synthesis by the liver in fasting and post ingestion periods (Lewis et al., 2014). DMII accounts for 90% of diabetes patients and typically has a gradual onset (years) with very little or no symptoms (Lewis et al., 2014). Risk factors of DMII can be divided in to modifiable and non-modifiable. Modifiable risk factors include obesity, sedentary lifestyle and poor diet while non-modifiable include heredity, age, and ethnicity (Lewis et al., 2014). Other risk factors such as history of impaired glucose tolerance or fasting glucose can also lead to DMII (Lewis et al., 2014). Many people are diagnosed with DMII during routine blood tests. Treatment of DMII often includes insulin, oral antihyperglycemics, exercise and nutritional therapy (Lewis et al., 2014). Adjunct medications such as ace inhibitors, angiotensin II receptor antagonists, lipid lowering agents, antiplatelets are also used in preventing diabetes complications (Lewis et al., 2014). Treatment also typically involves patient education on diabetes management strategies such as controlling blood pressure and blood sugar.

Barriers to Self-Management

Barrier 1: Patient Lifestyle

Patient lifestyle is not only a risk factor of developing DMII but can also be a major barrier to self-management. For therapeutic outcomes to be accomplished, patients have to be willing to make some lifestyle changes especially in regard to diet and exercise. Prevalence of DMII development is more common in adults age 35 and older; furthermore, approximately 80 to 90% of those with diabetes have an increased body max index during the diagnostic period (Lewis et al., 2014). Patients who don’t adhere to treatment goals and medications also increase their chances of developing acute and chronic complications of DMII. In some cases, patients who adhere to treatment goals including a combination of diet, exercise, and self-monitoring strategies (blood sugar control, blood pressure monitoring), are able to return to normal body weight and even normalize their blood sugar (Lewis et al., 2014).

Barrier 2: Social Economic factors

Social economic factors play a major role when it comes to the management of patient conditions as clearly noted in (Sav et al., 2013) and (Lewis et al., 2014). In Sav et al. (2013), several interviewees attributed their lack of medication adherence to high medication costs. According to Lewis et al. (2014), low income Canadians are three times less likely to fill their prescriptions, and 60% less likely to seek out necessary medical tests and treatment due to cost compared to their mid to high income counterparts. Social economic factors may influence whether an individual is able to get access to the appropriate care they need (Sav et al., 2013). Factors such as transportation, medications, health insurance and even geographical location can all affect an individual’s ability to access healthcare (Sav et al., 2013).

Barrier 3: Lack of Cultural Competence in Healthcare

A lack of cultural knowledge in healthcare can be a barrier to communication, proper self-management and a cause to eventual adverse health outcomes (Lewis et al., 2014). There are numerous people from varying cultures accessing healthcare and all these people come with varying beliefs and outlooks about disease and health (Lewis et al., 2014). According to Sav et al. (2013), most knowledge today in regard to chronic disease is relevant but unfortunately only focuses on the disease aspect of the individual and not as a whole. Furthermore, the information is mostly from people of similar or the same culture (mostly older Caucasian adults) and therefore may be blind to the experiences of minority cultures with chronic diseases (Sav et al., 2013).

Nursing Interventions

Educate Patients on Diabetes Management

Patient education on DMII management is key to ensuring optimal patient health outcomes. As aforementioned, DMII patients who are well educated and aware of the disease process management strategies and adhere to treatment goals are more likely to improve their condition significantly (Lewis et al., 2014). Patients should be educated on the DMII disease process first by analyzing what they know the filling in the gaps. Knowledge of the disease process may aid in increasing adherence to treatment as patient will better understand the reasons for their prescription (Lewis et al., 2014). Teaching should also involve the importance of nutritional therapy and exercise as maintaining adequate body weight and controlling blood sugar. Following recommendations by the Canadian Diabetes Association (CDA), the patient should be educated on limiting fatty foods, sugar and sweets, increasing fiber in diet, eating 3 meals a day about 6 hours apart and increasing fluid intake to prevent dehydration (Lewis et al., 2014). Patients should also be educated on exercise and rest regimens as exercise has been shown to have a sensitizing effect on insulin thus resulting in a lowering of blood glucose in the body (Lewis et al., 2014). Exercise also helps in reducing body fat and weight which in turn helps to reduce insulin resistance which may further aid in the normalization of blood sugar and even blood pressure (Lewis et al., 2014). Although exercise is good, diabetic patients should also be taught about rest periods, eating before and after exercise, carrying diabetic approved snacks or glucose tablets in order to prevent the occurrence of hypoglycemia (Lewis et al., 2014). The CDA also reccomends that diabetics should be started on exercise regimen after the approval and assessment by a doctor (Lewis et al., 2014). Diabetic patients should also educated on the importance of medication and or treatment adherence if necessary, as they are at risk of developing acute and or chronic complications that can affect the whole body system and even lead to death (Lewis et al., 2014). Acute complications typically manifest as a result of mild, moderate and extreme blood glucose flactuations(Lewis et al., 2014). Some acute complications of DMII include hypo/hyperglycemia, diabetic ketoacidosis, and hyperosmolar hyperglycemic state(Lewis et al., 2014). All the afformentioned acute complications can also lead to additive adverse effects on the body resulting in kidney failure, fluid shifts, hypovolumea, electrolyte imbalances Etc(Lewis et al., 2014). Chronic complications often result from vascular problems such as damage or accumulation of plaques in small, medium and large vessels(Lewis et al., 2014). Chronic complications can increase a patient’s risk for heart disease, stroke, hypertension, neuropathy, nephropathy, retinopathy, altered immune system, and skin breakdown (Lewis et al., 2014). Patients should be educated on recognizing symptoms especially for the acute symptoms as these happen fast and can lead to seriouse harm or death.

Advocate for Policy Change to Improve Patient Outcomes

According to the Canadian Nurses Association (CNA) as noted in Lewis et al. (2014), being an advocate is part of a nurse’s role. Nurses play a key role in healthcare and as a result are positioned well to help in the shaping of care standards, policy and education (Lewis et al., 2014). Using Evidence Informed Practice (EIP), nurses can gather information based the topic of interest (DMII), gather relevant data related to the topic, assess collected data and relevance to profession, (nursing), patient population and beliefs; this data can then be used in the making of necessary changes to practice and subsequent evaluation (Lewis et al., 2014). Nurses can use EIP to assist in creating new care standards that would aid in reducing barriers and improving management strategies for patients with DMII. An example of a new management strategy can be seen in Steinman et al., (2020) where new care approaches are examined such as mobile health to help keep track and link those with DMII with their healthcare providers, pharmacies, educators and community groups with similar conditions. Using the mobile health strategy in the management of diabetes and hypertension may increase adherence to treatment and allow for those suffering with diabetes to be educators and community builders for those in similar situations (Steinman et al., 2020). According to Steinman et al., (2020), mobile health may also be used to remind patients to take medications, keep medical appointment and other necessary care services. Mobile health seems to have some promise in low to middle income countries and may just work for those in low to middle income status elsewhere including Canada. If implemented, mobile health may help in building more communities and may even lead to an increase in healthcare resource allocation and treatment goal adherence to those suffering with DMII as a result of this peer support model. As noted in Steinman et al., (2020), physician assistive personnel such as nurses, pharmacists and Etc. may be better positioned to educate patients on self-management strategies due to a lack of time by physicians.

Practice Culturally Competent Care

Due to the diverse range of cultures and people who frequent healthcare centers, it is important for healthcare providers to be culturally aware and be ready to provide care that is congruent with the patients’ beliefs as this would encourage adherence to treatment goals and lead to better outcomes (Sav et al., 2013). An analysis of high-risk populations for the development of DMII reveals that visible minorities in the Asian, Aboriginal, African, and Hispanic populations are at greater risk and thus further drives the point of the importance of cultural awareness and competence (Lewis et al., 2014). The afforementioned highrisk populations all come from varying cultures and as a result will have varying beliefs on issues relating to their health (Sav et al., 2013). For example, when it comes to diet modifications for diabetic patients, adherence to diets may be increased if the educator is aware of some food preferences within a certain culture that may be favorable to the patient and his or her condition (Lewis et al., 2014). As noted in Lewis et al. (2014), The CDA provides dietary information based on specific cultural preferences that may help healthcare providers and patients when meal planning for diabetic patients. New immigrants and people from different parts of the world may also lack the knowledge to navigate the healthcare system and are also more likely to have language barriers which may present challenges in communication (Sav et al., 2013). In order to foster understanding in a patient with a language barrier, Lewis et al. (2014) recccomends that having an interepretor present who is known to the nurse and the patient. The interpretor should be assesed for their values and ability to translate information accurately, furthermore the translator should meet with the nurse and patient prior to the meeting to build rapport. Nurses can also make sure to schedule more time, be proffesional, patient, and speak with clear simple words and sentences avoiding medical jargon (Lewis et al., 2014). Approximately 60% of Canadians have deficiencies in health related knowledge such as how to access necessary care services and information related to increasing skills necessary for self health management(Lewis et al., 2014). As potrayed in the following examples, it is clear that being culturally aware and practicing cultural competence can be a great way for nurses and other care providers to assisst in ensuring that patients are getting the utmost care that alligns with their beliefes and preferences.

Conclusion

To conclude, Chronic disease is rampant globally and many care strategies have been deployed to aid in the management of these diseases. This paper mainly focused on barriers to self-management, nursing interventions and the role nurses play in the management of chronic diseases, specifically DMII. Although some strategies currently exist to aid patients in management of DMII, more research is needed in order to improve and ensure the utmost care for this patient population.

INTRODUCTION

Diabetes is a world renowned killer and is one of the causes of death that is leading in the world. (Elfein) There is no cure for diabetes and it is a chronic health condition. Diabetes is distinguished between Type I diabetes (DM I) and Type 2 diabetes (DM II) along with gestational diabetes.(Thom2) The DM I entails high levels of glucose that floods the body due to the lack of ability to produce insulin. The DM II and gestational entails of the body’s inability to utilize the insulin to regulate its blood sugar levels.(THo2)

Worldwide in the year 2019, there are about 463 million people diagnosed and afflicted with the chronic disease of diabetes.(Thom2) In 2019, most of that 463 million are diabetic patients derived from China, then India, then followed by the United States.(thom2)

It is estimated that diabetes killed over 1.6 million people in 2016. (Elfein) The non communicable disease of diabetes causes the death toll to be high in China due to lack of sufficient and appropriate treatment of its affected population.(eflein) Diabetes is ranked as such a non communicable disease around the world that it is predicted that India’s population will account for 134 million people having diabetes by the year 2045.(elfin, Thom3) Yet as it stands, China has the world’s largest accounted population of folks with diabetes. (ELfein, Thoma3) It is estimated that China has about 116 million people diagnosed with diabetes.(Elfein Thoma3, Lou) The 116 million people is what causes China to rank higher than any other country in the world.(Elfin, thoma3, Lou)

In China during the 2019 year, there was a significant age group of people between 20 and 70 years old that had diabetes. (Thoma3) Of that age group China has an estimated 28.7 thousand has Type 1 diabetes (DM I) of which are children up to 14 years of age. (Thoma3) The remaining group of about 114 million people have Type II diabetes (DM II). (Lou)

REVIEW OF LITERATURE

There is a major health care challenge for policy makers in China because they have already extended healthcare insurance to its constituents over the past decade, yet more is needed.(Lou) It is estimated that China nationally spends approximately 8.5% on health care costs managing diabetes not including complications deemed from diabetes. (lou,natl/interl,natl)

China is highly interested to gaining control over its diabetes problem for fear of the high costs of diabetes care is draining their monetary gains.(lou) While China has the highest amount of diabetes in its population, Germany, Mexico, and Portugal had the highest rates in healthcare cost expenditure. However, China spent more on healthcare diabetes related costs which is over half of the amount spent by the entire Western Pacific region.(thom2)

DISCUSSION

Risks

Skolnik states that lifestyle is to blame significantly for risk factors of noncommunicable diseases. (skolnik) Skolnik relates that lifestyles can be self controlled by people.(skolnik) The risks for diabetes have increased over the years yet obesity remains the largest risk for obtaining diabetes (elfein). Other risks include diet, physical activity, tobacco use, alcohol, family history, genetics, infections, and other environmental influences. (skol, Thoma)

Design an Intervention to Improve the Health of Those Affected by This Condition

China prefers to gain control over its diabetes healthcare challenge because they feel that all the wealth that they have gained over the past 30 years will be debunked due to all the expense that would come from increased dialysis needed for its affected population.(Lou)

Why? Why such a chronic problem in China? It is thought that due to the aftermath of the Great Famine during 1958-1962 in China helped to contribute to the socioeconomic and cultural determinants contributing to diabetes.(Luo) There was a transition period of transitioning diet and genetics factors transcending causing a generational shift.(Hu) In China’s larger inner cities, while the parents worked the grandparents usually were left to take care and raise the grandchildren. (luo) All the while those grandparents had experienced the Great Famine and therefore the grandparents likely stocked pile, eat dense high calorie foods to ward off starvation. (luo) Coupled with having low activity due to advanced age the kids likely were not able to expend as much energy as neighboring kids. Hence this combination gave rise to increased risks for diabetes not only for the grandparents, but also for the grandchildren and the parents since the parents often ate what the grandparents prepared for meals.(luo)

In essence a retraining and rethinking must take place to break generational habits and thinking.

Detail Short Term Goals of the Intervention

In the short term interventional plans are to utilize artificial intelligence and data to help promote healthier well being, detect and gain control over diseases that are chronic in nature in areas that are most impacted.(Luo) Primary care providers are to be used to promote healthier lifestyles, including diet, regular exercise,weight management, including decreasing tobacco use and controlling alcohol use.(luo) People are known to look to their leaders for guidance, so the Chinese CDC takes leadership and responsibility and has championed local governments (eg, propaganda, women’s federation, educators as well as top county officials) to help with the overall coordination and promotion of well being.(luo) Overall despite its challenges and disparities this method of promoting and education of a healthier lifestyle has been on track to be successful.(jin) In order to control diabetes it is important to learn about disparities, learn about diabetes awareness amongst the population, and proper treatment of diabetes.(luo) It is imperative to have health promotion, testing and monitoring tools in place and teaching as well as allowing people to self manage while having standardized approaches to controlling diabetes.(Luo)

Long-Term Goals of the Intervention

In the long term goals and plans for intervention are to further the use of artificial intelligence (AI) and data to continue to extend the efforts of promoting even healthier well beings, to detect diabetes and gain control and manage diabetes in areas that are most impacted well into the future.(luo) There must also be an integration of integrating academic medical centers and hospitals with the most effective primary care.(luo) There must be a promotion of Chinese goals such as healthcare reform, to include upgrading the primary care workforce all the while reducing inequalities in access to healthcare as in any country around the world.(Luo) There will be an upward of partnership and trust building amongst the community, including patient care providers to provide basic services such as routine blood tests, urinalysis and electrocardiography for the patients. This will help support the primary care healthcare worker shortage which will help fuel the trajectory of diabetes in China. As patients reap the rewards or healthier living they too will inspire more health care workers in the field to help control and reduce diabetes in the Chinese population.(Luo)

Another strategy is to continue the use and promote artificial intelligence as tools. Some examples would be patient self-management tools (eg, activity and dietary tracking devices and improved glucose sensors), automated retinal screening, predictive population risk stratification. Also should be included are artificial intelligent activity trackers and smartphone applications, as these have a trajectory to improve and prevent DM II by encouraging healthier behaviors that prevent diabetes. These devices will promote physical activity and dietary changes during the times when patients would need it most during the day to day routines. (Luo) Also, use of connected sensors or mobile applications that will improve and promote better daily monitoring of patients with DM II.(fag) Also utilize the AI by way of telehealth such as Alibaba’s Dia Doc, that was launched in 2018. (lou) The Dia Doc has the capability to doctors, specialists, higher officials, all while utilizing guidelines to treat patients while helping to promote healthier living, education and decreasing diabetes. ( lou, Peas)

References

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