Category: Diabetes

Or the one which depends on insulin. Now a day in 2020 very common condition in young children and elders. Type 1 diabetes is a long term medical condition, happens when the pancreas produces little or no insulin at all that every healthy body needs and the reason why insulin is necessary its because this is an essential hormone which our body needs to allow sugar or glucose to enter in our cells and produce energy which acts as fuel or battery for our body and if not required energy your body starve energy.

Causes

causes are still unknown and regular one are immune responses. At the point when the body detects risk from an infection or contamination, the immune system becomes active and attacked it. And this why we called it immune response but, that bad thing is that sometimes it caught up the healthy cells in this process which they shouldn’t, cells like pancreas cells (Beta Cells) which make insulin and if diabetes happens, then maybe the autoimmune response is the one which makes this situation happen. And other causes are genetic and some still don’t get even the are likely to.

Symptoms

Type 1 diabetes symptoms don’t show up right after you get or within a week. It may take months to show up the clear symptoms or even it can take a year and surprisingly in some cases symptoms developed rapidly Some common symptoms are.

• Extreme thirst.
• Frequent urination.
• Sudden weight loss.
• Fatigue.
• Uncontrolled appetite.
• Mood swings.
• Blurred vision.
• Slow healing.
• More likely to caught up infections.

Diagnosis

Random Blood Sugar Test

Now a day it’s easy to do a home test. The primary screening test for type 1 diabetes is the random blood sugar test. Anybody can do his easily a home A blood sample is taken at a random time. A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per litre (mmol/L), or higher than that can suggest diabetes. Another way for diagnosing diabetes is.

(A1C) Test

Glycated Haemoglobin (A1C) Test

This test measures the average amount of glucose in a person’s bloodstream over the past 90 days or 3 to 4 months. A normal healthy A1C level is below 5.7%, But If your A1C level is between 5.7 and 6.4 then you should need to see your doctor right away as this glucose level is pre-diabetes and it could become type 1 if you delay longer even after knowing. An A1C level of 6.5% or higher indicates diabetes. Make sure your glucose level falls, because even after treatment if your glucose level stays up then you would face many complications.

Complication With Type 1 Diabetes

Sorry to say but, yes even with this long term illness some short term illness may have an influence on your health in between. But all of them can be treated easily by yourself.

Hypoglycemia

Hypoglycemia or low blood sugar, When a person blood sugar falls too much. A rare condition in a normal person but, a diabetic person is likely to face hypoglycemia. People who are continuously on medication or have too much insulin, Not having proper healthy diet even with having type 1, because a normal healthy person shouldn’t need too much medication but a diabetic patient especially with type one face this condition a lot. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per litre (mmol/L), or below should be an alarming sign especially if you’re diabetic.

Symptoms

These are some early signs and symptoms

• Fatigue.
• Fast heart rate.
• Plae skin.
• Sweating.
• Hunger.
• Shakines.
• Blurred vision.
• Restless nights

And sever symptoms includes.

• Confusion, abnormal behaviour or Feeling confuse while doing anything.
• Siezures and loss of consciousness. The condition would worsen if left untreated.

Treatment

At a time you should drink glucose drinks, and eating a healthy diet full of carbs and proteins, Healthy fresh fruit juices and at least drinks 8 glass of juices a day, or fresh juice if needed then take some glucose tablets. And just after 2 to 3 hours check your blood sugar level again, if it still lows then ask your doctor for help and immediately.

Abstract

The paper greatly focuses on the advent of type 1 diabetes in USA, the statistical data is presented and the concurrent research has been presented as well. Type 1 diabetes affects millions of Americans annually, of whom a huge and alarming number of patients go undiagnosed. This paper discusses the statistics of the patients and methods and techniques for control and management of the disease.

Literature Review

The number of diabetics in America is increasing at a very alarming rate. More than 26 million residents of America are affected by this very ailment. Approximately 25% of senior residents of America, i.e. ones aging above sixty-five years and about ten percent of grown-ups, i.e. ones aging between nineteen and sixty-five have the ailment. (Association, 2020) Meanwhile, a substantial portion of this very population is afflicted by diabetes type 2, approx. one million of these residents have prevailing type 1 diabetes as well. An alarming seventy-nine million residents of USA are affected by prediabetes, this number of people, along with the ones suffering from diabetes constitute to be about more than fifty percent of the US populace being affected by this ailment i.e. they are suffering from glucose digestion problems. (Lindy Kahanovitz, 2018) When these rates and statistics are taken into account, the predictions that show up for current rate suggests that by the year 2050, one in three Americans will be suffering from glucose in digestion and/or diabetes ultimately, taking the various races and ethnicities into account as well. (Lindy Kahanovitz, 2018)

The high pervasiveness of diabetes, particularly among the maturing populace, comes at an impressive monetary expense. In 2007, diabetes and prediabetes represented roughly $218 billion in direct clinical expenses and lost efficiency in the U.S. Human services uses for people with diabetes are 2.3 occasions more prominent than consumptions for those without diabetes, and diabetes difficulties represent a critical extent of those expenses. (DrMark A Atkinson, 2001) Diabetes fundamentally expands the danger of cardiovascular occasions and demise, and is the main source of end-stage renal ailment, visual impairment, and nontraumatic lower-appendage removals in the U.S. In spite of clinical advances fundamentally diminishing the danger of confusions and related mortality, the direction of these decays has been blunted by the general increment in the quantity of individuals beset with diabetes. (Prof Mark A Atkinson, 2014)

Type 1 diabetes is an infection wherein immune system demolition of pancreatic β-cells prompts insulin lack. (DrMark A Atkinson, 2001) Controlling blood glucose with an adequate range is a significant objective of treatment. Estimations of hemoglobin A1c and blood glucose levels are utilized for both the determination and the drawn-out administration of the malady. (Prof Mark A Atkinson, 2014) This section quickly depicts the pathophysiology, analysis, and the board of type 1 diabetes.

As our insight into type 1 (insulin-subordinate) diabetes increments, so does our gratefulness for the pathogenic unpredictability of this illness and the difficulties related with its treatment. (Lindy Kahanovitz, 2018) Numerous new ideas about the pathogenesis of this issue have emerged. (Prof Mark A Atkinson, 2014) The job of hereditary qualities versus condition in infection arrangement has been addressed, and the premise on which type 1 diabetes is portrayed and analyzed is the subject of much discussion. (Prof Mark A Atkinson, 2014) Also, the consideration and treatment of patients with type 1 diabetes has seen a quick advancement; with hereditarily built insulins, glucose observing gadgets, and calculations all adding to a lessening in illness related difficulties. (Lindy Kahanovitz, 2018) We center this workshop around these evolving perspectives, and offer another viewpoint on our comprehension of the pathogenesis of type 1 diabetes and on standards for helpful administration of patients with this issue. (DrMark A Atkinson, 2001)

Introduction

Diabetes is alluded to a collection of ailments described by high glucose levels in blood. (DrMark A Atkinson, 2001) It is brought about by an insufficiency in the creation or capacity of insulin or both, which can happen due to various reasons, bringing about protein and lipid metabolic issues. The drawn out impacts of hypoglycemia are tissue and organ harm. (Lindy Kahanovitz, 2018)

Side effects of diabetes incorporate polyuria, thirst, vision issues, and weight reduction. At times there are more serious types of diabetic ketoacidosis and hyperosmolar that may prompt trance and extreme lethargies. (DrMark A Atkinson, 2001) Yet, most indications are not extreme, which may cause harm or even disappointment of various organs over the long haul and lead to unsalvageable wounds, for example, visual impairment, removal, stroke and in the end passing. (Lindy Kahanovitz, 2018) Already, type 1 diabetes was called insulin-subordinate diabetes and it could occur at any age however is generally normal in youngsters and youngsters. (DrMark A Atkinson, 2001)

Individuals with type 1 diabetes can’t deliver enough insulin. This sort establishes about 5%–10% of all instances of diabetes. In this sort, the cell devastation of beta cells happens in the pancreas. (DrMark A Atkinson, 2001) In type 1 diabetes, the pancreas doesn’t deliver any insulin. Since there is no epidemiologically precise data on the predominance and rate of type 1 diabetes on the planet and in the area, along these lines, the current examination was structured and executed as an efficient survey and meta-investigation, on account of international guide of the strategy on the counteraction and treatment of this malady should be possible better. (DrMark A Atkinson, 2001)

Diabetes affects millions annually in USA, given the yearly statistics of 2018, 10.5% of the overall population which constituted of around 34.2 million had shown the prevalence of diabetes, out of which around 26.8 million were actually diagnosed with diabetes while 7.3 million went undiagnosed. (Association, 2020) Of this populace, 1.6 million had type 1 diabetes out of which around 187,000 were constituted by adolescents and children.

Discussion

Diabetes, overall is very prevalent in US given the presented statistical data. (Association, 2020) Type 1 diabetes, although less prevalent than type 2, is yet dangerously high and given the amount of patients who go undiagnosed present an alarming state. (Lindy Kahanovitz, 2018) Methods for prevention of disease and even controlling it are readily and easily available. (DrMark A Atkinson, 2001) The populace suffering from disease, although being focused upon by the American Diabetes Association ADA, needs more focus so that the management and control of the diabetes could be improved and enhanced.

Keeping up blood glucose focuses close to the ordinary range is basic for fruitful long-haul soundness of patients with diabetes. (Prof Mark A Atkinson, 2014) Current treatments needed to accomplish great glucose control in insulin-subordinate diabetes are very requesting, requiring continuous blood control checks and computations of insulin necessities to treat dinners and glucose outings over the objective range. When the portion is determined, patients should physically oversee the insulin by infusion or utilizing an insulin siphon. (Prof Mark A Atkinson, 2014) The pace of insulin retention after subcutaneous infusion is slower than the assimilation of starches from food, worsening keeping up glucose levels inside the objective range. Quick acting insulin analogs which opened up during the 1990s have improved pharmacokinetic properties, however are still a long way from ideal, and insulin absorbance rates are profoundly factor from patient to tolerant, and in any event, for similar patient on various events. This adds to the trouble of knowing the right measurements of insulin for a given circumstance. Insulin’s more quick ingestion energy are being created and approaching endorsement. (Lindy Kahanovitz, 2018)

Grown-ups with type 1 diabetes currently range an enormous age range—from 18 to 100 years old and past. (DrMark A Atkinson, 2001) Dissimilar to the very much portrayed formative phases of youngsters, the existence stages crossed through adulthood are regularly less all around recorded and undervalued. (Prof Mark A Atkinson, 2014) Notwithstanding, a comprehension of every individual’s conditions is indispensable. This is valid for maturing all in all, yet especially valid for those with huge comorbidities because of long-standing sort 1 diabetes. (Prof Mark A Atkinson, 2014) Accordingly, it is critical to survey the clinical needs of the patient, defining explicit objectives and desires that may vary essentially between a solid 26-year-old and a slight 84-year-old with CVD and retinopathy. (Lindy Kahanovitz, 2018)

References

1. Association, A. D. (2020). Statistics About Diabetes. Retrieved from American Diabetes Association: https://www.diabetes.org/resources/statistics/statistics-about-diabetes
2. DrMark A Atkinson, G. S. (2001). Type 1 diabetes: new perspectives on disease pathogenesis and treatment. The Lancet, 221-229.
3. Lindy Kahanovitz, P. M. (2018). Type 1 Diabetes – A Clinical Perspective. Point Care, 37-40.
4. Prof Mark A Atkinson, P. G. (2014). Type 1 diabetes. The Lancet, 69-82.

A Qualitative study by Forte et al, (2015) on opportunity to involve men and families in chronic disease management in Chiapas, Mexico and a quantitative study by Goncalves et al, (2017) on knowledge of individuals with DM in the family health strategy in Brazil were selected. Both papers are taken from Latin American country, Brazil and Mexico which has the highest prevalence of diabetes than any other country in the region ( Chapa,2017 ; Telo et al,2016).

In the United Kingdom (UK), there is a high prevalence of diabetes specially among ethnic minority groups (Diabetes UK, 2019) which is costing the nation 8.8 billion per year ( NHS England, 2020). Diabetes is a global issue with a significant impact on individuals, economy of the country and the health care system ( WHO, 2020), therefore the finding of both types of research can be applicable to the UK nursing practise.

Critique paper 1

Goncalves et al, ( 2017) conducted a cross-sectional study with a quantitative approach using stratified sample of 222 individuals with T2DM from five families health strategy ( FHS) unit of Itau de Minas, Brazil, to examine the knowledge of the subjects on the disease. The research was carried out from October 2013 till May 2014 . This method appeared to fit well with the inquiry, as the data are collected at a single point of time to examine the knowledge of chosen participants on T2DM ( Nieswiadomy,2008). Kesmodel ( 2018) suggested that there can be a systematic bias in a cross-sectional study due to systemic differences between participants who were selected and who did not get selected, however Burns and Grooves (2011) argued that due to increasing in the representativeness of stratified sample, it reduces the possibility of systematic bias.

Goncalves et al, (2017) used Diabetes Knowledge Scale questionnaire ( DKN-A) which is self-administered questionnaire(SAQ) with 15 multiple choice questions on different elements connected to the general knowledge of Diabetes as a research tool as it is proven to have validation and demonstrated reliability and internal consistency (Eigenmann, Skinner and Colagiuri, 2011). However, Polit and Beck (2014) argued that for SAQ to be effective, respondent must be able to understand the questionnaire as different individuals may have different level of literacy. If the respondents skip the question, it will result in gathering incomplete data which can affect the validity and reliability of the tool (Burns and Grove, 2011). Similarly, Goncalves et al, (2017) also acknowledged that they observed difficulties in data collection due to respondents not being able to understand the questions and their confusion regarding choice of answers provided and mentioned that few other studies in the past had experienced similar problems due to the use of SAQ. This suggest that the questionnaire was not easy to understand, and the wording were confusing and unfamiliar to the respondents. Therefore, this demonstrated tool of data collection was not appropriate instead face to face interviews should have been used to yield more reliable and valid data ( Boswell and Cannon, 2014).

Goncalves et al,( 2017) analysed the collected data in the Statistical Package for Social Science ( SPSS) version 15 and presented them in a descriptive way in frequencies and percentages using descriptive statistics which is fairly straightforward and valuable ( Selvanathan, Selvanathan and Keller, 2017). Age and time of the diagnoses were presented as a mean and standard deviation and reported that 81.5% of the participants had satisfactory knowledge about T2DM , and the results were presented in the text and the table. This method is deemed appropriate for this cross-sectional study as it describe and summarise data from the sample ( Roberts and priest, 2010), beside summarising the data it reduces a large amount of data and present it precisely ( Holcomb, 2017).

Goncalves et al, (2017) had a sample recruited from five FHS, out of 524 individual enrolled in the computerized system of Registration and Monitoring of Individuals with Systemic Arterial Hypertension and Diabetes Mellitus ( HIPERDIA), Individuals with gestational diabetes, type 1 diabetes, who declined to complete questionnaire and declined to be involved in the research were excluded, hence only 222 individuals with T2DM were selected as a representative sample, which is appropriate for the cross -sectional quantitative research as it can be representative of the population being examined provided that there is minimal missing data (Nieswiadomy,2008). However due to possibility of incomplete data as the result of data collection tool, the suitability of the sample size is questionable. Using stratified sample has helped researchers to compare groups and generate valid interpretations from the sample of the population used, however, due to the research being carried out in a small geographical area with predominantly female participants, generalization of the finding to the global population is questionable (Eysenck,2015).

In addition to the study being approved by the Ethics Committee ( CEPE) of the University of Franca, all participants signed the informed consent term and the Individual who refused to participate were excluded from the study demonstrated the ethical issues were considered (Brooks et al, 2014). However, the remaining participants were not explained their right to leave the study or withdraw their consent and data, which should be explained to them in order to respect their human right ( Nieswiadomy,2008). Dyson and Norrie ( 2010) stated that the participants have right to expect that the information collected from them is kept securely and confidently, however Goncalves et al, (2017) failed to mention where and how the data will be held and there is no mention of debriefing the participants or advising them of the ways of contacting the researchers, which puts the ethical rigor in questioning ( Harvey and Land, 2017).

Critique paper 2

Forte et al, ( 2015) has used the interpretative phenomenological method to explore why male participants were not involved in health promotion activities and to develop strategies to involve them in chronic disease management and this method fits well with the level of the inquiry as this method explores people’s experience and how they understand their living world (Glasper and Rees , 2016) .

Forte et al, ( 2015) recruited 9 males with diagnosis of hypertension and/or T2DM, who had limited or no participation in health education program, 6 families in which at least 1 family member had diagnosis of T2DM and/or hypertension and 9 health care providers from 4 different health centres of the secretary of health in Chiapas, Mexico. All 3 subpopulations were interviewed in Spanish, on disease self-management activity, barrier to participating in health promotion activities at the health centre. Interviews were audio-recorded and transcribed into a separate word document in Spanish. In-depth semi structured interviews were used, which was appropriate for this research as it permits flexibility where the interviewer has sets of guiding questions but does not have to rely on the pre-set questions (Wilson,2012). This is because the interviewer can inquire further according to the participants responses, which can generate powerful data that provides insights into the participants’ experiences, feelings or views (Peter and Halcombe,2015). However, the researchers failed to mention their rationale for conducting face to face interviews in the university and clinics, as they represent more of the formal environment, which can be daunting and intimidating for some participants (Glasper and Rees, 2016) and some may not be comfortable talking about their personal life and experience in a formal setting (Harvey and Land ,2017). The researcher did not mention how long the interview lasted, how the researcher ensured participants were made comfortable to speak about themselves and to develop rapport with each participant as gaining true information is vital ( Glasper and Rees, 2016). However, due to the presence of the researcher to clarify questions and seek clarifications from the participants during the interview, the validity of the response is enhanced (Parahoo, 2014).

Researcher used General Inductive Analysis (GIA) approach to identify themes related to male’s limited involvement in health promotion activities, how the family was involved in disease management and recommendation for both which demonstrate methodological rigour as it produce reliable and valid findings, using a systematic approach (Lui, 2016) therefore, it is appropriate to use GIA for this research. All transcripts from the interviewees were entered into ATLAS. ti version 7 which is a software program that aids in analysing qualitative data (Nieswiadomy,2008). To avoid misinterpretation, three Spanish speaking analysts used open coding and focused coding to produce an initial list of codes; that was analysed collectively and converted into an agreed set of codes which were then reviewed by two members of research team, this demonstrates trustworthiness and authenticity of the data ( KO, 2011). Use of Eco maps and Genograms are appropriate for this research as they portray personal, family and social relationships and permit understanding and imagetic visualisation which would complement the interview questions ( Souza et al., 2016).

Researchers used Purposive sampling to facilitate a detailed analysis of the data produced. Participants were purposively selected to ensure an evenly homogeneous sample, which can offer rich data about their understanding and perceptions of their health conditions and management of disease ( Polit and Beck 2014) ; consequently, sampling is appropriate, however it is difficult to ascertain if sample size of 9 males,6 families and 9 health care professionals is the representative of the study population and data saturation was achieved or not as Beck and Polit ( 2014) stated that small sample sizes are not likely to represent the study population. Therefore, the validity and trustworthiness of the sample is questionable.. Furthermore, due to the male focus in the research within the small geographical area, it is questionable if it can be generalised to the wider population where cultural difference exists.( Eysenck,2015)

In addition to approval from the Institutional Review Board of the RAND Corporation, the Institute of Nutrition of Central America and Panama, and Health Institute of the State of Chiapas, this research is funded by the seed grant hence it is likely to assure ethics and ensure participants right were upheld. To ensure compliance and data protection, transcripts of the interviews and ATLAS.ti coded files are kept in the School of Nutrition of the University of Science and Arts in Chiapas, Mexico. Pseudonyms were used throughout the article also confirmed confidentiality. However, ethical rigour is questionable due to; participants not being aware of the procedures, debriefing was not carried out, participants were not informed of how to contact researchers, and participants rights to withdraw were not discussed. Even though participants consented to take part in the study they should have been explained their rights and procedure of the study (Nieswiadomy,2008)

Discussion

Both research articles were successful in responding to the research question generated in some aspect. Forte et al, ( 2015) focussed on how to identify strategies to involve males with hypertension and/ or T2DM and family of patient with T2DM in a health promotion and disease management. They were also able to recognise that the structure and relationship of the family of the patient can be diverse where, some had full support and some lacked support which is similar to the families in the UK (Gunn et al, 2012). Goncalves et al (2017) analysed knowledge of individuals with T2DM and found that health professionals must focus on effective educational actions and aim to improve patient’s health as increased knowledge can empower patients by improving their self-efficacy which can be a valued means for managing or preventing T2DM.

Suresh and Chandrasekhara ( 2015) suggested using satisfactory sample size with excellent data collection efforts will result in reliable, valid and generalizable results, but in both researches, data collection tool and sample are questionable. Even though questionnaires used in quantitative research and in- depth semi structure face to face interview used in qualitative research are a valid tool to collect data, they had some flaws in the study, which affected the validity and reliability of the finding, hence limit their contribution to UK nursing practice which requires the use of best available evidence (NICE,2020 ). Nevertheless, the finding of the both researches can be significant to increase the knowledge of the nurses on effective interventions and to develop strategies to improve self-efficacy on patients with T2DM. Saeedi et al, ( 2019) highlighted that it is imperative to develop and implement strategies to tackle T2DM as currently there are 3.8 million people living with diabetes in the UK and expected to be 5.5 million by 2030 ( Diabetes UK , 2019). Consequently, the findings of the both researches are noteworthy for UK nursing practice for theoretical knowledge to deliver effective health promotion to manage or prevent T2DM on patients as stated by the NICE guideline ( 2015), which emphasise on promoting health and educating patients to manage or prevent T2DM. However, it is also crucial to be aware that the findings of both researches are insufficient to meet the needs of patients due to their various needs and distinctiveness. Furthermore NHS (2020) highly emphasise on involving patients in their health care and delivering person centred care, this is further emphasised in the king’s fund report “no decision about me without me”. Both researches have emphasised on carrying out future research related to health promotion for management of T2DM.

Conclusion

This assignment has reviewed qualitative and quantitative research papers obtained from CINAHL and BND database. The research question was generated using PIO model and successfully identified the importance of evidence-based practice. The research assignment found that whilst ethical rigour was applied to both papers, both were lacking when it came to informing participants of their rights and some flaws with data collection tool and sample which questioned the validity and reliability of the researches. However, despite these shortcomings, both research articles showed that health promotion is crucial in managing and preventing T2DM. Whilst the research was conducted in Latin America clear parallels could be made with the UK nursing practice, given the global impact of diabetes.

Introduction

Transmittable sicknesses include ailment exuding from the microscopic organisms or infections and are spread through contact with the tainted surfaces, blood items, body liquids, bug chomps and even through air. The infrequent compassionate crises cataclysmic event coming about to the relocation of the populace, with unfriendly obstruction of the fundamental framework, over crowdedness, poor access to clean water, nourishment uncertainty, sanitation and inadequacy of the essential wellbeing administrations make the causative specialists and spread of the transferable infections. In Miami Dade, the referenced ominous ecological circumstances in instances of the compassionate crises encouraging the transmittable illnesses results to expanded mortality and grimness rate. The general reconnaissance of The study of disease transmission, Malady Control and Inoculation benefits in the region incorporated the Bioterrorism, Creature Chomp and nourishment brought into the world transferable sickness.

Influenza

Every year, the living arrangement of Miami Dade District, encounter flu ailment coming about to million disorders and a thousand passings of individuals. Flu is brought about by the assault of infection on the respiratory framework along these lines coming about to early indications of Body hurts, hack, high fever, sore throat clog, extraordinary weariness and chills. The dangers of flu diseases on grown-ups, kids, pregnant moms and even the older include the improvement of intricacies, for example, pneumonia and ear contaminations (sinus). The flu season is flighty as it changes each year. The difference in the flu infection is hastened by the change in the hereditary cosmetics of the infection as they repeat every so often. This circumstance clarifies the need on the difference in the flu antibody to check the dynamic and changing hereditary creation of the infection to control its spread. In the aversion of the spread of the flu ailment disease, vaccination is fundamental. The objective of vaccination as per the Solid individuals 2020 include the endeavors on the augmentation of inoculation and at the same time diminishing the preventable irresistible infections at present focusing on 17 Antibody preventable sicknesses over the individual life expectancy. The goal of the Wellbeing individuals 2020 on fighting the occasional flu incorporate the addition of the level of grown-ups and kids who get the regular flu immunization. Accomplishment of the regular flu immunization inclusion is inescapable just if the rate is expanded. The inoculation need as a preventive measure ought to be given to the pregnant moms, youngsters, old, people with interminable respiratory sickness, and perpetual conditions, for example, diabetes. Other preventive proportion of flu incorporate restricting contact with the wiped out, washing of hands with clean water and cleanser, purifying surfaces and repelling the hands from the eyes, nose and the mouth.

Diabetes

Diabetes is one of the ailments that has turned into a major issue in Miami and the entire world on the loose. Glucose in the body is frequently utilized as a wellspring of vitality and when the body can’t legitimately deal with glucose then that means that diabetes. There are three kinds of diabetes to be specific: type 2 diabetes, type 1 diabetes, and gestational diabetes. The sort 1 happens when the body can’t create insulin while type 2 comes because of the activity of insulin being stood up to. Gestational diabetes, then again, entangles pregnancies. There are additionally costs identified with unexpected losses and inabilities and this regularly happens when there isn’t enough therapeutic consideration for a patient. Demise implies lose a piece of the work constrain and, in the meantime, making internment courses of action signifies the costs like medical clinic bills. Handicaps additionally come up because of diabetes as in the unfortunate casualty’s eyes could get harmed prompting visual impairment. Other than visual deficiency, there are benefits that individuals with this malady apply for so as to ensure they support themselves by getting appropriate medicine. This is exorbitant to the district’s financial plan and the resultant impact is that the network endures in different areas where open administrations are required. This is on the grounds that most assets are directed into the advantage’s programs. This prompts the part of how family ancestry where individuals can without much of a stretch know whether they are probably going to be diabetic by concentrate their family therapeutic history. Despite the fact that there are different side effects to recognize diabetes like vision haziness and incessant pee, family ancestry remains the most ideal approach to advise whether an individual is probably going to be diabetic. To deal with the circumstance, Sound Individuals 2020 suggests that there be intercessions where the network wellbeing specialists are locked in. This will help the exploited people as in the wellbeing laborers will go about as the crossing over factor between the patients and those districts that are short on restorative administrations. It is additionally suggested that patients start utilizing cell phone applications in checking their circumstances.

HIV

HIV has awfully influenced our overall population just as social requests over the world. The contamination manages the death of a considerable number of people far and wide and to date despite all that it continues annihilating the world when all is said in done. HIV has affected families just as the economy, preparing part, cultivating among various other key fragments. The disable, ailment and downfall brought about by HIV have affected our overall population in a wide scope of levels. Families for example experience the insufficiency and going of their loved ones in view of this disease. The illness accomplishes loss of productive work in schools, associations, mending offices and other basic foundations. In light of the amount of young adults who are failing miserably on account of the disease there has been a decline of the amount of people choosing in school. Moreover, there has been a decline in the settlements for advantages in preparing in light of the high rates of going among the pre-adult as a result of the HIV pandemic. The all around financial cost of watching out for the impact of HIV in our overall population has incited a situation whereby resources are being diverted from essential portions of the economy to address HIV. This has provoked frustrated enhancement in a couple of divisions which along these lines has incited a poor state of economy. As a result of the frailty that is accomplished by the contamination, various nuclear families continue persisting financially on account of how their suppliers are debilitated. This has incited an extension of poverty levels in the overall population as families that are affected consume most of their money hunting down treatment. These families are not prepared to save or partake in endeavors that could help improve their cash related status. Children and more established people are most exceedingly terrible hit by this pandemic due to the manner in which that various nuclear families affected by the infirmity are not prepared to manage the expense of nutritious weight control designs on account of the financial weight that goes with the illness

References

1. Caini, S., El-Guerche Séblain, C., Ciblak, M. A., & Paget, J. (2018). Epidemiology of seasonal influenza in the Middle East and North Africa, 2010-2016: circulating 20 influenza A and B viruses and spatial spread of epidemics.
2. Reproductive and Sexual Health. (n.d.). Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Reproductive-and-Sexual-Health
3. Taylor, B. D., Zheng, X., O’Connell, C. M., Wiesenfeld, H. C., Hillier, S. L., & Darville, T. (2018). Risk factors for Mycoplasma genitalium endometritis and incident infection: a secondary data analysis of the T cell Response Against Chlamydia (TRAC) Study. Sex Transm Infect, sextrans-2017.
4. Salinas JL, Mindra G, Haddad MB, Pratt R, Price SF, Langer AJ. Leveling of Tuberculosis Incidence — United States, 2013–2015. MMWR Morb Mortal Wkly Rep 2016;65:273–278

Abstract

Diabetes Mellitus is a chronic metabolic disorder characterized by hyperglycemia due to absolute (Type 1 Diabetes Mellitus) or relative (Type 2 Diabetes Mellitus) deficiency of insulin hormone. Diabetes Mellitus virtually affects every system of the body as a result of the metabolic disturbances caused by hyperglycemia, and if improperly managed can cause medical complications such as cardiovascular diseases, neuropathy, retinopathy and peripheral vascular diseases which can result in chronic morbidities and premature death. Genetic susceptibility and environmental factors seem to be the most crucial factors responsible for the progression of this condition. Simple changes in your lifestyle can greatly reduce the risk and chances of becoming a diabetic patient. Therefore, to prevent this condition, actions should be taken regarding the modifiable environmental factors that influence its development, lifestyle and dietary habits. This includes maintaining a healthy diet, promoting walking, exercise, and other physical activities which have beneficial effects on human health and prevention or treatment of diabetes.

Introduction

Diabetes Mellitus (DM) is a chronic progressive metabolic disorder manifested by hyperglycemia and resulting from absolute (Type 1 Diabetes Mellitus) or relative (Type 2 Diabetes Mellitus) deficiency of insulin hormone. Diabetes mellitus or type-2 diabetes, is one of the major non-communicable and rapidly growing public health problems in the world, a condition difficult to be treated and expensive to be managed (Asif M. et.,al 2014). It has been founded that the number of diabetic patients will double from the current value of about 190 million to 325 million during the next 25 years (Asif M. et.,al 2014).

Diabetes Mellitus is associated with some medical complications such as cardiovascular diseases, nephropathy, retinopathy (changes to the retina and blindness), and neuropathy that can lead to disability and premature death. Genetic susceptibility and environmental factors seem to be the most important factors which are responsible for the development of this condition (Zucchi P et al., 2005). Lifestyle management is a substantial aspect of diabetes care and includes diabetes self-management education (DSME), diabetes self-management support (DSMS), nutrition therapy, physical activity, smoking stoppage counseling, and psychosocial care (Powers MA et al., 2015).

Patients and care providers should focus together on how to optimize and enhance lifestyle from the time of the initial comprehensive medical evaluation, throughout all following evaluations and check-ups, to promote overall nutritional well-being, glycogenic control, and prevent diabetes-related complications. Fortunately, since environmental factors are modifiable, diet is one of the major factors now linked to a wide range of diseases including diabetes. The amount and type of food consumed is a fundamental aspect of human health and plays a crucial role in diabetes management. Diet is dependent on age, weight, gender, health condition, and occupation (Asif M. et al., 2014).

Carbohydrates

Individuals with diabetes should be encouraged to replace refined carbohydrates and added sugars present in their diet with whole grains, legumes, vegetables, and fruits. The consumption of non-sugar-sweetened beverages and processed “low-fat” or “nonfat” food products with high amounts of refined grains. Most of the carbohydrate consumed should be in the form of starch (polysaccharides) such as maize, rice, beans, bread, potatoes. All refined sugars such as glucose, sucrose, and their products (soft drinks, sweets, toffees) and honey should be avoided, except during extreme illness or episodes of hypoglycemia. These foods contain simple sugar, which is easily absorbed causing rapid rise in blood sugar. Non-nutritive sweeteners, e.g., Canderel, saccharine, and NutraSweet are suitable sugar substitutes for diabetic subjects (Bouchard C et al., 2010).

Fats

Diabetics should be advised and encouraged to follow the guidelines for the general population for the recommended intakes of saturated fat, dietary cholesterol, and trans fat. Generally, trans fats should be avoided. Animal fat such as butter, lard, egg yolk, and other foods high in saturated fatty acids and cholesterol should be reduced to a minimum and be changed with vegetable oils, particularly polyunsaturated fats. Many trials including patients with type 2 diabetes have reported that a Mediterranean-style eating pattern, rich in monounsaturated fats, can improve both glycemic control and blood lipids (Estruch R et al.,2013).

Protein

There is no evidence that regulating the daily level of protein ingestion (typically 1–1.5 g/kg body weight/day or 15–20% total calories) will enhance and improve health in individuals without diabetic kidney disease. Protein intake goals should be individualized based on current eating patterns. Some research has found successful management of type 2 diabetes with meal plans including slightly increased levels of protein (20–30%) (Ley SH et al., 2014). For diabetic kidney disease patients (with albuminuria and/or reduced estimated glomerular filtration rate), dietary protein should be regulated at the recommended daily allowance of 0.8 g/kg body weight/day. Reducing the amount of dietary protein below the recommended daily allowance is discouraged because it does not alter glycemic measures, cardiovascular risk measures, or the rate at which glomerular filtration rate declines (Pan Y et al., 2008). Proteins (fish, meat, beans, soyabean, and chicken) are restricted for those with diabetic nephropathy (Sinitskaya N et al., 2007). In individuals with type 2 diabetes, ingested protein may enhance the insulin response to dietary carbohydrates (Layman DK et al., 2008). Therefore, carbohydrate sources high in protein should be avoided in treatment and prevention of hypoglycemia.

Sodium

Diabetics should limit their sodium intake to 30 min) by briefly standing, walking, or performing any other light physical activities (Katzmarzyk, P. T. et al., 2009). This may help prevent type 2 diabetes for those at risk and may also aid in glycemic control for diabetics.

Physical Activity and Glycemic Control

Regular physical activity helps the body cells absorb glucose and thus lower blood glucose levels and blood pressure. Crucial advantages of a regular aerobic exercise program in diabetes management include decreased need for insulin, decreased risk of obesity, and decreased risk for heart disease. Exercise reduces total cholesterol, improves the ratio of low-density lipoprotein (LDL) to high-density lipoprotein cholesterol (HDL), decreases blood triglycerides and reduces stress levels. Walking, easiest and fastest exercise, is one activity that can be done for a lifetime without special equipment and with no or little risk of injury. Supervised activity is recommended due to the risk of an insulin imbalance, for any fluctuations to be under control (Qi L et al., 2008).

Smoking, Alcohol, and Caffeine

Smoking: may have a role in the arise of type 2 diabetes (Jankowich M et al., 2011). One study in smokers with newly diagnosed type 2 diabetes showed that smoking cut off was associated with improvement of metabolic parameters and decreased blood pressure and albuminuria at 1 year (Voulgari C et al., 2011). Nonsmokers should be recommended not to use e-cigarettes as there are no studies that showed that e-cigarettes are a healthier alternative to smoking or that e-cigarettes can facilitate smoking cessation. (Schraufnagel DE et al., 2014).

Alcohol: limit to less than 2 drinks per day (1 drink = 12 oz beer = 1.5 oz liquor = 4 oz wine). Alcohol intake is not advised if you have high triglycerides (blood fats), increased blood pressure, liver problems, are pregnant or breastfeeding. If you decide to drink alcohol, drink with your meal or snack (not on an empty stomach), to drink slowly or dilute with water or diet soda.

Caffeine: drink no more than four (4) cups of coffee or caffeine containing beverages per day.

Conclusion

In conclusion, effective lifestyle modifications including weight loss, maintenance of a healthy dietary pattern like the Mediterranean diet, together with physical activity are the cornerstone in the prevention and control of type-2 diabetes. Emphasis must be given to promoting a healthier lifestyle and finding solutions in order to increase adherence and compliance to the lifestyle modifications, especially for high-risk individuals. Your diabetic meal plan, physical activity, and medication are all balanced to help regulate your blood glucose levels and prevent the risk of getting diabetes. Over the short run, people with uncontrolled diabetes may experience fatigue, thirst, frequent urination, and blurred vision. In the long run, they are at risk for heart diseases, kidney problems, disorders of vision, nerve damage, and plenty of other difficulties which in severe cases may lead to premature death. There is no cure for diabetes. However, you can manage or delay diabetes through diet, exercise, weight control and, if necessary, medication.Figure 4. (Melanie J. Davies et al., 2018)

References

1. Asif, M. (2014). The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. Journal of education and health promotion, 3.
2. Bray, G. A., Vollmer, W. M., Sacks, F. M., Obarzanek, E., Svetkey, L. P., Appel, L. J., & DASH Collaborative Research Group. (2004). A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. The American journal of cardiology, 94(2), 222-227.‏
3. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F., … & Lamuela-Raventos, R. M. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 368(14), 1279-1290.‏
4. Jankowich, M., Choudhary, G., Taveira, T. H., & Wu, W. C. (2011). Age-, race-, and gender-specific prevalence of diabetes among smokers. Diabetes research and clinical practice, 93(3), e101–e105.
5. Janssen, I., & LeBlanc, A. G. (2010). Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International journal of behavioral nutrition and physical activity, 7(1), 40.‏
6. Katzmarzyk, P. T., Church, T. S., Craig, C. L., & Bouchard, C. (2009). Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998-1005.‏
7. Layman, D. K., Clifton, P., Gannon, M. C., Krauss, R. M., & Nuttall, F. Q. (2008). Protein in optimal health: heart disease and type 2 diabetes. The American journal of clinical nutrition, 87(5), 1571S-1575S.‏
8. Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007.‏
9. Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.‏
10. Sinitskaya, N., Gourmelen, S., Schuster-Klein, C., Guardiola-Lemaitre, B., Pévet, P., & Challet, E. (2007). Increasing the fat-to-carbohydrate ratio in a high-fat diet prevents the development of obesity but not a prediabetic state in rats. Clinical science (London, England: 1979), 113(10), 417–425.

A genetic disease is typically an illness that rises due to the deformity of the genetic makeup of a person. Genetic disorders may occur in a single-gene, chromosomal or complex disorders. Obesity is one of these diseases that is caused by genetic disorders. According to the World Health Organization (WHO), 8.5 percent of individuals who were above 18 years had diabetes in 2014. Additionally, in 2016, diabetes caused more than 1.6 million deaths and further triggered other diseases such as high blood pressure that consequently claimed more than 2.2 million lives. The United States of America has the highest obesity infection at around eight percent. However, some other countries such as India and China have only one percent of the population suffering from diabetes. Therefore, the paper will focus on the genetic basis, physiological effects of the mutation and the influence of the environment regarding diabetes.

Genetic Basis

According to several scientific research papers, genetics play a critical part in obesity. Thus, genes can cause diabetes through disorders such as Bardet-Biedl syndrome and Prader-Willi (Swerdlow et al., 2015). Both syndromes may directly cause diabetes. Most importantly, the HLA genes are the cornerstone for the cause of severe obesity among individuals. Science claims that proteins are the primary materials for the immune system, but the interference of the process of making proteins due to HLA genes may alter the operation of the immune system (Fall et al., 2015). Take, for instance, Type 1 diabetes that is an autoimmune disease, that causes the body to terminate important cells that create insulin. Thus, there is positive correlation between genes specifically the HLA genes and diabetes.

DNA variation may increase the susceptibility of diabetes infections among the toddlers. Single gene disorder such as melanocortin four receptor (MC4R) seldom causes diabetes. However, in most cases, a polygenic model postulates that diabetes arises due to complex gene disorders. Thus, scientific research hypothesizes that there is a link between genetic alteration and BMI in many people across the globe.

Comprehending the genetic connection with diabetes may help individuals to know more about their health and what they have to do so that they can prevent diabetes. Genetics assist individuals in understanding how they are unique and why families have some things in common. Thus, knowledge that genes increase the risks in the family to have particular health complications, it will help in early diagnosis and the offers chance to change some environmental aspects such as habits and diet (Wheeler et al., 2017). In essence, if an individual learns that specific disease is genetic then the individual can change behavior since genes cannot be changed once someone has been borne. Generally, learning genetics helps an individual to make healthy choices that may reduce the susceptibility of heritable diseases such as diabetes.

Physiological Effects of the Mutation

The genetic basis of inheritable diseases can either be complex or single gene. Single-cell disorders occur due to monogenic disorganization. On the other hand, complex genetic disorder occurs due to the multiple causes of diseases such as environmental aspects and mutations (Fall et al., 2015). Thus, understanding the type of genetics that occur in diabetes depends on the risk factors that may cause the disease. Since the disease’s risk factors are genes and other environmental factors, then the condition is complex gene disorder. Therefore, for diabetes, genetic disorder is not enough to cause the diseases hence the environment triggers the disease. Some scientific researches claim that Type 2 diabetes has more gene connection than the other type of diabetes.

Role of Environment in the Expression of Diabetes

Although diabetes is a genetic disorder disease, it can also retreat from the environmental aspects. Therefore, ecological situations of an individual may cause diabetes. Prenatal and postnatal is a common factor that affects pregnant women. The environmental element may cause diabetes (Swerdlow et al., 2015). Some behaviors such as smoking may create a harsh environment for the development of an infant hence becoming vulnerable to diabetes. Some mothers may choose to smoke thus affecting the unborn baby to have high risk of contracting diabetes. Besides, some pregnant mothers may be overweight; hence it can affect the baby when it grows up since it can develop weight complications just like the mother. Finally, if a baby is overweight, it adversely affects health conditions in the future; for instance, it increases chances of an excessive weight hence developing adult obesity. The environmental factor may have some solutions and preventions. Pregnant mothers should avoid smoking, maintain their weight and breastfeed their babies.

Diabetes is a very complex and serious condition that can have an immense affect on the whole human body. If an individual is diagnosed with Diabetes, daily medication and daily care. However, if complications further arise, the disease can have a further impact on their quality of life and life expectancy. Quality of life is health, comfort and happiness which is experienced by an individual, whereas life expectancy is a calculation which is based on different aspects of someone which is put together to determine how long an individual is expected to live. Currently, there is no cure to diabetes, however it is believed that a cure will arrive in the future.

Diabetes comes in various forms. The three main forms of diabetes are type 1, type 2 and gestational diabetes.

Type-1 diabetes is an auto-immune condition and in type-1 diabetes, the immune system is then activated to act upon destroying the cells in the pancreas which produces insulin. However, it is still unknown what causes the immune system to react this way, which is why it is dangerous, as without insulin, the human body can exceed regular sugar levels which eventually develops into diabetes. Also, there is no cure for this disease, and it cannot be prevented.

Type-2 diabetes is a more progressive form of diabetes where the body becomes more resistant to insulin which then leads to the body losing the capacity to create the adequate amount of insulin needed. Like type-1 diabetes, there is no cure and stuns professionals as it is still unknown why this happens. Also, type 2 diabetes has strong genetic factors and can travel in the family.

Gestational diabetes is a form of diabetes which is formed during a woman’s pregnancy stage. It is likely that when the baby is born, the woman will then lose the diabetes, however, in some cases, the diabetes affect sticks around and some women will maintain the high blood glucose levels after the baby has been delivered. This form of diabetes is the fastest-growing form of diabetes which affects thousands of pregnant women. Cases are continually being reported and it is estimated that 12 to 14 percent of pregnant woman will develop the disease. It usually occurs in between the 24th and 28th week of pregnancy, and pregnant women around this time period are advised to be tested.

Outline c.

Diabetes has had a huge impact on the Australian population, and it is estimated that people experiencing diabetes has well exceeded the one million mark. The form of diabetes known as type-2 diabetes becomes more common with an increase in age and is more common in men than women. Type-1 diabetes is more common with younger people, in particular, those aged between 0 and 14. Australia is also ranked 7th in the world for prevalence of type-1 diabetes of those aged between 0 and 14. There is also a growing trend of individuals aged between 0 and 14 who are starting to develop type-2 diabetes.

Diabetes has a large and broad effect on the human body. It is reported that 13 per cent of Australians suffering from diabetes also suffer from nerve damage within their lower limbs, 15 per cent of sufferers also contract diabetic retinopathy. Also, diabetes has developed to be the leading cause of end-stage kidney stage. Cardiovascular disease also impacts on how severe diabetes can be and believed that around 65 per cent of all Cardiovascular diseases occur to people who have had a past or present experience with diabetes. Furthermore, around 41 per cent of sufferers experienced a form of anxiety, stress and depression.

Indigenous Australians are estimated to have a 4 times more likely chance to develop type-2 diabetes when compared to a non-indigenous Australian. This number is only higher when the Aboriginal lives in a rural or remote area. Also, 1 in 8 adult aboriginals have had diabetes at some point in their life and that it was more common in females.

Due to cases of diabetes being exponentially common, it is believed that by the year 2025, that around 3 million Australians over the age of 25 will have developed a form of the disease. Type-2 will be affected immensely due to the rising rates in obesity, ageing, dietary changes and finally sedentary lifestyles. Obesity is perhaps the biggest factor influencing type-2 diabetes, that if obesity was to be eliminated, it has the ability to reduce type-2 diabetes by over 40 per cent.

Diabetes is also a very expensive disease as people need to buy health care and medication to minimize the effect of diabetes. It is estimated that in 2010 around $6 billion had been spent on type-2 diabetes related expenses. Also, it was recorded that the average amount of money spent per-person annually was $4025. Type-1 diabetes also had an extreme amount of money spent on it. As of 2010, around $570 million had been spent by sufferers, and the average amount spent annually by each person was $4669.

Describe how each of the following may contribute to the prevalence of the condition

Individual Factors

There is a wide range of individual factors that could contribute to the prevalence of diabetes. Individual factors simply mean the factors of an individual which may increase the risk of diabetes towards the individual, factors like these include genetics and personal characteristics, however, this is a much larger spectrum of factors when talking about individual factors. An individual factor that may contribute to the prevalence of the condition may be genetics.

Genetics is where the health issue can be transferred through the family through genes, and also increases the chance of inheriting diabetes. Due to this, and diabetes being a transferable condition, it is safe to say that genetics can be a huge individual factor.

Another factor which can impact diabetes are skills. Skills are a major necessity in life, and without skills, people would constantly fail. A skill like decision-making is crucial when controlling diabetes. It allows you to decide on the right choice, which may be to take certain tablets at certain times or to do certain activities.

Attitude also plays an important role in preventing diabetes. If someone’s attitude is really low, they may avoid the doctor for check-ups and assistance. A low attitude is where someone can’t be bothered to go see their doctor or a professional about their health, and in particular to ask about diabetes. Diabetes is more common than most people think, and a lot of people who don’t think they have the disease actually have it without knowing. So, this is why having a positive attitude is important as it may help prevent the disease or minimise the effect.

Another factor which may contribute to diabetes is knowledge. If an individual does have little to no knowledge on diabetes, this will only raise the risk of developing diabetes. They may do things which will only cause diabetes such as eat foods that contain unhealthy ingredients which is prone to developing it.

Socio-Cultural Factors

Family could also link with genetics. It is due to genetics and diabetes running through the family that someone can develop diabetes. Also, family does have the biggest influence on health within the socio-economic section.

Peers also can influence the effect of diabetes on an individual. A huge part of peers is per pressure. This is where friends convince you to do something you are not sure if it is safe or not. You might already be on the verge of developing diabetes and might be at a friend’s place. They ask you to have a few drinks such as soft drinks which contain a large sugar amount, even if you done want to, you are peer pressured to have rink which is very bad for your health.

The media also has the potential to contribute to the prevalence to diabetes. If there is a new popular form of food or drink out, it will be shown to millions of Australians through the media and advertisement. If this food contains a high amount of sugar or other unhealthy ingredients, it will be very unhealthy and especially for diabetes, it will only increase the risk of it. Also, the item may be highly addictive, which only means that if people discover a highly addictive item that contains a lot of sugar, it will also be prone to developing diabetes.

Religion could have a huge effect on someone’s effect on diabetes. Some religions have special specifications on what one eats, and due to this, it can cause one to develop a form of diabetes.

Socio-Economic Factors

Income also, is a huge factor on diabetes. Most, healthy meal plans like ‘lite n easy’ charge large amounts of money for healthy eating, and the pricing is as high as $150 a week for a full meal plan, whereas the cheaper alternative is junk food as well as fast food. These alternatives are much cheaper and like healthy foods, they are pre-packed and easy to eat. There is a way around expensive healthy food, and that is to make the food yourself. Not only do you save money, but the food is healthier and can reduce your risk of developing diabetes. Also, people may not be able to afford health care as well as check ups from a private doctor or professional. If they can not be checked for potential signs of diabetes, they will not know if they should change their lifestyle so that they can work around the diabetes, therefore, the diabetes will only get worse which can cause heavy medication, or potentially death.

Education also can contribute to a form of diabetes. If one is very low educated on health, such as what foods are unhealthy or healthy, they will most likely consume more foods that appeal and taste better to them, which is most likely to be unhealth foods. Mostly, this applies to people who have little access to education such as those living in rural and remote areas, as well as the disadvantaged.

Environmental Factors

Geographical location has a huge impact on diabetes. If one lives in a rural or remote area, they may have little access to healthier food options, which means they could become reliant on unhealthy, junk food. If they continue this trend and continually eat unhealthy food and drink such as chocolate and soft drink it will eventually lead to diabetes and obesity.

Access to health care also can contribute to the prevalence of diabetes. If one has very little access to health services such as someone living in a rural or remote area has a much higher chance of developing diabetes compared to someone who has a many health services near their area. The individual will not know whether they’re consuming too much unhealthy foods and can prove to be terrible as they will eventually develop diabetes. Not only will this result in diabetes, it will also result in obesity.

Access to technology provides anyone with health tips at any time. There are various sites on the internet which can help you work on your health which are free. However, if someone does not have access to technology,

Part B

Explain how each action area of the Ottawa Charter has contributed to positive health outcomes for your selected priority area.

What is the Ottawa Charter?

The Ottawa charter was first developed in 1986 and was designed to recognise the determinants of health, as well as developing 5 action areas which are used in health promotion to explain the determinants. The 5 action areas of the Ottawa charter are to build a healthy public policy, as well as creating a supportive environment, strengthen community actions, develop personal skills and finally to reorient health services.

Developing Personal Skills

The area known as developing personal skills has positively contributed to positive health outcomes for diabetes in numerous ways. This area was aimed at the individual to realise any changes that they can adapt to their life which could help reduce the risk of developing diseases. It is designed to help people discover skills that are crucial when attempting to make improvements in their life. Skills like these include decision making, problem solving, time management and numerous others. All these skills are crucial when dealing with diabetes, and if dealt with well, will ensure that you are doing the best possible things to help with your diabetes. Also, it is compulsory that students attend PDHPE lessons which helps educate them to broaden their knowledge which then results in them applying this knowledge to the real world. This promotes and social and personal development through providing information to the public, as well as health education such as PDHPE and life skills like decision-making. The ‘National Diabetes action Program’ is Australia’s type-2 diabetes prevention and awareness area. The main objective for this program is to spread the importance of how bad type-2 diabetes actually is, however they aim at explaining that it is preventable and also provides information that proves to help, as well as providing support services to anyone.

Creating a supportive environment

The second action of the Ottawa a charter is creating supportive environments. This area is focusing on how a positive environment can affect someone’s health. It allows friends, family and neighbours to work together to build a healthy environment which leads to them supporting, encouraging as well as supplying resources to those who chase room for improvement in their health. This action is displayed by those organisations who provide a positive environment from those who suffer from diseases such as diabetes, groups like this include Diabetes Australia and the National Diabetes Service Scheme. These organisations help by providing the community with diabetes related products as well as financially supporting those and providing sufferers with information and support. This proves how this area of the Ottawa charter has influenced others to create a supportive environment for sufferers.

Reorienting Health Services

The second action area of the Ottawa charter is directed at reorientating health services. This basically means to ensure that health services are accessible, as well as being available to everyone within the community, also, it assesses if the services are effective in different aspects such as how effective they are at prevention, cure and promotion. Promotion of the health services is responsible for everyone within the community including community groups, organisations and the government. If these groups work together to achieve the best outcome possible, it will benefit the wellbeing of the community immensely. Services within the health sector such as free clinic check ups for diabetes are very important as it encourages people to get them self checked, which will increase prevention rate. Also, sufferers can feel assured as the government is dedicated to supporting them by financially supporting them by helping with medical costs which only benefits patients

Building healthy public policies

The fourth action area of the Ottawa charter is aimed at Building healthy public policies. The focus point of this area is to give assistance to those on making healthier choices by creating and implementing public policies focusing on health barriers that prevent one being healthy in a way, and then work on eliminating them. These policies provide individuals with an alternative which is aimed at choosing healthier options, doing this gives the individual with a sense of choice as well reducing the risk of them developing conditions such as Diabetes. Similar actions to these are seen in schools which are enforced. This also provides students with several alternative options and informing them through education and physical activity such as PE lessons. This will reduce their risk of diabetes even as they get older due to the physical activity and the healthier options they had previously taken. Also, physical activity and a healthy diet two main protectors against diabetes.

Strengthening Community Action

The fifth and final action area of the Ottawa Charter is based around ‘Strengthening Community Action’. This allows those to work together to ensure that strategies are being implemented which will then lead to better health. It is also prone to improving the support and enthusiasm, as well as encouragement throughout the community, also that individuals within the community are participating in ensuring that services all accessible to everyone and are unrestricted, this then makes all information available as well as educating them. Also, this is demonstrated in the schools P&C, (parent and citizens) where the parents get a say in what rules should be abolished or made as well as providing decisions. Topics such as improving health within schools are talked about, this then branches off to healthier canteens and physical PE lessons which are aimed at reducing the student’s chances at developing conditions such as diabetes.

Evaluate the effectiveness of each action area of the Ottawa Charter in relation to your selected priority area.

The effectiveness of the Ottawa charter on diabetes is immense. It has encouraged governments and health organisations and take a stand against difficult conditions and to put forward campaigns to help the wider communities health status. Each action area has positively effected diabetes immensely and reduced the prevalence of the disease as well as reducing the diseases effectiveness and ultimately reducing fatality rate. Due to governments, organisations and health related businesses taking on the Ottawa Charter, it outlines how much the Ottawa Charter has had an impact on reducing the effect of diabetes on the Australian population.

Propose alternative evidence-based strategies that may reduce the prevalence of the condition.

The Ottawa charter provides many different strategies which are aimed at reducing or ultimately elimination certain effects of diabetes. However, there are several other strategies aimed at preventing or reducing the effect of diabetes. A strategy used to help with your form of diabetes is to know facts on the form that you have. Knowing information on your form of diabetes allows you to discover alternatives to bad habits for it such as healthy eating, however, you may need to stop eating more of a particular food or eat more of it. At the moment, there is no prevention for type-1 diabetes, however type 2 diabetes has many strategies which can help reduce the prevalence and effect of the condition. These strategies include ensuring that you maintain a healthy weight, exercise regularly, consume healthier foods more often, managing blood pressure, maintaining a healthy cholesterol level and to avoid smoking. Also, there are state programs aimed at helping prevent and reduce the prevalence of the condition.

Introduction

Diabetes Mellitus type 1 (DM1) is one of the most common chronic health conditions in youth, with over 18,000 new cases diagnosed each year, and the prevalence is increasing. (Hamman et al, 2014) The recommended treatment regimen is complex and demanding, including frequent blood glucose monitoring, insulin administration (via injections or pump), careful tracking of diet and activity levels, and frequent insulin adjustments. (American Diabetes Association, 2015)

Adherence to this regimen is linked with better glycemic control and reduces the risk for acute and long-term medical complications. (Hood et al, 2010) However, adolescents and young adults with DM1 are at increased risk for deteriorating glycemic control, with only 16% of adolescents (age 13–17) and 25% of young adults (age 18–25) meeting targets for glycemic control. (Miller et al, 2015)

Sleep is a crucial determinant of psychological, emotional, and physical health, and evidence suggests that reduced sleep efficiency may be associated with poorer diet quality, obesity, hypertension, diabetes and cardiovascular disease (Grander et al, 2014).

Sleep has also been associated with non-medical outcomes such as poor judgment, lack of motivation, inattention (Harrison et al, 2000), motor vehicle crashes (Pizza et al, 2010), and lower academic achievement (Curcio et al, 2006).

Inadequate sleep in adolescence is due to a combination of biological processes, modern lifestyles, and obligations (Owens et al, 2014). Some studies have found that socioeconomic status and schooling positively affect with sleep efficiency (Marco et al, 2011). Furthermore, social pressures and poor environmental conditions may negatively affect sleep efficiency in lower socioeconomic groups (Knutson et al, 2013).

Body mass index (BMI) has also been associated with sleep problems, with over weight and obese individuals sleeping less than their counter parts (Al Hazzaa et al, 2014). Obesity leads to increased intra-abdominal pressure, and this mechanism has been implicated in sleep disorders (Rodrigues et al, 2014).

Sleep Disordered Breathing (SDB) has primarily been examined in adults with DM2. (Aronsohn et al, 2010) As the severity of SDB increases, there is an association with poor glucose control (Punjabi et al, 2004) and complications of diabetes, such as neuropathy. (Bottini et al, 2003).increased frequency and longer apneas, in particular central apneas, in young children (ages 5 to 11 years) with DM1 compared to healthy children, also, participants with poorly controlled diabetes (hemoglobin A1c ≥ 8.0%) had more frequent and longer apneas compared with patients with better controlled diabetes and controls.(Villa et al, 2000)

Inadequate amounts of sleep and SDB may be particularly problematic for individuals with DM1 (Perfect et al, 2010). However, the relationship between sleep quantity and quality with children with DM1 is largely unstudied.

Sleep architecture may be altered in adults with DM1. In some studies, diabetic patients spent more time in lighter stages of sleep (N1 and N2) (Jauch-Chara et al, 2008), Rapid Eye Movement (REM) and less time in Slow Wave Sleep (SWS). (Pallayova et al, 2010), in contrast, other studies with children with DM1 did not show a difference in sleep architecture compared to healthy participants. However, these studies demonstrated that patients with DM1 had more frequent and longer awakenings. (Matyka et al, 2000)

In this study, we hypothesize that DM1 can affect sleep architecture in the children.

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14. Miller K M, Foster N C, Beck R W, Bergenstal R M, DuBose S N, DiMeglio L A, Maahs D M & Tamborlane W V (2015). Current state of type 1 diabetes treatment in the U.S.: Updated data from the T1D Exchange clinic registry. Diabetes care, 38 (6): 971–978.
15. Owens J, Adolescent Sleep Working Group, Committee on Adolescence (2014). Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics, 134: e921–e932.
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1. Dataset Description

UCI Machine Learning repository – Diabetes 130-US hospitals for years 1999-2008 Data Set

This research includes a publicly available dataset taken from the Center for Clinical and Translational Research, Virginia Commonwealth University. It consists of over a million records collected across 130 US hospitals and from various healthcare providers over 10 years (1999 – 2008) [1]. It consists of fifty features representing diabetic patients’ information, mainly regarding readmission. As per our research in the dataset, the essential features that can affect our model are:

• Admission source – It consists of 21 unique parameters of patients’ admission
• Discharge disposition information – Includes 29 values indicating patient discharge location
• Medication changes – Includes information about patients’ medication changes
• Diagnosis information – Consists of ICD-9 (International Statistical Classification of Diseases and Related Health Problems) code [2]
• Drug usage – Lists drug dosage information among 23 different types of drugs.
• Readmission time – Shows if patient readmission was within or after 30 days or no readmission at all.

The train-test split initially includes 80% training and 20% test set data. Also, 5 folds cross-validation is to be applied to get the best evaluation parameters for the given model.

2. Introduction

Background: A considerable number of problems have been solved in the healthcare sector using machine learning techniques. We plan on researching one such domain. Hospital readmissions not only prove costly but also risks the patients’ medical condition. Moreover, hospital readmission has been a decisive factor in ranking health center credibility. An increase in hospital visits after discharge is costly and time-consuming for both hospitals and patients [3].

Major studies [4] propose that if there is unplanned readmission within 30 days, it indicates treatment or diagnosis error, which could be avoided. However, if readmission is after 30 days, it depends on the patients’ lifestyle or several other factors [5]. So, an early prediction of readmitting the patients becomes an important task.

Current research and existing models on similar research predict readmission in less than 30 days after discharge [6]. Our research includes predicting unplanned readmission in diabetic patients using multiclass classification. It includes testing whether patients are readmitted within or after 30 days or not readmitted at all. The primary tasks to perform include data preprocessing steps such as data reduction, data cleaning, and data transformation. Furthermore, a good model requires extracting essential features. So, we plan on using various feature selection algorithms to obtain the best features. Using such features, different models such as Random Forest, Support vector machine, Logistic regression, Multilayer perceptron, Naïve Bayes, and Ensemble model is to be tested and compared to obtain the best evaluation parameters (accuracy, precision, recall, F1-score, AUC curve).

3. Methodology/Approaches

Following are the goals of our research:

Predict if the patient will be:

• Readmitted within 30 days (• Readmitted after 30 days (>30)
• Not be readmitted (No)

To achieve the goal, we will perform the following tasks:

1. Task 1: Data Analysis for Decision Making

The first step includes collecting data, analyzing the data by projecting graphs among various features, check correlation among the features, and interpret results. Based on the results, an idea about essential features and outliers is obtained.

1. Task 2: Data Cleaning

The data contains ‘?’ instead of standard missing values such as ‘NaN’ or ‘NULL’. So, encoding such data and removing redundant features becomes an important task. This step also includes replacing or modifying the dirty data.

1. Task 3: Data Preprocessing

Process missing data: The features with more than 50% missing data and irrelevant to predicting the target variable are removed.

Encode categorical data: Imputation of categorical data such as gender, race to be done using oneHotEncoder and Label Encoding.

Scale features and apply transformation: In the dataset, some of the features are highly skewed. So, to balance the data, we plan to use various transformation functions such as normalization function, sigmoid function, log function, and cube root function.

1. Task 4: Feature Selection and Addition

Selecting essential features for the model: In Machine Learning, when there are too many features, it is better to select only the relevant features. We plan to use various algorithms such as SelectKbest, SelectPercentile, and Boruta algorithm for feature selection.

Feature addition: By combining some of the features in the dataset, we can create additional features. It helps to predict the target variable better.

1. Task 5: Model Building

After splitting the data into train and test, algorithms to select the best model are applied based on accuracy, and test data is fit on it.

We plan to use the following multiclass classification algorithms:

• Logistic Regression
• Random Forest
• Decision trees
• ExtraTreeclassifier
• LDA
• LogisticRgressionCV
• LinearSVC
• Gaussian Naïve Bayes
• XGboost
• Support vector machine
• Neural networks (MLPClassifier, feed-forward backpropagation network)
• GradientBoosting

1. Task 6: Evaluation and Prediction

Evaluation parameters are essential to satisfy the goal of the research. We plan to evaluate the models using various matrices such as confusion matrix, F1 score, precision, and recall.

4. Potential Tools

• Python
• Jupyter Notebook
• Kaggle Notebook
• Google Colab

5. Potential Timeline

Date

Objective

15th March-30th March

Data analysis for decision making

Data cleaning

Data preprocessing

31st March-5th April

Feature selection and Addition

Progress report

6th April-25th April

Model building

Evaluation and Prediction

26th April-1st May

Project Report

Project Presentation

6. References

1. Beata Strack, ‘Impact of HbA1c Measurement on Hospital Readmission Rates: Analysis of 70,000 Clinical Database Patient Records,’ BioMed Research International, 2014. [Online]. Available: https://www.hindawi.com/journals/bmri/2014/781670/.
2. ‘Wikipedia,’ 30 December 2019. [Online]. Available: https://en.wikipedia.org/wiki/List_of_ICD-9_codes.
3. N. Hammoudeh, ‘Predicting Hospital Readmission among Diabetics using Deep Learning,’ November 2018. [Online]. Available: https://www.researchgate.net/publication/328887677_Predicting_Hospital_Readmission_among_Diabetics_using_Deep_Learning.
4. D. Mordaunt, ‘Improving 30-day readmission risk predictions using machine learning,’ in Health Informatics New Zealand (HiNZ) Conference, 2016.
5. Medicare.gov, ’30-day unplanned readmission and death measures,’ 2017. [Online]. Available: Medicare.gov.
6. Ti’jay Goudjerkan, ‘Predicting 30-Day Hospital Readmission for Diabetes Patients using Multilayer Perceptron,’ Patients using Multilayer Perceptron, vol. 10, no. 2, pp. 268-275, 2019.

Abstract

Beneficial effect of plants in treatment of diabetes is well-known in traditional medicine and confirmed in numerous scientific studies. The basic platform for testing potential antidiabetic activity of traditionally known plants and their bioactive compounds are experiments in vitro. These assays usually measured enzyme inhibitory activity such as α-amylase and α-glucosidase controlling starch breakdown and other aspects connected with diabetes mellitus disease. In recent years the interest in plant-derived compounds useful in diabetes treatment or complication reduction is in great expansion. The main goal leads to establish a mechanism of action of plant extracts or active compounds for finding novel antidiabetic drug with as less toxicological properties. The aim of this work is data collection and discussing the newest result in area of plant extracts, compounds and their antidiabetec effects using in vitro models. The data covered in this review are include plant extract, compounds polyphenols, terpenoids, indicating that some of less known plants and isolated new compounds might be a promising source for treatment and prevention of diabetes mellitus.

INTRODUCTION

Diabetes mellitus (DM), known as diabetes, is serious metabolic disease that occurs due to insulin secretion disorders, its inefficiency or both. Uncontrolled hyperglycemia, in time, caused serious health complications to the heart, blood vessels, eyes, kidneys and nerves. The most common type of diabetes in world is type 2, which is characterized by insulin resistance or insulin relatively deficiency (WHO, 2016). The fact that this disease became more ubiquitous in developing countries with estimation that the number of patients with diabetes it is hard to count, because it takes a years before complete diagnosis. Different data occurs, and the estimation is that in 2030. number of patients with DM disease will be over 366 or even 592 million, which is for serious concern (Malviya et al., 2010., Wang et al, 2017). In focus of many researchers groups is the idea to testing plants which are recognized in treatment of diabetes in traditional medicine of different countries. Some sources recognized even 800 plant species to have importance in treatment of DM, while for 108 plants was found that could delay disease occurrence or correct the disturbed metabolism (Mamun-or-Rashid et al, 2014). Plant organs contain different bioactive compounds which could be extracted by various solvents and types of extractions from row or dry material and tested. Plant extracts or isolated plant compounds are of great importance regardless which they active against symptoms or could be efficient in diabetes prevention or complication caused by DM reduction. Intensively searching for finding new more effecting drugs are based on experience of traditional medicine knowledge. Importance of traditional medicine in antidiabetic purpose is connected with reparation effect to pancreas tissue to produce enough insulin or inhibit intestinal absorption of glucose (Malviya et al., 2010). Besides extracts efficiency and mechanism of action its safety is required.

The first step of testing potential antidiabetics from plants includes in vitro tests. Methods which are used in vitro are mostly based on potential inhibition activity of enzymes caused by compounds present in plant extracts. Intestinal enzymes, α-amylase and α-glucosidase are involved in carbohydrate metabolism. α–amylase (α-1,4-glucan-4-glucanohydrolase), is an enzyme produced in saliva and by pancreas catalyzes the hydrolysis of starch. Enzyme α-glucosidase, regulate digestion of oligosaccharides to glucose (Lin et al., 2016). Spectrophotometric methods are useful tool used for measuring the inhibition of carbohydrate digesting enzyme (α-amylase, α-glucosidase, sucrase), dipeptidyl peptidase IV (DPP IV), protein tyrosine phosphatase 1B (PTP 1B), as well as to measure glucose uptake assays using dialysis bag. The yeast cells are convenient for measuring the hemoglobin glycosylation and glucose transport thro yeast cell membrane as well as cell lines such as pancreatic Rat insulinoma cells (RIN m5F cells), β cell line, 3T3 L1 cells, etc.) (Dsouza and Lakshmidevi, 2015). α-amylase inhibition performed using different assays such as starch iodine method, 3, 5-Dinitrosalicylic acid method (DNSA) or glucose-stimulated insulin secretion (GSIS assay), as well as glucose transport inhibition assay were used for validation of plant extracts activity (Kumar et al., 2013; Wang et al, 2018). The synthetic hypoglycemic agents which act as the enzymes inhibitors which are in clinical use are acarbose, miglitol and voglibose. These drugs are with limited effects and produce serious side effects (Kumar et al., 2018).

Secondary metabolites isolated from plants such as alkaloids, terpenoids, cartenoids, glycosides, phenols, etc. (Malviya et al., 2010)., tannins, flavonoids, C and E vitamins are were found to possess antidiabetec effects and ability to maintain β-cells performance and decrease glucose levels in the blood (Kooti et al, 2016).

LITERATURE SEARCH AND SELECTION CRITERIA

All necessary information for this review are collected in the period of the January 1st 2014 and December 31st 2018. The keywords: plant, extract, antidiabetic and in vitro are used for that. The main criteria for articles selection was plants and their isolated compounds which have antidiabetic activity using in vitro models. Review also includes studies with pure compounds, as well as extracts, fractions or mixture of compounds without testing isolated compounds. The table were used for analyzing collected data from relevant articles (Table 1). The information were statistically processed and explained.

RESULTS

Geographical origin of plants

The base of Indian and Chinese traditional medicine is usage a lot of plants in treatments for many disease [2]. This usage dated over 1000 years ago and represent important sources for the development of antidiabetic drugs [5–10]. Accordingly, most of the tested plants in our research were from India (24.2%) and China (22.6%), followed by Nigeria (6.5%), Mexico (4.8%), Korea, Malaysia, South Africa, Turkey, United States and Vietnam (3.2%), South Africa, Algeria, Bosnia and Herzegovina, Brazil, Cuba, Ecuador, Eritrea, France, Indonesia, Italy, Ivory Coast, Peru, Sri Lanka and Tunisia (1.6%).

Plants families and genera

In this manuscript, we analyzed 41 families and 68 species with antidiabetic activity. The most frequently was Fabaceae family with 12.1%, followed by Asteraceae (10.6%), Arecaceae, Meliaceae and Moraceae (4.5%), Apiaceae, Apocynaceae, Lamiaceae, Mimosaceae, Myrtaceae and Solanaceae (3.0%), Acanthaceae, Adoxaceae, Anacardiaceae, Ascelpediaceae, Betulaceae, Burseraceae, Caprifoliaceae, Cucurbitaceae, Euphorbiaceae, Fagaceae, Hypericaceae, Malvaceae, Melastomataceae, Musaceae, Phyllanthaceae, Platanaceae, Poaceae, Polygalaceae, Polygonaceae, Punicaceae, Rosaceae, Rubiaceae, Rutaceae, Sapindaceae, Sapotaceae, Sterculiaceae, Symplocaceae, Theaceae, Zingiberaceae and Zygophyllaceae (1.5%).

The genera most studied in the selected articles were Achillea, Ficus and Momordica with 2.9%. All other analyzed genera were present with 1.5% (Acacia, Albizzia, Allophyllus, Arctium, Artemisia, Astragalus, Azadirachta, Betula, Brachylaena, Calotropis, Camellia, Capsicum, Caralluma, Chrysophyllum, Chukrasia, Cicer, Cocos, Coriandrum, Crotalaria, Cyclopia, Dacryodes, Dalbergia, Derris, Eugeissona, Euphorbia, Grewia, Hamelia, Hedychium, Hypericum, Khaya, Lonicera, Meriandra, Miconia, Morus, Muehlenbeckia, Musa, Parkia, Phoenix, Phyllanthus, Physalis, Pistacia, Pithecellobium, Platanus, Plectocomiopsis, Psiadia, Psidium, Pterospermum, Punica, Quercus, Rosa, Ruellia, Sarcostemma, Scutellaria, Securidaca, Sphallerocarpus, Symplocos, Syzygium, Taraxacum, Tribulus, Viburnum, Zanthoxylum and Zea.

Plant parts

Ethnopharmacological knowledge about using different parts of plants represent base for choosing plant material for extraction and isolation of chemical compounds with antidiabetic activity (Munhoz and Frode, 2018). In the present study, 32.4% used leaves for the isolation of active compounds, followed by aerial parts (16.2%), fruits (9.5%), roots and stems (6.8%), seeds and stem bark (5.4%), flower buds, flowers, fruit coat, fruit peel, heartwood, husk fiber, palm hearts, rhizomes, root bark, corn silk and trunk bark (1.4%).

Solvent used for extraction

Variation in extract activity has caused by solvent polarity as its major factor (Matejić et al., 2018). The most used solvent in the selected articles were polar solvents: water (20.6%), methanol and ethanol (16.8% and 16.0%, respectively) and non-polar solvent (ethyl acetate – 14.5%). Also, they utilized hexane (8.4%), dichloromethane (4.6%), acetone (3.1%), n-butanol (2.3%), chloroform (1.5%), petroleum ether (0.8%), solvent mixture like hydro alcohol (1.5%), hydro methanol (0.8%), acid-ethanol (0.8%) and different fraction for isolation active compound (ethyl acetate, n-butanol, hexane and water – 1.5% and chloroform, ethanol and anthocyanin-rich fraction – 0.8%).

In vitro Models of DM

The very important instrument for screening activity in bioassay studies and detail explanation the mechanism of action of an active compound is in vitro model for evaluating new antidiabetic compounds.

Determining the action mechanism of new drugs is done using a lot of enzymes. When investigating antidiabetic action, different extracts were most commonly tested against α-glucosidase activity (56.5%), followed by inhibition of α-amylase (32.9%), PTP1B (7.1%), β-glucosidase, lipase and DPP-4 (1.2%).

The common for screening and evaluating the compound mechanism of action in in vitro tests is the analysis of enzymes [20]. The most prevalent cell lines identified in the present review were 3T3-L1 (30.4%), L6 (26.1%), HepG2 (13.0%), C2C12 and BRIN BD11 (8.7%), H4IIE, AML12 and INS-1 (4.3%) cells.

Antidiabetic Compounds Isolated from Plants

In the present review, 42 compounds group were found to have antidiabetic activity. The most frequently were flavonids (23.4%), followed by phenolic acids (8.9%), phenols and tannins (6.5%), saponins and triterpenoid (4.8%), flavonoid glycosides (4.0%), phytosterols, terpenoid and alkaloids (3.2%), carbohydrate and fatty acids (2.4%), limonoids, protein and steroidal (1.6%), acetate, anthocyanin, anthraquinones, benzyl alcohol, caffeoylquinic acids, cardiac glycosides, carotenoids, catechin, chlorins, cholesterol, chromones, coumarins, curcuminoids, diterpene alcohol, ester, ethyl ester, flavones, heteropolysaccharide, indole alkaloid, ketones, lignans, lipid, monosaccharides, sterols, terpenic lactones, tetranortriterpenoid and triterpenic acid (0.8%).

DISCUSSION

Antidiabetic Activity of Plants extracts

The most powerful plants which are officially recognized and supported by clinical evidence, are Ocimum tenuiflorum L., leaves and Trigonella foenum-graecum L., seed (Governa et al, 2018). Current research represent antidiabetic agents obtained from seed extract from Trigonella foenum-graecum FenfuroTM, CR0010810 which have promising activity and now is during clinical trials for human uses (Swaroop et al., 2018). The major compound of the seed fiber of fenugreek with antidiabetec potential is galactomannan Singab et al., 2014. Leaves of Ocimum tenuiflorum contains high amount of eugenol, ursolic acid, flavonoids (orientin and vicenin) and many phenolic compounds which contribute to biological activities including antidiabetic (Parasuraman et al, 2015). Traditional uses of well-known plant Allium cepa L. all over the world ratify its medicinal benefit. Its bulbs are rich in sulphur amino acids, flavonoids (flavonols and anthocyanin), phytosterols and saponin possessed different biological activities. Flavonoid alliuocide G showed in vitro α-amylase inhibitory activity (Marrelli et al, 2019). Apart from these plants, World Health Organization (WHO) monographs showed plants and their vegetative or reproductive organs with antidiabetec activity described in Pharmacopoeias of different countries such as Azadirachta indica A. Juss. (Meliaceae), Momordica charantia L. (Cucurbitaceae), Panax ginseng C.A. Meyer, P. quinquefolius L. (Araliaceae) and Rehmannia glutinosa (Gaertn.) DC. (Scrophulariaceae) (Governa et al, 2018).

In study of Vijayalakshmi et al., 2018, in vitro glucose uptake activities of the methanol extract of Sarcostemma brevistigma were examined using 3T3L1 cell lines. It was found that considerably higher glucose uptake activity of 38.04% which is equivalent to the glucose uptake shown by 100 nm insulin (40.10%).

Hyperglycemic activity from aerial part of methanolic, water and hydro methanolic extracts of Caralluma umbellata were analyses by Bellamakondi et al., 2014. The methanolic extract was found to have significant glucose uptake. Further, this extract was also found to have promising role in inhibiting alpha amylase and pancreatic lipase. The results show that Caralluma umbellata has potential antidiabetic property.

The antidiabetic effect of hydroalcoholic extract of aerial parts Achillea millefolium was evaluated by Chávez-Silva et al., 2018. Extract promoted the α-glucosidases inhibition by 55% at 1 mg/ml respect to control. On the other hand, extract increased the PPARγ (five-times) and GLUT4 (two-fold) relative expression than control.