Category: Diabetes

The article “Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults”, introduced by Hays, Giacomin, Loukas, and McDermott was written for the journal Diabetes Research and Clinical Practice in 2015. It addresses the relationship that exists between two items: the infection known as Strongyloides stercoralis (S. stercoralis) and patients with type 2 diabetes.

The authors of the article aim at developing a cross-sectional survey, including the participation of Aboriginal adults in Australia during 2013. The main focus of this study is not to prove the possibility of the relationship between the infection and the diagnosis, but rather to explain this relationship and facilitate a discussion to see if there is a chance to develop a plausible immunological mechanism that can be used to help prevent and control the development of type 2 diabetes in the future (1).

The results of this study prove that the process of immunomodulation by the chosen infection can, indeed, be observed. It also highlights the necessity to engage future research in order to show how the proteins work in this infection and confirm the metabolic process. Several months before, Hays, with his team, introduced the investigation in which the researchers aimed to prove the connection between the infection and the disease using worms and less than 100 people, who agreed to participate in the study (2). It was necessary to answer one question: ‘Could Strongyloides stercoralis infection protect against type 2 diabetes in humans?’ It is this main goal that is under analysis.

The peculiar feature of this article is its role in a group of studies developed by Hays and his team. It is crucial to pay attention to different factors connected with the infection and the chosen disease, including eosinophil count, the role of secretary protein, and the importance of nutritional burden of the infection. At the beginning of 2016, Hays and a new team of researchers investigated the prevalence of eosinophilia in relation to the chosen infection (3). All three studies prove that Aboriginal communities are predisposed to both having type 2 diabetes and infection. Instead of treating patients with these two health problems, finding a solution using the characteristics of both issues is proposed.

After reading the abstract, it is possible to discern the objectives and methods of the study. The authors introduce a clear question and develop a methodology to find answers. The introduction of the article clearly establishes that developing countries suffer from such infections like S. stercoralis, in addition to additional health problems such as obesity and chronic diseases (1). The Aboriginal communities in Australia are defined as unique due to the fact they are affected by the two identified problems simultaneously. On the one hand, this territory and its people are under threat of having S. stercoralis infections (4).

On the other hand, the same group of people is characterised by having type 2 diabetes more frequently than other citizens on the same continent (5). Therefore, it is necessary to investigate the chosen field in terms of the specific population and find any solutions that can be offered to cope with the disease and related complications. Hays and his team introduce one of the best research groups, who are involved in the discussion of this topic and the development of new methods of treatment and prevention of serious health problems, such as type 2 diabetes and the complications caused by S. stercoralis infection.

There are three main aspects in regards to which the article should be analysed: innovation, strengths, and weaknesses. This study is not innovative because this topic has already been discussed in several previous studies, and there have also been articles specifically about S. stercoralis and its relation to different diseases among the Aboriginal people in Australia(2), (4), (5). At the same time, it is important to acknowledge that the authors of the article under analysis discovered a strong negative connection between the chosen infection and the Aboriginal population with type 2 diabetes. Such a correlation could be observed after an appropriate indexation of age, gender, and body mass (1).

Causality was not implied, and it may be defined as one of the main downfalls of the article. Regarding such an important relationship between infection and disease, causality can become a helpful tool to make conclusions and create appropriate conditions for future research. The investigations conducted by Hays have been frequently used by other researchers who dealt with type 2 diabetes and hygiene hypotheses defining the positive association with S. stercoralis (6), and who worked with immunomodulation by helminths among patients with type 1 and 2 diabetes (7). The fact that several other studies came to the same conclusions as Hays proves the appropriateness and worth of the chosen study.

The authors produced logical, coherent and appropriate information. There were no doubts and concerns about the chosen topic. The study design was clear, and data collection, as well as data analysis, was explained and supported by credible sources. Finally, the interpretation of the presentation of data clearly showed the awareness of the authors understanding of the key points and provided a sound basis for any conclusions.

In the chosen remote community, S. stercoralis is a common infection. The risks of having type 2 diabetes are also high. Therefore, the discussions about this type of relationship are well-grounded. The results and interpretations offered provided a direct link to the possible prevention of type 2 diabetes and other metabolic disorders that may be observed in those who live in the Aboriginal regions of Australia (1).

Overall, the research presented in the article has more strengths than weaknesses. In addition, it makes a good contribution to the innovative field of medicine in general and the explanations on how to treat patients with type 2 diabetes and those who are under threat of having complications because of the infection that is known as S. stercoralis specifically. At the outset, the authors clearly stated their goals and expectations, as well as describing their findings and interpretations. In order to explain the urgency of their research, they used descriptive statistics of Aboriginals who lived in Australia in 2013.

However, the article is also relevant and appropriate in terms of theory and practice that can be used in medicine to solve the questions of S. stercoralis and type 2 diabetes challenges globally. There are also clear opportunities for the improvement of the methodology in future work, as well as providing an impetus to develop new ideas on how to contain the infection and the disease.

References

1. Hays R, Esterman A, Giacomin P, Loukas A, McDermott R. Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults. Diabetes Res Clin. Pract. 2015;107(3): 355-361.
2. Hays R, Esterman A, McDermott R. Type 2 diabetes mellitus is associated with Strongyloides stercoralis treatment failure in Australian Aboriginals. PLOS Negl Top Dis. 2015;9(8), e0003976.
3. Hays R, Thompson F, Esterman A, McDermott R. Strongyloides stercoralis, eosinophilia, and type 2 diabetes mellitus: the predictive value of eosinophilia in the diagnosis of S stercoralis infection in an endemic community. Open Forum Infect Dis. 2016;3(1): ofw029.
4. Miller A, Smith ML, Judd JA, Speare R. Stongyloides stercoralis: systematic review of barriers to controlling stronglyloidiasis for Australian indigenous communities. PLOS Negl Top Dis. 2014;8(9): e3141.
5. Duong JK, Kumar SS, Furlong TJ, Kirkpatrick CM, Graham CG. Greenfield JR, et al. The pharmacokinetics of metformin and concentrations of haemoglobin A1C and lactate in Indigenous and non-Indigenous Australians with type 2 diabetes mellitus. Brit J Clin Pharm. 2015;79(4): 617-623.
6. Ruiter K, Tahapary DL, Sartono E, Soewondo P, Supali T, Smit JW, Yazdanbakhsh M. Helminths, hygiene hypothesis and type 2 diabetes. Parasite Immunology [Internet]. 2017. Web.
7. Surendar J, Indulekha K, Hoerauf A, Hubner MP. Immunomodulation by helminths: similar impact on type 1 and type 2 diabetes? Parasite Immunology [Internet]. 2017. Web.

Introduction

One of the increasing health crises in the world is diabetes mellitus. The studies have indicated that 30 million people having been affected by the disease in the past one decade. The number has arisen to 135 million today, most of them having attained 5o years and above. The challenge posed by DM is more evident due to dramatic changes across the globe.

There is a high possibility of diabetes mellitus 1or 2 patients getting a stroke, heart disease, blindness, high blood pressure and kidney failure complications.

The development of diabetes mellitus causes substantial suffering to the patient and the family members, leaving them with massive economic burdens. Complications that develop in the long run have an immense role in causing premature death, disability and morbidity (Delamater, 2006).

These losses will continue to accumulate if no action is taken. “In response to these challenges, several countries have already adapted their MDG targets and indicators to include chronic disease” (Delamater, 2006).

This study focuses on such goals to ascertain whether the patients have shown any marked improvement in the Hemo A1C levels, upon receiving education on the possible interventions. The global increase in chronic disease is driven largely by lack of adequate information on how to handle the situation as it arises, and the rapid aging of populations.

These determinants contribute to the three primary risk factors common to most chronic disease — unhealthy diet, physical inactivity, and tobacco use.

However, the population should be educated on complications, risk factors and management practices of diabetic mellitus cases. The WHO estimates that 80% of all cardiovascular disease and type 2 diabetes, and 40% of all cancer cases can be prevented by eliminating these risk factors (Delamater, 2006).

Literature Review

Diabetes mellitus (DM) is a chronic disease that can go undetected for several years before permanent target organ tissue damage is caused to the human body, such as diabetic retinopathy, end stage renal disease, peripheral, small vessel disease, limb amputation and even death. Uncontrolled and less managed diabetes can cause rapid deterioration of the patient’s health.

It will lead to an acute exacerbation of life-threatening conditions that can only be managed in an expensive hospital emergency room. Education on early detection and high quality management of Diabetes mellitus can reduce healthcare costs and prevent further healthcare complications to patients.

In relation to the identification of the diabetic population and educating them based on Wojcik et al (2010) recommendation, another study was conducted to evaluate the efficacy of education on hemoglobin A1C level (HgA1c).

Castillo et al (2010) study examined the efficacy of community based “Diabetes Empowerment Educational Programs” geared toward Hispanic/Latino neighborhoods in the Southeast area of Chicago. It was observed that Hispanic/Latinos have high incidences of diabetes when compared to non-Hispanic whites.

The latter may be due to the inability to gain employment, low educational levels and language barriers, lack of social support, and cultural barriers. The implementation of the program involved the participation of community health workers who were culturally educated and, had undergone exhaustive training in human subjects’ protection.

It is worth noting that all community health care workers are knowledgeable in blood pressure monitoring, blood glucose meter usage and, the DCA 2000+ analyzer, which measures pre and post blood glucose levels, a key outcome of this study (Wojcik, Gjelsvik, & Goldman, 2010).

According to Castillo, et al (2010), a total of 108 Hispanic participants were interviewed by community health care workers whereby knowledge of diabetes, self-care management, self-efficacy and, Hemoglobin A1C was tested. Based on these results, 70 residents with a mean age of 58.2 years officially enrolled in the 12 course module held during the months of May 2006 throughout March 2007.

The educational piece utilized participatory techniques and consisted of (1) two-hour weekly session within a 10 week time frame. Classes of 10-15 members were conducted in Spanish. Friends and family members were also invited to share the experience.

Weekly topics such as diabetes knowledge, self-empowerment, recording of daily physical activities, proper diet intake and, depressive symptoms were discussed. Each group determined the location and time of the class to accommodate work schedules, transportation needs and family participation.

Castillo, et al. (2010) concluded that diabetes self-management programs held in community settings and led by community health workers are feasible and effective based on the results of their study, which demonstrated a significant reduction in the Hemoglobin A1C value.

According to Fukunaga, Uehara, & Tom (2011), there is limited research on existing barriers and social support needs for the Hawaiian adult working class population diagnosed with diabetes. This study was aimed at identifying the components needed for successful patient DM self-management.

The aim of the study was to explore whether clinical interventions and social service support systems, would assist in improving the overall self-management of diabetes. Finally, it sought to assess if the process would prevent loss of employment due to DM disease related complications.

In the research article, by Wojcik, Gjelsvik, & Goldman (2010), four of the world’s five largest geriatric diabetic populations are located in India and Pakistan. The focus of the study was to provide medical and educational guidelines to health care professionals treating the geriatric population (Fukunaga, Uehara, & Tom, 2011).

The World Health Organization (WHO) estimated that about 79.4 million diabetics would reside in India by 2030, with (53%) being older than 60 years of age. Due to health complexities associated with this age group, family members and caregivers require cultural and educational assistance. Emphasis should be on dietary, physical activity, signs and symptoms of the disease process.

Hemoglobin A1C test should be utilized in three month intervals. According to Delamater (2006), hemoglobin A1C tests is considered the “gold standard” that is meant to gauge control of high blood glucose levels and the complications associated with diabetes mellitus. The focus of the study was to provide a better understanding of Hemoglobin A1C testing and patient knowledge and comprehension of Hemoglobin A1C results.

Delamater (2006) conducted several studies with regard to patient knowledge of Hemoglobin A1C. Findings from one Norwegian study revealed that (86.2%), from 201 diabetes 1 sample size, knew what their last A1C reading was. Another research conducted in the United States consisted of 663 ethnically diverse type 2 diabetes patients.

The results demonstrated that (66%) of the patients had no knowledge of their last A1C result. Delamater (2006) was able to demonstrate the importance of patient, clinician communication. The ability to engage and motivate a patient is crucial when trying to overcome language, educational and cultural barriers (Castillo, Giachello, Bates, Concha, Ramirez, & Sanchez, 2010).

This was the first report to show knowledge of diabetes among Saudi non-diabetic population in Island of Oahu. Our data show that, non-diabetic population in Island of Oahu has enough knowledge of the general knowledge of diabetes regarding risk factors and symptoms. However, they are not exceptionally well aware of the diabetes associated secondary complications.

Furthermore, the majority of young age population has the misconception that diabetes can be cured. Therefore, our study suggests that more efforts should be put in to widen knowledge on DM and how to manage patients with such condition (Fukunaga, Uehara, & Tom, 2011).

There are a few factors that influence home self management of diabetes. These include: quality of the education received, regular diabetes educator-patient follow up, the high quality self management of the patient at home, and a supportive home environment. There are a number of barriers to access to proper health care including medical charges, communication barriers and inaccessibility of specialty providers among other.

The frequent interaction between educated medical providers and patients during home visits and medical follow up helps to keep the patient alert of the condition and what is required of them in order to maintain good health. The role of social workers in helping the patients to manage themselves while at home is very significant.

These social workers bridge the gap between outpatient clinical setting and the patients’ home setting.

The social workers have a variety of involving tasks including: educating the patient about community diabetes resources and access to healthcare; involving and educating the patients’ family in the care necessary; and increasing the awareness of the patients and people around them, on the chronic disease and ways to achieve reduced A1C results (Fukunaga, Uehara, & Tom, 2011).

Research Methodology

This chapter describes the methodology used in the research. It describes the place of study, design and population of the study, and sample used. It also describes the instrument used to collect data and methods implemented to ensure the information is valid and reliable.

Research Approach and Design

The researcher employed a qualitative approach to the study. The study examined the cause and effect of interactions among the variables. We selected descriptive survey in order to portray accurate characteristics of the population.

Examples of the characteristics that were studied are beliefs, knowledge, opinions, and behavior of an individual. The design was chosen with the main objective of meeting the study objectives. The objective was to determine what opinions the patients, family members and medical personnel had regarding diabetes mellitus and its treatment

Research Setting

The study targeted residents of the Island of Oahu who lived with DM in Hawaii. The region has an average of three million people with a quarter living with DM. The researcher identified the subjects who met the sample criteria. The sample size of 362 DM diagnosed patients was chosen. They were willing to take part in the research during the period of data collection approximated to be six months.

Sampling Criteria

The subjects were supposed to meet certain criteria in the sampling guidelines. The highlights of the criteria that were to be met by the patients included one having had the disease for more than five years. The patient was to be of sound mind in order to give consent for participation in the survey.

Finally, the patient was to be of either male or female but no restrictions on the race. Patients with age below 16 years had to get consent from the parents or guardians before being allowed to take part.

Data Collection

The main data collection instrument was the questionnaire, a self-report form that is designed by the researcher to obtain information from the respondents. Data was collected with an aim of evaluating the patients and family member’s knowledge on DM. The choice of a questionnaire was based to the fact that it provides high response rate as they can be distributed to various respondents.

It takes a short time and less energy to get the information as the researcher moves around collecting the questionnaires. Finally, they gave the respondent a chance to remain anonymous or declare his identity.

However, the question of validity and accuracy was raised as a weakness to the use of questionnaires. It is feared that the responds do not give their true opinions, but aim to please the researcher. Some give views that are doctored towards their favor hence missing the objective of the study.

Collection Procedure

The researcher team distributed the questionnaires to patients and their family members. They helped nine respondents to fill the questionnaires owing to their inability to read and write. The data was collected over a period of six months. Some respondents were found in home while others in hospitals or home care facilities.

Reliability and Validity

Reliability

The questionnaires that were answered revealed adequate consistency in responses. Reliability of such a survey can be achieved by reducing sources of measurement errors like biases in data collection. This was achieved by the research team being the only ones that distributed the questionnaires. They exhibited similar personal attributes to patients and family members, without treating others differently.

Validity

The questionnaire included a number of questions on the patients’ background and about DM and its regimen of treatment. Questions were based on the information gathered during the literature review. They were presented in clear, understandable language for clarity.

Pretesting the Questionnaire

The research team pre-tested the questionnaire on the twenty respondents at the Hawaii Medical Centre and five families within the state. All the questions were answered, and no single questions were altered.

Limitations for the study

It is worth noting that no survey can be carried out without hindering objects. These are the factors that limit the speed or accuracy of data collection processes, not to mention the quality of data.

The research team had a number of barriers including limited amount of funds available for the survey and language barrier. Most of the locals do not understand the basic language-English. This forced the team to get a translator and an assistance team was created to help them fill the questionnaires.

Conclusion

The research team employed the use of qualitative, descriptive survey design. The research team administered all the questionnaires to ensure validity and reliability. The questions were open-ended and close-ended. The sample characteristics comprised of mentally sound adults who had live with DM for a period not less five years, and had the will to take part in the survey.

It also had members of the family who had patients suffering from the disease. The team obtained permission from the relevant authorities in Hawaii and the Island of Oas. The respondents provided consent by themselves. The team assured the subjects of anonymity, confidentiality and self-determination during dissemination of the questionnaires and report writing.

References

Castillo, A., Giachello, A., Bates, R., Concha, J., Ramirez, C., & Sanchez, C. (2010). Community-based Diabetes Education for Latinos: The Diabetes empowerment education program. The Diabetes Educator , 36(4), 586-594.

Delamater, A. (2006). Clinical Use of Hemoglobin A1c to Improve Diabetes Management. Clinical Diabetes , 24(6), 10.

Fukunaga, L., Uehara, D., & Tom, T. (2011). Perceptions of diabetes, barriers to disease management, and service needs: A focus group study of working adults with diabetes in Hawaii. Preventing Chronic Disease , 8(2), 32.

Wojcik, K., Gjelsvik, A., & Goldman, D. (2010). Identifying populations at risk for Diabetes with the behavioral risk factor surveillance system, Rhode Island. Preventing Chronic Disease , 7(4), 21-33.

Abstract

Type 2 diabetes mellitus (T2DM) is a serious metabolic disease that manifests with chronic conditions such as hypertension, nephropathy, and adverse cardiovascular events. This case report analyzes a patient presenting with T2DM at the ED with the major symptoms being abdominal pain, polydipsia, polyurea, and lightheadedness. The significant vital signs were tachycardia, elevated blood pressure, hyperglycemia (550mmol/dL), subnormal bicarbonate and BUN levels, high creatinine level, and anion gap, consistent with the diagnosis of microvascular and macrovascular complications related to T2DM. The primary etiologies linked to the patient’s T2DM condition include morbid obesity (350lbs) and family history. The treatments considered, including insulin drips, further pharmacological interventions, and diet/weight management plan for the patient are discussed.

Introduction

Diabetes mellitus (DM) is a group of metabolic disorders that manifests clinically as long-term hyperglycemia (PG ≥ 8.0mmol/l) due to impaired insulin production or resistance in the liver and skeletal muscles (Wu, Ping, Tanaka, & Zhang, 2014). Its two major variants include type 1 DM (insulin-dependent) and type 2 DM (non-insulin-dependent). Type 2 DM or T2DM is a major global health problem that affects 90-95% of diabetics worldwide, causing significant implications for health spending (Wu et al., 2014). The primary effect of inadequate insulin or repressed insulin sensitivity is impaired glucose uptake and metabolism, resulting in hyperglycemia.

T2DM is a complex disease whose etiology is linked to a host of genetic and environmental factors and their interactions. The genetic factors implicated in T2DM pathogenesis relate to a family history of the disease. Genetic polymorphisms involving insulin receptor genes expressed in the pancreatic β cells, e.g., PPRAG and IRS receptors, have been associated with T2DM pathogenesis (Zhang et al., 2016). The mutations cause pancreatic β cell dysfunction, resulting in impaired insulin secretion or resistance. Mutations in other genes involved in the insulin transduction pathway, i.e., glucokinase and mitochondrial genes, also lead to the pathophysiological T2DM progression (Wu et al., 2014). Due to repressed postprandial insulin secretion reduced insulin sensitivity the pancreatic β cells are overworked, resulting in their apoptosis.

The apoptotic progression reduces the pancreatic β cell mass, resulting to lower basal insulin release. With regard to environmental/lifestyle risk factors, obesity (BMI>25) due to physical inactivity and high fat intake is associated with a fivefold risk of developing T2DM (Pulgaron & Delamater, 2015). Other risk factors include aging, alcohol abuse, and smoking. Because it manifests with chronic hyperglycemia and related complications, T2DM is associated with low quality of life for diabetics (Kahn, Cooper, & Prato, 2014).

Further, T2DM-related comorbities, including cardiovascular disease (hypertension) and stroke, account for the high morbidity and mortality among diabetics. Studies show that up to 80% of T2DM patients develop hypertension or succumb to poor glycemic control (Handelsman, 2013). T2DM patients also suffer from symptoms like weight loss, nephrosis, and impaired vision that affect their quality of life. This paper will utilize a case study approach to discuss T2DM etiology and pathogenesis, clinical manifestations, psychosocial implications, and diagnosis, among others.

Case Study

Background Information

The patient is a 22-year-old male with morbid obesity (350lbs) with no past medical history who presents to the ED with abdominal pain and vomiting. The pain is located in right upper quadrant, sharp, non-radiating, worse when pressed, and continuous. The pain scale is 8/10. The patient states that he has been vomiting for 3 days without bleeding. He further complains of polydipsia (frequent thirst), poly urea (frequent urination), excessive sweating, and lightheadedness.

Etiology of T2DM

T2DM is a multifactorial disorder linked to genetic and environmental causes. The etiology of T2DM has a heritable genetic correlation with a family history of the disease (Sanghera & Blackett, 2012). Family history is one etiological factor specific to the patient. The patient’s type 2 diabetes new onset could be related to a paternal history of diabetes, as his father has DM type 2. T2DM involves a significant genetic component that accounts for its higher incidence rate first-degree relatives compared to the general population. First-degree relatives with a positive family history have up to 40% T2DM risk compared to those with no first-degree relative with the disease (Cullmann, Hilding, & Ostenson, 2012).

Another etiological factor relevant to the case is obesity. Morbid obesity (BMI>25) is associated with visceral fat mass gains; hence, a significant risk factor for T2DM (Pulgaron & Delamater, 2015). Further, the adiposity gains increases the risk of low insulin sensitivity in key target organs – liver and muscles. The patient has a positive diagnosis of morbid obesity (350lbs), implying that his T2DM has a positive lifestyle factor correlation. He presents with elevated blood pressure (200/94) and metabolic syndrome (glucose level = 550mg/dL), which are the usual co-morbidities related to obesity (Pulgaron & Delamater, 2015).

Obesity is related to lifestyle factors, such as lack of exercise, alcohol use, and smoking. The patient’s obesity could be related to alcohol use, diet, and genetics. Epidemiological studies demonstrate that obesity increases the T2DM risk due to its impact on insulin sensitivity (Cullmann et al., 2012). Further, low-fiber diet and intake of fatty acids also reduce insulin sensitivity contributing to T2DM progression.

The patient’s racial background could also be an etiological factor in T2DM new onset. Individuals of particular racial/ethnic backgrounds, e.g., African-American, have a higher T2DM risk than European or Caucasian descent populations (Sanghera & Blackett, 2012). Further, diabetes-sensitive genes have been identified in Japanese populations that reduce the postprandial insulin production capacity (Sanghera & Blackett, 2012). Thus, the patient’s ethnic/racial background coupled with lifestyle factors significantly increases the T2DM risk.

Pathogenesis

The primary pathophysiological features of T2DM include inadequate insulin secretion and low insulin sensitivity or resistance. In the case of the patient, his morbid obesity is the likely cause of insulin resistance that predisposed him to the insidious onset of T2DM. The patient’s T2DM is at its early stage. The development of insulin resistance in this patient was progressive, leading to T2DM onset at age 22.

Resistance arises when the insulin secreted by the pancreatic β cells does not produce the desired effects on the target organs, i.e., the liver and muscles (Cullmann et al., 2012). As a result, the cells secrete more insulin to compensate for the reduced sensitivity, leading to pancreatic β cell dysfunction. This process causes a decline in the secretory response of the beta cells, even when the blood glucose level is beyond the normal range, which is 7.8 mmol/l two hours postprandial (Wu et al., 2014). Therefore, reduced insulin sensitivity of receptors in the liver and skeletal muscles affects insulin metabolism, leading to hyperglycemic spikes.

Low insulin sensitivity can occur in individuals with morbid obesity; however, T2DM develops when the pancreatic β cells cannot overcome the resistance through more insulin secretion (Pulgaron & Delamater, 2015). Peripheral insulin resistance may occur in obese individuals due to free fatty acids. Elevated fatty acid levels in the blood induce the gluconeogenesis process in the liver that leads to glucose synthesis from non-carbohydrate sources, resulting in hyperglycemia (Pulgaron & Delamater, 2015).

Impaired insulin secretion could also account for the patient’s new onset T2DM. A reduction in glucose-responsive secretion leads to high postprandial blood glucose level (Kahn et al., 2014). In individuals with obesity, a reduction in early-phase secretion occurs when blood glucose levels are high (glucose toxicity).

This process is a pathophysiological feature accounting for the onset of T2DM in overweight individuals. Impaired secretory response occurs in a progressive manner and leads to pancreatic β cell dysfunction (Kahn et al., 2014). While in prediabetes (onset T2DM) is characterized by elevated postprandial glucose due to reduced insulin sensitivity and secretory response, hyperglycemia is due to the pancreatic β cell dysfunction resulting from these processes.

Clinical Manifestations

Patients with either T1DM or T2DM show three major symptoms – polyuria, polydipsia, and polyphagia (Wu et al., 2014). The patient’s complaints of polydipsia and polyurea are symptomatic of early stage acute T2DM. Polyuria manifests as frequent urination due to the elevated blood glucose levels that cause the drawing of water from the cells, resulting in the excretion of large volumes of pale dilute urine by the kidneys (Wu et al., 2014). Polydipsia (frequent thirst) results from polyuria. The cellular dehydration resulting from hyperglycemia triggers the hypothalamus, which monitors blood solute levels and pressure that causes the feeling of thirst (Wu et al., 2014). Thus, the patient’s polydipsia is connected to the polyuria condition that causes body dehydration due to hyperglycemia.

The other symptom of T2DM shown by the patient is abnormal blood urea nitrogen (BUN) level of 6 (the normal level is 7-22). The BUN test indicates the plasma levels of urea nitrogen. Urea is the product of protein metabolism that is excreted through the kidneys (Kahn et al., 2014).

Therefore, the lower than normal BUN levels in the patient indicate reduced liver function due to diabetic neuropathy. However, low protein diet, over-dehydration, and high carbohydrate intake have been associated with low BUN levels. The elevated creatinine level of 1.28mg/dL (normal = 0.6-1.2mg/dL) is another symptom of diabetic nephropathy. The building up of plasma creatinine levels is an indication of impaired renal function due to hyperglycemia.

The patient also presents with excessive sweating, lightheadedness, tachycardia (HR = 127 beats/min), and elevated blood pressure (200/94). Hypertension is a common co-morbid condition in diabetic patients related to impaired insulin metabolic action/resistance. Insulin stimulates glucose metabolism in the muscles and represses the lipoprotein synthesis in the liver cells (Kahn et al., 2014). Insulin resistance causes dyslipidemia whose effects include arterial stiffness and reduced vasodilation.

These effects contribute to elevated blood pressure in patients with T2DM. Other possible symptoms include polyphagia (elevated appetite) and glycosuria. The patient also presents with GI complications, i.e., abdominal pain and vomiting. According to Wu et al. (2014), chronic abdominal pain in diabetic patients is due to T2DM-related complications such as “neuritis and autonomic dysfunction” (p. 1189). Another T2DM-related symptom seen in the patient is ischemia.

Tissues, Organs, and Organ Systems Affected

The pathogenesis of T2DM implicates multiple tissues, organs, and systems involved in glucose homeostasis in the patient presented in this case. They include tissues – skeletal muscle and adipose tissue, organs like the liver, pancreas, kidneys, and brain, and systems such as the digestive system, circulatory system, and the endocrine system. The liver is the main regulatory organ that controls the blood glucose in circulation (Kahn et al., 2014).

It contains glycogen reserves that are converted to glucose for a rapid glycemic control. The liver also synthesizes glucose from non-carbohydrate substrates, e.g., amino acids. It compensates for low plasma glucose through glucagon-mediated glycogen-glucose conversion. The patient’s diabetic ketoacidosis is linked to liver malfunction due to insulin resistance that results in the inhibited glucose release by the liver cells (Kahn et al., 2014). As a result, the body utilizes other substrates, resulting in the buildup of ketones.

The skeletal muscle tissue contributes to hyperglycemia through insulin resistance. In this tissue, the insulin-mediated glucose uptake declines depending on the level of adiposity (Wu et al., 2014). Further, adipocyte-derived factors called adipokines and free fatty acids have been shown to step-up the resistance (Wu et al., 2014). Given the patient’s visceral obesity, insulin resistance in the liver and muscle tissue is the likely cause of his acute hyperglycemia. Visceral fat build-up in insulin-sensitive tissues, including the adipose tissue, liver, and muscle cells is a significant factor in insulin resistance. Increased breakdown of the adipose tissue in T2DM patients to provide cell substrates increases free fatty acids in circulation that cause insulin resistance.

The pancreas is another organ affected by T2DM in the patient presented. Pancreatic β cells (islets of the Langerhans) secrete insulin, while α cells release glucagon (Wu et al., 2014). Glucagon is involved in the conversion of glycogen reserves in the liver/muscle cells into glucose during fasting or hypoglycemia. The two hormones are part of the endocrine system. The pancreas also secretes Amylin that controls the postprandial glucose levels in the blood (Wu et al., 2014).

The patient’s kidneys may also be affected. His lab results include normal sodium level of 139mmol/L, low potassium level of 3.3mmol/L, low bicarbonate/BUN level, and elevated creatinine level (1.28mg/Dl). The anion gap level was also high at 27. From these values, the organ affected includes the kidneys due to electrolyte imbalance that results in low levels of bicarbonate/BUN and potassium.

Lesion Distribution

Hyperglycemia (550mmol/dL) in the patient is a systemic condition that affects multiple body organs. The patient’s vitals and complaints are manifestations of a metabolic disorder involving multiple organs. T2DM patients are at risk of various complications, including macro-vascular disorders (hypertension, CAD, and stroke) and micro-vascular conditions (nephropathy). Hypertension is the leading co-morbid condition associated with T2DM.

The patient presented symptoms of tachycardia (127 beats/min and elevated blood pressure (200/94) may be linked to cardiovascular disease. Studies show common environmental factors cause hypertension and T2DM in most populations (Wu et al., 2014). Reduced insulin sensitivity, oxidative stress, and hyperlipidemia due to obesity have been implicated in the development of T2DM and hypertension.

Some of the patient’s symptoms are a manifestation of diabetic nephropathy. The lab results show elevated creatinine level (1.28mg/dL) and lower BUN levels, consistent with diabetic neuropathy diagnosis. This indicates that T2DM has a systemic effect on renal functioning. The renal disorder correlates with insulin resistance in the patient. Further, the large anion gap (27) indicates a positive diabetic ketoacidosis (DKA) diagnosis (Puttanna & Padinjakara, 2014).

The buildup of the harmful ketones results from insulin resistance by the liver cells. As a result, the liver cannot metabolize glucose, contributing to hyperglycemia. A review by Puttanna and Padinjakara (2014) found insulinopenia (insulin deficiency) and elevated free fatty acids as the primary causes of DKA in prediabetes. The mechanism involves a lack of adequate insulin to control ketosis.

Factors that may have Contributed to T2DM Development

Certain aspects of the patient’s life could have contributed to the development of the disease. His social history shows that he does not use illicit drugs or smokes, but drinks occasionally when out with friends. The consumption of beer and spirits has been associated with increased risk of abnormal glycemic profiles associated with pre-diabetes and T2DM (Cullmann et al., 2012). This study also found that low alcohol use reduced the T2DM risk in females. In this study, the risk of developing T2DM was higher in samples that consumed spirits than those with a moderate wine intake. Therefore, the patient’s occasional alcohol use could have predisposed him to T2DM.

Another risk factor relevant to this case is genetics. The patient’s father has a history of T2DM, an important factor in the pathogenesis of the disease. Family history accounts for the high T2DM incidence of up to 40% in first-degree relatives compared to non-first-degree relatives (Sanghera & Blackett, 2012). The heritable genetic component relates to genes involved in glucose metabolism or homeostasis. Heritable mutations in the insulin receptor genes, such as the KCNQ1 gene, have been associated with impaired insulin secretion and resistance (Sanghera & Blackett, 2012). The patient may have inherited genetic abnormalities that affected insulin function or secretion from his father, predisposing him to T2DM.

The patient’s morbid obesity (350lbs) is another identifiable risk factor for hyperglycemia. Obesity (BMI>25) results from high intake of fat and simple sugars in junk/processed food and physical inactivity. The patient’s obese status may childhood overweight that persisted into adulthood. It indicates that the patient does not engage in healthy dietary practices and physical exercise to achieve normal BMI. Studies show that an overweight condition accounts for up to a fivefold improvement in the risk of developing T2DM (Zhang et al., 2016). Further, morbid obesity is associated with visceral fat accumulation that causes insulin resistance. The father has a medical history of high cholesterol; therefore, the patient has a genetic predisposition to obesity, which is a T2DM risk factor.

Sequelae of T2DM

T2DM is associated with chronic complications such as hypertension and renal disorders. At the time the patient presented to the ED, he manifested symptoms associated with macrovascular disorders. His vitals were tachycardia (HR=127 beats/min), elevated bp = 200/94, normal body temperature (98.6^oF), and RR = 20. Tachycardia and elevated blood pressure are signs of hypertension as a comorbid condition.

According to Wu et al. (2014), a positive hypertension diagnosis often precedes T2DM onset, which indicates that the two conditions have a common metabolic cause. Hypertensive individuals have a threefold risk of developing T2DM within a 5-year period, compared to normotensive individuals (Wu et al., 2014). Therefore, in the present case, hypertension is the major sequelae related to the patient’s T2DM. Other sequelae that may occur include cardiovascular disease and strokes.

The patient also presented with symptoms characteristic of microvascular complications. He had a large anion gap, elevated creatinine levels (1.28mg/dL), and electrolyte imbalance (low BUN, K⁺, and bicarbonate), which are highly suggestive of diabetic nephropathy. The condition develops when the intraglomerular pressure builds up, causing hypertension in the glomeruli (Cullmann et al., 2012).

The patient’s severe abdominal pain (sharp, non-radiating, and continuous) indicates GI abnormalities due to the diabetic neuropathy. The pathogenesis of this condition relates to the hyperglycemic damage of vessels nourishing the nerve fibers in the abdominal area. The condition may also be due to microvascular circulation impairment, which affects the autonomic system and causes pain (Cullmann et al., 2012). Another sequelae that is likely to occur includes diabetic retinopathy that is characterized by blurred vision due to retinal vessel destruction (Cullmann et al., 2012). The patient’s elevated sinus tachycardia (127bpm) could lead to the rupturing of capillaries supplying the retina and occasion blindness.

Further, the signs of ischemia in leads II and III are highly suggestive of possible inferior myocardial infarction (MI). The MI risk factors present in the case include hypertension and T2DM. Hyperglycemic profiles increase the risk of atherosclerotic plaques in T2DM patients that cause high blood pressure and unstable angina. Another possible complication the patient may develop in his old age is diabetic foot ulcers. Peripheral neuropathy related to T2DM causes suppressed pain sensation in the lower extremities of T2DM patients (Cullmann et al., 2012). As a result, non-healing foot ulcers develop due to impaired blood flow.

Patient Prognosis

T2DM is a major risk for adverse cardiovascular prognosis in our patient due insulin therapy. Effective glycemic control through agents like insulin is linked to improved cardiovascular event prognosis in T2DM patients (O’Keefe, Abuannadi, Levie, & Bell, 2012). However, the agents increase the risk of hypoglycemia that causes adverse cardiovascular events. T2DM patients receiving intensive insulin/sulfonylurea therapy may develop mild hypoglycemia. This condition stimulates the sympathetic nervous system that may induce the development of cardiovascular problems, including myocardial infarction, arrhythmias, and cardiopulmonary arrest (O’Keefe et al., 2012). Further, hypoglycemia may cause lengthened QT interval and ventricular tachyarrhythmias that increase the risk of cardiovascular problems.

Aggressive glycemic control may also cause cardiovascular toxicity in the patient given his predisposition to heart disease. He has morbid obesity and a paternal history of elevated cholesterol that could predispose him to adverse cardiovascular events. According to Handelsman (2013), individuals with atherosclerosis and ventricular hypertrophy are at a higher risk of developing cardiovascular complications during an aggressive glycemic control with insulin therapy. Therefore, long-term insulin therapy for T2DM may lead to cardiovascular disease prognosis due to hypoglycemia in the patient.

Glucose-lowering therapies may fail to give a better cardiovascular prognosis due to postprandial hyperglycemia (Handelsman, 2013). The treatments aim to achieve better glycemic profiles during fasting and pre-prandial cycles, as opposed to controlling postprandial spikes. Postprandial hyperglycemia is linked to a high risk of cardiovascular disease due to elevated triglyceride levels (Handelsman, 2013). Another prognosis relevant to the present case is atherosclerosis. The sinus tachycardia is highly suggestive of fatty deposits (atheromas) in arterial walls, causing endothelial dysfunction (arterial narrowing).

Therapies Used/Considered

After presenting at the ED, the patient was started on an insulin drip and hourly glucose check to lower the acute hyperglycemia. Insulin therapy is an effective strategy for achieving normal glycemic profiles in T2DM patients. The underlying mechanism involves the repression of glucose release by the liver and promotion of postprandial glucose metabolism (Tamez-Perez, Proskauer-Pena, Hernrndez-Coria, & Garber, 2013). The patient was started on an insulin drip to achieve an immediate reduction in glucose concentrations (550mmol/dL) to normal levels. The exogenous insulin therapy was also meant to minimize the effects of glucose toxicity and ketoacidosis by preventing ketosis. Rapid-acting insulin analogues can also be used in place of insulin drips.

Early-stage T2DM can be controlled through diet to achieve appropriate BMI levels. The treatment plan for the patient includes diet and weight management plan targeting the modifiable risk factors. The plan will involve working with the patient to help him achieve healthy eating, quit drinking, and start exercising/resistance training.

The pharmacological management of T2DM involves various anti-diabetic drugs. Sulfonylureas are second-line anti-hyperglycemic agents that could be given to the patient if he cannot respond to metformin or biguanine (Tamez-Perez et al., 2013). The sulfonylureas induce insulin secretion through pancreatic β cell stimulation (Cullmann et al., 2012). However, this class of drugs is not recommended for obese/overweight patients.

The first-line drugs that will be prescribed to the patient will be biguanide (metformin, 100mg twice daily). The drug reduces glucose production by the liver by inhibiting gluconeogenesis and glycogenolysis (Handelsman, 2013). It also stimulates glucose metabolism in skeletal muscle cells. The rationale for giving metformin at the early stage of T2DM is to improve treatment success rates. Metformin combination therapy with GLP-1 RAs (sulfonylureas) would lead to effective glycemic control without causing hypoglycemia (Handelsman, 2013). GLP-1 RAs induce feelings of satiation through slow gastric emptying, resulting in steady weight loss (Handelsman, 2013).

Conclusions

T2DM is a severe metabolic disorder with systemic disruption of glycemic control. In the introduction, T2DM was associated with chronic co-morbidities, such as hypertension, stroke, and nephrosis. Comparable clinical manifestations of T2DM seen in the case study imply hyperglycemia that has remained undetected in the patient; hence the severe abdominal pain. The T2DM progression has followed the typical path described in literature. In the patient, a family history and morbid obesity occasioned a progressive development of the pathophysiological features of T2DM, i.e., impaired insulin production and resistance, leading to disease onset. The two factors are the likely etiologies of T2DM. The associated clinical manifestations included elevated blood pressure, signs of nephropathy, polydipsia, and polyurea.

References

Cullmann, M., Hilding, A., & Ostenson, C. (2012). Alcohol consumption and risk of pre-diabetes and type 2 diabetes development in a Swedish population. Diabetic Medicine Journal, 29(4), 441–452.

Handelsman, Y. (2013). Diabetes and hypertension: A comprehensive report on management and the prevention of cardiovascular and renal complications. The Journal of Clinical Hypertension, 13(4), 221-223.

Kahn, S., Cooper, M., & Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: Perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083.

O’Keefe, J., Abuannadi, M., Levie, C., & Bell, D. (2012). Strategies for optimizing glycemic control and cardiovascular prognosis in patients with type 2 diabetes mellitus. Mayo Clinic Proceedings, 86(2), 128-138.

Pulgaron, E., & Delamater, A. (2015). Obesity and type 2 diabetes in children: Epidemiology and treatment. Current Diabetes Reports, 14(8), 508-515.

Puttanna, A., & Padinjakara, R. (2014). Diabetic ketoacidosis in type 2 diabetes mellitus. Practical Diabetes, 31(4), 155-158.

Sanghera, D., & Blackett, P. (2013). Type 2 diabetes genetics: Beyond GWAS. Journal of Diabetes and Metabolism, 3(1), 198-205.

Tamez-Perez, H., Proskauer-Pena, S., Hernrndez-Coria, M., & Garber, A. (2013). AACE comprehensive diabetes management algorithm 2013 endocrine practice. Endocrine Practice, 19(4), 736-737.

Wu, Y., Ding, Y., Tanaka, Y., & Zhang, W. (2014). Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. International Journal of Medical Sciences, 11(11), 1185-1199.

Zhang, J., Yang, Z., Xiao, J., Xing, X., Lu, J., Weng, J.,…Yang, W. (2016). Association between family history categories and prevalence of diabetes in Chinese population. Plos One, 10(2), 1-8.

The problem of a growing number of people suffering from different types of diabetes is becoming one of the burning issues in the modern world. That is why it is important to approach this problem from its both ends and pay attention to preventive measures, as well as finding more efficient means of treatment.

One of the advances in the modern medicine is the implementation of holistic medicine that aims to investigate the broader context of treating the medical conditions, rather than focus purely on the biological component.

Thus, this paper’s objective is to analyze the interdisciplinary nature of the application of holistic medical treatment, to study traditional and modern methods of implementation of the mind-body medicine to diabetes, and investigate the techniques based on the humanistic image, of how to be effective at self-management with diagnosed diabetes.

The interdisciplinary nature of the modern holistic medicine

Among modern medical scientists, the research of diabetes is one of the topics to be most focused on, it includes thousands of researchers in different fields of medicine from all over the world, who in recent years managed to make many advancements of how to ease, at least to a certain merit, life of people diagnosed with diabetes (Peyrot et al. 174).

Another significant advancement made in the last couple of decades concerning people who have medical conditions is the implementation of the holistic medicine techniques. Those approaches aim to find and apply the different ways of treatment involving not only biological side of the human organism but also being attentive to the psychological, spiritual, mental, social and emotional health of the patients (Teixeira 278).

It stands in the direct correlation with the general humanistic image of a human being in medicine, and it is especially important for people who are to manage their conditions, such as diabetes, since it focuses on the psychological and social aspects of overcoming difficulties caused by a disease.

Given the complexity of the factors that affect the psychological state of an individual, the implementation of the humanistic image for managing diabetes is only possible within the interdisciplinary approach that would involve other than just biological aspects, including social and economic nuances (Asche, LaFleur and Conner 75).

The objective of the formatting humanistic image for those who are diagnosed with diabetes is to employ various scientific branches, concerned with studying a human body, mind, practices, spiritual and socio-economic life, to ensure the effective functioning of those individuals on all the levels, rather than just treating the symptoms.

The psychological and social comfort not only provides the ground for the more self-awareness but also ensures that those individuals are not left out of the workplaces, social life so that they have their guaranteed rights and commitments. In this, way it is a system beneficial for all the society since it involves the inclusion of all its members.

Approaches used by the mind-body medicine to treating diabetes

There are a few main approaches within the biological anthropology attempting to explain the nature of humans as biological organisms, particularly the interaction between the spiritual and biological aspects, the interconnection between mind and body. Those approaches can roughly be divided into two groups, one of which is inclining towards reductionism and simplification while the other is viewing the complexities of mind-body relations as the unique human feature (McKinnon and Silverman 181).

Even though, the reductive oversimplification is not now widely spread in the approaches to anthropological studies; however, it is important not to reduce the medical conditions to purely biological level. Such conditions as diabetes of any type require certain lifestyle and diet, as well as, of course, medication, and to which degree people diagnosed with it can be engaged in these aspects successfully depends on economic, social, psychological and other factors of their living.

Contemporary diabetes treatment is related primarily with the dietary and lifestyle self-management. In this context, it is clear that the complex humanistic approach is directed to the wider range of issue concerned with diabetes. Since, at this stage, diabetes cannot be cured, it appears to create not only physical but also social and psychological discomfort for people diagnosed with it.

The lifestyle awareness will allow them to feel more humane and more included in the social life. With the implementation of self-management, it is possible to change the not only the attitude of those have diabetes but also the general public’s attitude towards it.

Humanistic approaches to diabetes management

The framework of the diabetes management includes such major components as medication intended to control and to lower the glucose levels in blood, levels of lipids and blood pressure, dietary restriction on the products containing sugars, appropriate exercising activities and following the basics of the healthy lifestyle (Nathan et al. 2644).

Depending on the type of diabetes, age, and other biological factors, the patients are usually prescribed the medicine to lower the blood sugar levels. Other medications are used to lower the liver’s glucose production.

Also, in many cases, especially with the type II diabetes and especially for the elder categories of patients, there is a range of cardiovascular diseases associated with diabetes, which is why a lot of the patients’ strength are going into overcoming those potential threats. In terms of humanistic image, it emphasizes the vulnerability of the diabetics not only to the health threats but also to the discomfort associated with the restrictions in the new lifestyle.

Quite often the diseases and pains that go alongside diabetes and the vulnerabilities stand in the way of normal life of the patients more that the condition itself. Based on the humanistic image approach to self-management in this case, seeks to introduce not only the physical side of the new lifestyle but also the spiritual and psychological relief that the holistic medicine can provide.

The sudden introduction of string ban on foods and the obligation to exercise for those who is not used to the healthy living is just another social stress that goes along with the disease, whereas, mindfulness meditation is spiritual practice that also shows results in decreasing the painful diabetic neuropathy (Teixeira 280).

Apart from meditation, it employs many other practices, including different types of yoga, visualization, some practices date back to ancient civilizations, some are borrowed from psychoanalysis but, most importantly they are all based on biological feedback that unifies mind and body, which is the principle of whole-person care (Chriswell and Serlin 662).

Conclusion

Diabetes is now a problem that arises concerns all over the world, and since, at this stage, diabetes cannot be cured, it appears to create not only physical but also social and psychological discomfort for people diagnosed with it. Holistic medicine due to its positive effect on the spiritual and psychological attitude of the patients with diabetes improves their success in managing their new lifestyle and makes the change to it less stressful, as well as medically proven helps in many cases to relieve the pains that go alongside the disease.

Holistic medicine contributes to the humanistic image since it does not reduce the patients with diabetes to purely biological aspects, and employs the advancements from all the branches of science associated with humanistic studies to help the people diagnosed with diabetes live a fuller life in harmony between spirit and body.

Works Cited

Asche, Carl, Joanne LaFleur, and Christopher Conner. “A review of diabetes treatment adherence and the association with clinical and economic outcomes.” Clinical Therapeutics 33.1 (2011): 74-109.

Chriswell, Eleanor, and Ilene A. Serlin. “Humanistic Psychology, Mind—Body Medicine, and Whole-Person Health Care.” The Handbook of Humanistic Psychology. Ed. Kirk J. Shneider, J. Fraser Pierson, and James F.T. Bugental. Los Angeles, CA: Sage, 2015. 653-66. Print.

McKinnon, Susan, and Sydel Silverman. Complexities. Chicago, IL: University of Chicago Press, 2005. Print.

Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B. “Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.” The New England Journal of Medicine 353.25 (2005): 2643–53.

Peyrot, Mark, et al. “Diabetes Attitudes Wishes and Needs 2 (DAWN2): a multinational, multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes care.” Diabetes research and clinical practice 99.2 (2013): 174-184.

Teixeira, Elizabeth. “The effect of mindfulness meditation on painful diabetic peripheral neuropathy in adults older than 50 years.” Holistic nursing practice 24.5 (2010): 277-283.

When a program is started, it is important to evaluate it after some time in order to determine the performance. By evaluating a program, those who are in charge are able to determine whether the program is implemented well and what changes should be made.

The Center for Disease and Control (CDC) has been launching several programs to eradicate various diseases from the public. One of the major diseases that CDC has put efforts to stop is diabetes. Subsequently, CDC has also carried out several evaluations of the diabetes eradication program in order to determine its effectiveness (Centers for Disease Control, 2008, p. 5).

The Center for Disease Control (CDC) chose the qualitative method to evaluate the programs used to stop diabetes. It is worth noting that diabetes is a lifestyle related disease and the programs aimed to stop it should emphasize how to encourage people to change their lifestyles in order to be healthier (Centers for Disease Control, 2008, p. 6).

In most cases, quantitative methods are used to evaluate programs whereby the outcome of the programs can be represented in terms of figures. However, in this case, diabetes eradication program evaluation was done using qualitative method in order to give the true picture of what was happening on the ground as far as the disease was concerned (Posavac, 2010, p. 44).

Interviews were greatly used during the evaluation of the program whereby the diabetes patients, program facilitators, medical practitioners and the general public members were asked for their views about the success of the program. Generally, all parties involved in the running program were engaged in direct interviews for being able to collect reliable information about the achievement made by CDC in order to eradicate diabetes.

Unlike in the quantitative method, whereby the outcome is given in figures, qualitative method gives more details that represent the actual environment of the issues that have been evaluated. One of the major reasons why CDC decided to use qualitative program evaluation method is the thematic insights associated with qualitative program evaluation (Boulmetis & Dutwin, 2012, p. 18).

The interviews enabled the CDC to collect actual and the emotional information from both patients and other stakeholders involved in the running program. The program is supposed to change the social life of the people and it was essential to hear what those who were involved in the implementation of the program felt about it.

Additionally, collecting the actual information about what people feel about the program is more accurate than having figures recorded down (Centers for Disease Control, 2008, p. 3).

Information collected during qualitative program evaluation is more accurate in decision making than the one collected using quantitative methods.

Those compiling and sorting data using quantitative program evaluation method sometimes make mistakes that are reflected in the information used in the decision making process (Boulmetis & Dutwin, 2012).

The qualitative method gives accurate and quality information about the program being evaluated because it normally includes first hand information that contains the reactions and feeling of the respondents.

Generally, the CDC chose to use qualitative methods in order to obtain quality and accurate information about the diabetes eradication program.

References

Boulmetis, J., & Dutwin. P., ( 2012), The Abcs Of Evaluation: Timeless Techniques For Program And Project Managers, KY, United States: Cengage Learning.

Centers for Disease Control., ( 2008). Framework for Program Evaluation in Public Health, the eradication of diabetes. Atlanta, Georgia 30360

Posavac, E. J., ( 2010). Program Evaluation: Methods and Case Studies , Upper Saddle River, NJ: Prentice Hall.

There are several facts, which point to the significance of this study. First and foremost, type II diabetes is one of the most widely spread health concerns around the globe, as more than 400 million people in different countries are diagnosed with diabetes mellitus (World Health Organization, 2016). Among them, more than 1 million people with diabetes dwell in the United Arab Emirates (International Diabetes Federation, 2015). Moreover, this topic requires an in-depth understanding because knowing the socioeconomic background of type II diabetes would be beneficial for decreasing the risks of the further expansion of the epidemic and improving the quality of life of those belonging to risk groups. Finally, this study might become a comprehensive educational initiative, which promotes preventive measures helpful for diminishing the risks of susceptibility to diabetes mellitus.

Literature Search Process

A thorough search using the Google Scholar database was the initial decision for locating scholarly articles for the literature review. As the focus is made on the correlation between socioeconomic status and susceptibility to type II diabetes, primary search requests were the following: socioeconomic status, causes of type II diabetes, socioeconomic status and diabetes mellitus, etc. During the search process, I faced the challenge of relevance and accuracy of sources. To cope with this problem, I decided to analyze only scholarly articles published in peer-reviewed journals. At the same time, I decided to review only recent papers in order to guarantee that only up-to-date information is mentioned in the literature review. That is why I have chosen the timeframe of five years – just like the frame of the research. Finally, I decided to avoid limiting the geographical scope of publishing. That said, articles investigating the correlation between socioeconomic status and type II diabetes in different countries and regions were analyzed.

Finding of Literature Review

During conducting a thorough literature review, the following conclusions were made:

• Socioeconomic status is a complex phenomenon, which incorporates a great variety of determinants such as age, race, gender, income, education, etc. (Rivera, Rosenbaum, & Rosela, 2015; Saydah & Lohner, 2010).
• The level of education and income are two factors, which are inversely associated with the risks of type II diabetes (Lee, Glynn, Peña, Paynter, & Conen, 2011). Moreover, they are among the most valued determinants of an individual’s socioeconomic status (Saydah, Imperatore, & Beckles, 2013).
• Low socioeconomic status leads to higher risks of diabetes mellitus due to poor metabolic control and lacking knowledge of preventive measures (Piper, Chalakalal, Sebastian, Warren-Findlow, & Thompson, 2015; Tao, Li, Zhu, Zhao, & Jiao, 2016).
• Understanding the correlation between socioeconomic status and predisposition to type II diabetes is critical for developing efficient preventative strategies for coping with this challenge (Piccolo, Pearce, Araujo, & McKinlay, 2014).
• Type II diabetes is a prevalent health concern among adult residents of the Gulf countries, especially those living in urban areas due to excessive industrialization, the prevalence of sedentary jobs, and giving preference to unhealthy food (Alhyas, McKay, & Majeed, 2012; Shalaby & Bauer, 2015).

Conclusions and Research

All of the conclusions mentioned above can be used for supporting the research, as the located articles offer valuable information for making up a comprehensive theoretical background of the proposed study. The fact that they are drawn based on scholarly articles would make the research persuasive and help to avoid the inclusion of irrelevant information.

References

Alhyas, L., McKay, A., & Majeed, A. (2012). Prevalence of type II diabetes in the State of the Cooperation Council for the Arab States in the Gulf: A systemic review. PLoS One, 7(8), 1-8. Web.

International Diabetes Federation. (2015). United Arab Emirates. Web.

Lee, T. C., Glynn, R. J., Peña, L. M., Paynter, N. P., & Conen, D. (2011). Socioeconomic status and incident type II diabetes mellitus: Data from the women’s health study. PLoS One, 6(12), 1-8. Web.

Piccolo, R. S., Pearce, N., Araujo, A. B., & McKinlay, J. B. (2014). The contribution of biogeographical ancestry and socioeconomic status to racial/ethnic disparities in type 2 diabetes mellitus: Results from the Boston Area Community Health Survey. Annals of Epidemiology, 24(9), 648-654.

Piper, C., Chalakalal, S., Sebastian, N., Warren-Findlow, J., & Thompson, M. (2015). Race, socioeconomic status, health-related quality of life, and self-care of type II diabetes mellitus among adults in North Carolina. Southern Medical Journal, 108(4), 212-216.

Rivera, L. A., Rosenbaum, M., & Rosela, L. C. (2015). The influence of socioeconomic status on future risk for developing Type 2 diabetes in the Canadian population between 2011 and 2022: Differential associations by sex. International Journal for Equity in Health, 14(1), 101-112.

Saydah, S. H., Imperatore, G., & Beckles, G. L. (2013). Socioeconomic status and mortality. Diabetes Care, 36(1), 49-55.

Saydah, S., & Lohner, K. (2010). Socioeconomic status and risk of diabetes-related mortality in the U.S. Public Health Reports, 125(3), 377-388.

Shalaby, S., & Bauer, B. E. (2015). Economic development and diabetes prevalence in MENA countries: Egypt and Saudi Arabia comparison. World Journal of Diabetes, 6(2), 304-311.

Tao, X., Li, J., Zhu, X., Zhao, B., & Jiao, S. (2016). Association between socioeconomic status and metabolic control and diabetes complications: A cross-sectional nationwide study in Chinese adults with type II diabetes mellitus. Cardiovascular Diabetology, 15(1), 61-71.

World Health Organization. (2016). Diabetes: Fact sheet. Web.

The Western Care model, including American and European care models, reflects the holistic, humanistic image of the man. Such image derives from Christianity, which serves as the basis for defining the specifics of human nature, which unites soul and body.

While the mentioned care models pay much attention to the microcosm of a human body, they lack precision in reflecting the specifics of the macrocosm of the environment.

Such approach can be considered to lack comprehensiveness, as appropriate caring about the human body is impossible without caring about the external environmental factors. The analysis of the concepts of micro and macro-cosmos in medicine helps to reveal the important components of effective care models for such common diseases as Diabetes.

The theory of micro and macro-cosmos originates from ancient Greek philosophical concepts. According to this theory, a man (micro-cosmos) is a representation of a universe (macro-cosmos). Such thought is based on the assumption that many of the characteristics of human body reflect the structure of the universe. Therefore, a human body is a reflection of a harmonious organization of the world.

Pythagoras was one of the first scientists and philosophers identifying the continuity between the universe and a human while Plato described the “soul of cosmos in its anthropomorphic representation” in more details (“Microcosm and Macrocosm” par.7). Cosmos has a perfect structure that includes the elements that are related to each other and present a harmonious unity.

The human body has the same structure, as all organs and body systems are interrelated with each other and can function properly only as a healthy unity.

As a result of accepting the discussed theory, medicine ensures that treatment of health problems is holistic and takes into account the functioning of all body systems. Such concept is reflected in care models that emphasize the importance of taking care of the whole organism while treating a disease of a distinct organ or system.

While the described approach to medicine has its clear advantages, it usually lacks the attention paid to the macro-cosmos – the world where we live. However, the environment can be considered one of the main factors impacting the microcosm of the human body. The specifics of the world surrounding us influence the air we breathe, the water we drink, the food we eat, etc.

Therefore, the holistic care model should include not only care about all of the body systems but also care about nature systems. One of the most common chronic diseases, Diabetes, is directly related to the impact of environmental factors.

The importance of having a healthy diet consisting of organic products to prevent and lessen the manifestations of diabetes reflects the significance of environmental factors, as they impact the food we eat. The number of scientific studies has disclosed the relation between such dietary factors as the duration of breastfeeding and the quality of products and the elevated chances of getting Diabetes 1(Knip and Simell 6; Deed et al. 288).

Another environmental factor contributing to the prevalence of Diabetes is air pollution, which is considered responsible for triggering Diabetes 2 (Pasala, Rao, and Sridhar 63) and Diabetes 1 (Hathout et al. 86). Water pollution has also been recognized as the factor that influences the onset of Diabetes (Sofi et al. 632).

The knowledge about the external factors serving as triggers for Diabetes 1 and Diabetes 2 should become the basis of Diabetes prevention used in modern care models. Such prevention should be based on the assumption that the quality of our environment is directly related to the chances of the onset of Diabetes in children and adults.

The methods of preventing Diabetes through adjusting care model to the external factors should include the actions that make the general environmental situation healthier. For example, organizing efforts aimed at improving the quality of the grains, vegetables, and fruits raised in the country can benefit the diet of the population, and, therefore, decrease Diabetes incidence.

Moreover, such dietary recommendations to Diabetic people as lowering the consumption of red meat is directly related to the improvement of nature, as the massive production of meat is one of the main factors contributing to air pollution worldwide.

This example illustrates the strong relation between a microcosm of a human being and a macrocosm of the universe, as even the smallest everyday habits have an impact on the world.

Other efforts that should be included in care model aimed at preventing Diabetes should include avoiding water and air pollution caused by heavy industries, transport, etc. The discussed guidelines can significantly decrease the prevalence of Diabetes and are already used by many environmentally-conscious people.

The analysis of the concept of micro and macro-cosmos in medicine and the influence of environmental factors on the prevalence of Diabetes reveals that including care about such element of macro-cosmos as environment is one of the powerful keys to ensuring the harmonious functioning of the microcosm of a human being and preventing the growing rates of incidence of Diabetes.

Works Cited

Deed, Gary, John Barlow, Dev Kawol, Gary Kilov, Anita Sharma, and Liew Yu Hwa. “Diet and Diabetes.” Australian Family Physician 44.5 (2015): 288-292. Print.

Hathout, Eba, Lawrence Beeson, Mariam Ischander, Ravindra Rao, and John Mace. “Air Pollution and Type 1 Diabetes in Children.” Pediatric Diabetes 7 (2006): 81-87. Print.

Knip, Mikael, and Olli Simell. “Environmental Triggers of Type 1 Diabetes.” Cold Spring Harbor Perspectives in Medicine 2 (2012): 1-15. Print.

Microcosm and Macrocosm. n.d. Web.

Pasala, Sudhir, Allam Rao, and Gary Sridhar. “Built Environment and Diabetes.” International Journal of Diabetes in Developing Countries 30.2 (2010): 63-68. Print.

Sofi, Hanief, Radhika Gudi, Subha Karumuthil-Melethil, Nicolas Perez, Benjamin Johnson, and Chenthamarakshan Vasu. “PH of Drinking Water Influences the Composition of Gut Microbiome and Type 1 Diabetes Incidence.” Diabetes 63 (2014): 632-644. Print.

Introduction

Live Life Well program is a health program that New South Wales Ministry of Health uses in preventing or delaying the onset of type II diabetes mellitus among adults.

Since the incidences of diabetes in Australia are very high, it necessitates health promotion program, which helps people to prevent and manage their diabetic conditions with the objective of living a healthy and a happy life.

Statistics show that, in Australia, diabetes mellitus accounts for about 5.5% of health burden, prevalent rates is approximately 8% among adults with ages of 16 and above, and 275 adults develop it daily in Australia.

These figures show that type II diabetes mellitus is a serious health condition in Australia, which has led to the establishment of Live Life Well program.

Given that type II diabetes is common among adults, the program targets Australians aged between 50 to 65 years, who are likely to develop the diabetes.

In this view, the report analyses Live Life Well program, a program that aims at preventing or delaying the occurrence of type II diabetes mellitus among adult Australians.

Description of the Program

Live Life Well is a preventive health program, which aims at preventing type II diabetes among adult Australians with ages between 50 and 65. The programs enable adults, who are risk of developing type II diabetes, to prevent or delay the occurrence of the diabetes in their lives.

In selection of participants, the program uses the Australian Type II Diabetes Risk Assessment Tool (AUSDRISK), which assesses the diabetic risk of adults between the ages of 50 and 65 years.

Once assessed for the risk of developing type II diabetes, the participants go through a one-year program that guides them to perform a number lifestyle changes and monitors their progress.

The lifestyle changes that the participants perform are reducing intakes of total and saturated fats, reducing weight, increasing physical activity, increasing intake of fibre, moderating alcohol, quitting smoking, and managing stress well (New South Wales Ministry of Health 2014).

During the course of the program, general practitioners assess the progress of participants in line with the lifestyle changes that programs aim to achieve. Therefore, Live Life Well is a preventive program that focuses on lifestyle changes among adults in preventing or delaying the occurrence type II diabetes.

Analysis of the programs indicates that it employs both primary and secondary preventive strategies, which aims at preventing or delaying the occurrence of type II diabetes among Australian adults with ages 50 and 65 years.

National Public Health Partnership (2006) defines primary prevention as a strategy that reduces or eliminates risk factors that cause certain diseases and promote factors protect or sustain human health.

Since Live Life Well program aims to reduce intakes of total and saturated fats, reduce weight, reduce alcohol consumption, eliminate smoking, and promote healthy lifestyles such as increasing fibre intake and physical exercise, it qualifies to be a primary preventive program.

Furthermore, Live Life Well qualifies to be a secondary preventive program because it employs the strategies of secondary prevention.

National Public Health Partnership (2006) also defines secondary prevention as a prevention strategy, which “aims to reduce the progression of disease through early detection, usually screening at an asymptomatic stage and early intervention” (p. 3).

Live Life Well applies secondary prevention strategy because it assesses the risk of Australian adults to type II diabetes using AUSDRISK, a sensitive too, that detects type II diabetes at an asymptomatic stage.

Moreover, the program applies comprehensive intervention measures to prevent or delay the onset of the type II diabetes among Australian adults, who have high risks.

Characteristics of the Program

Live Life Well is a prevention program that relies on behavioural changes among Australian adults. The program relies on behavioural changes in terms of lifestyles because type II diabetes is a lifestyle disease.

Sharma and Majumdar (2009) state that type II diabetes is a lifestyle disease that emanates from physical inactivity and poor eating habits, which constitute behavioural factors.

Excessive intake of total and saturated fats, smoking, lack of enough physical activity, overweight and obese, and excessive consumption of alcohol are some of the behavioural factors that predispose people to type II diabetes.

Since Live Life Well aims to reduce or eliminate these factors, it employs behavioural interventions. Vermunt et al. (2013) argue that behavioural change is a complex process because it requires the application of numerous interventions, which focus one health issue.

This explains why Live Life Well program utilizes diet and major interventions of preventing or delaying the onset of type II diabetes.

The analysis of the behavioural approach that the program uses indicates that it complies with health promotion values and principles.

The values and principles of health promotion usually focus on the general population, the population at risk, or focus on both, depending on the determinants of health and target disease (Lardon et al. 2011).

In this case, since the program focuses on the population at risk of developing type II diabetes, it applies health promotion values and principles that aim to prevent or delay the occurrence of the diabetes among Australian adults.

Gregg and O’Hara (2007) assert that in health promotion, the overarching principles that are applicable among the populations, which are at risk of developing certain diseases, are empowerment and participation.

Empowerment of the population at risk enables them to understand healthy and unhealthy lifestyles that predispose them to certain diseases and thus provide the basis for them to make informed choices about their lifestyles and behaviours.

According to Heritage and Dooris (2009), participation is an important principle in health promotion because it “emphasizes on the necessity of participation, with actions being carried out by and with people, not to the people” (p. 45).

In this view, the program applies participation the principle participation because the participants perform virtually all activities while lifestyle officers and general practitioners merely guides and monitors the progress of the participants.

Appraisal of the Program

Live Life Well has two strengths, which make it an effective health promotion program. The first strength is that Live Life Well program applies the principle of empowerment in enabling and strengthening Australian adults to prevent or delay the onset of type II diabetes despite their susceptibility.

World Health Organization (2010) states that the health promotion principle seeks to enable the target population to enhance control of their lives and their health choices. Fundamentally, the program empowers Australian adults, who are at risk of developing type II diabetes to prevent and delay the diabetes.

The second strength is that Live Life Well supports participation of Australian adults in the prevention or delay of the onset of type II diabetes. Fienieg et al. (2012) state that for health promotion program to be effective, it must have purposeful action and personal development.

Appraisal shows that Live Life Well has clear action and personal development milestones, which drive Australian adults to participate actively for a period of one year.

The weakness of the program in relation to the principles of empowerment and participation is insufficiency of the time to conduct the program.

Geense et al. (2013) assert that time is a barrier that reduces the effectiveness of health promotion programs because public health officers do not have ample time to educate and monitor progress of participants appropriately.

Appraisal of Live Life Well reveals that general practitioners and lifestyle officers can interest with the participants for a period of about 10 hours per year, which is quite negligible when compare to the period of the program.

Such a short period of education and monitoring reduces empowerment and participation, which are central principles of health promotion. Thus, the amount of time that the program allocates to the participants is not sufficient for education, monitoring, and assessment.

Enhancement of the Program

Since type II diabetes does not only affect the old adults, the program needs to reduce the threshold for young adults from 45 to 35 years. Song and Hardisty (2009) early onset of type II diabetes at the age of below 40 years result in serious complications.

Centres for Disease Control (2014) has made a significant impact in the prevention of diabetes among Americans because it incorporates numerous stakeholders such as healthcare professionals, insurers, community-based organizations, employers, and federal agencies in promoting behavioural changes that prevent or delay the occurrence of type II diabetes.

In this view, Live Life Well should enhance its impact in the prevention and delay of type diabetes by incorporating additional stakeholders and increasing the amount of time it provides for teaching, monitoring, and assessment of participants.

Conclusion

Analysis of Live Life Well indicates that it is an effective program in the prevention and delay of type II diabetes among Australian adults because it employs both primary and secondary preventive strategies.

Live Life Well is a preventive program that relies on behavioural changes in reducing or eliminating risk factors of type II diabetes or promoting healthy lifestyle among Australian adults.

References

Centers for Disease Control. 2014, National Diabetes Prevention Program. Web.

Fienieg, B., Nierkens, V, Tokens, E, Plochq, T, & Stronks, K 2012, ‘Why play an active role? A qualitative examination of lay citizens’ main motives for participation in health promotion’, Health Promotion International, vol. 27, no. 3, pp. 416-426.

Geense, W, Glind, I, Visscher, T, Achterberg, T 2013, ‘Barriers, facilitators and attitudes influencing health promotion activities in general practice: An explorative pilot study’, BMC Family Practice, vol. 14, no. 20, pp. 1-10.

Gregg, J, & O’Hara, L 2007, ‘Value and principles evident in current health promotion practice’, Health Promotion Journal of Australia, vol. 18, no. 1, pp. 7-11.

Heritage, Z, & Dooris, M 2009, ‘Community participation and empowerment’, Health Promotion International, vol. 24, no. 1, pp. 45-55.

Lardon, C, Soule, S, Kernak, D, & Lupie, H 2011, ‘Using strategic planning, and organizational development principle for health promotion in an Alaska Native community’, Journal of Prevention & Intervention in the Community, vol. 39, no. 1, pp. 65-76.

National Public Health Partnership 2006, The language of Prevention. Web.

New South Wales Ministry of Health 2014, Live Life Well. Web.

Sharma, M, & Majumdar, P 2009. Occupational lifestyle diseases: An emerging issue. Indian Journal of Occupational & Environmental Medicine, vol. 13, no. 3, pp. 109-112.

Song, S, & Hardisty, C 2009, ‘Early onset type 2 diabetes mellitus: a harbinger for complications in later years: Clinical observation from a secondary care cohort’, International Journal of Medicine, vol. 102, no. 11, pp. 799-806.

Vermunt, P, Milder, I, Wielaard, F, Baan, C, Schelfhout, J, Westert, G, & Oers, H 2013, ‘Behavior change in a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention content’, BMC Family Practice, vo. 14, no. 78, pp. 1-8.

World Health Organization 2010, Milestones in Health Promotion: Statement from Global Conferences. Web.

Introduction

This paper analyzes data of three hundred individuals’ health records. The data summarizes the diabetes status of the sample and presents their medical, social, physical and economic characteristics. Previous public-health studies have investigated and identified the relationship between variables and the prevalence of diabetes. The results will be compared with the findings of previous research on diabetes.

Ten variables used to analyze the results were gender, race, salary, education, height, weight, Body Mass Index (BMI), allergies, family history of diabetes, and family history of allergies. Subsequent sections analyze the relationships between the variables.

Analysis

The relationship between each variable and diabetes may be observed by comparing the mean values for the two groups. Table 1 summarizes the mean values of the numerical variables for participants in the two groups.

Table 1: Descriptive Statistics of Numerical Variables

Two findings are deducible from the results presented in the table. The average age of those with diabetes was 70.47. However, those without diabetes had an average age of 38.95 years. This finding is supported by a previous study which reported that the decline in protein synthesis in aging tissues increased the risks of diabetes in older people (Yamamoto, et al., 2014).

The effect of income on diabetes is observed in the table. The average salary of those with diabetes is $45,522 and for those without diabetes is $70,226.45. These findings can be compared with previous research that suggested low-income earners were more likely to have diabetes than their wealthier counterparts (Lysy, et al., 2013).

Although discrepancies can be observed in the mean scores between the two groups, it is important to test the level of significance of these variations. Chi-Square tests and t-tests were used to investigate the significance of the difference in mean values. Table 2 summarizes the results of the Chi-square test. The p-values for salary (0.001), height (0.000), weight (0.000), BMI (0.000), family history of diabetes (0.000), and family history of allergies (0.000) showed the variables were related to diabetes.

The results are similar to previous studies, which suggest that income (Lipscombe, Austin & Manuel, 2010), physical characteristics (Narayan & Boyle, 2007), and family history (Uusitupa, Stancakova, Peltonen, & Eriksson, 2011) are related to diabetes.

Table 2: Chi-square values and p-values

Table 3 summarizes the p-values derived from the t-test. The findings are similar to the p-values derived from the chi-square tests however the p-value for age (0.000) derived from the t-test suggests a significant relationship between age and diabetes (Creatore, Moineddin & Booth, 2010).

Table 3: t-test values and p-values

References

Creatore, M. I., Moineddin, R., & Booth, G. (2010). Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada. CMAJ, 182(8), 781-789.

Lipscombe, L. L., Austin, P. C., & Manuel, D. G. (2010). Income-related differences in mortality among people with diabetes mellitus. CMAJ, 182(1), E1-E17.

Lysy, Z., Booth, G., Shah, B., Austin, P., Luo, J., Lipscombe, L. (2013). The impact of income on the incidence of diabetes: a population-based study. Diabetes Research for Clinical Practice, 99(3), 372-379.

Narayan, K. M., & Boyle, J. P. (2007). Effect of BMI on lifetime risk for diabetes in the U.S. Diabetes Care, 30(6), 1562-1562.

Uusitupa, M. I., Stancakova, A., Peltonen, M., Eriksson, J. G. (2011). Impact of Positive Family History and Genetic Risk Variants on the Incidence of Diabetes. Diabetes Care, 34(2), 418–423.

Yamamoto, K., Kitano, Y., Shuang, E., Hatakeyama, Y., Sakamoto, Y., Honma, T., & Tsuduki, T. (2014). Decreased lipid absorption due to reduced pancreatic lipase activity in aging male mice. Biogerontology, 15(5), 463-473.

Abstract

This paper will discuss the different types of diabetes found in different countries, the rate of growth of diabetes and how the new product helped in achieving all the above objectives. This group work will develop a short term market objective for the company products using the simple, measurable, attainable, realistic and timing method. The short term objectives are to be achieved within one year.

Background information

After inventing a new and effective instrument that could easily and quickly detect the quantity of insulin and glucose in the body, the group decided to choose a company that symbolizes the instrument.

The company chosen is known to be a leading one when it comes to matters related to diabetes for the past quarter of a century. It goes by the name Medtronic Inc, and the equipment they were to symbolize was Quik Fik. The company then set out to carry out their research and set the short term objectives as below.

Objectives

• To find out the general growth rate of diabetes in the selected countries.
• To find out the different types of diabetes in the selected counties.
• To find out the type of diabetes that is more common among men, women, and children.
• To find out at what stage it is advisable to administer the use of the new equipment and how effective the result would be.

Introduction

Medtro Inc. Company was built about sixty years ago for the purpose of supplying medical materials in America. This company is known to have set a worldwide pace in the health business and expertise. As said earlier the company was to symbolize the QuikFik equipment. This instrument is meant to manually monitor the amount of glucose in the body and mechanically dispense insulin depending on the outcome.

It is one of the many American companies that are known to use the collective insulin pump and glucose check up method. The company was meant to introduce the new Quik Fik facility in a distant environment. Medtro Inc is best acknowledged for its properly structured insulin pumps and their regular glucose examination process (Medtronic.com, 2010).

The new instrument allowed diabetic patients to check and be able to contain their daily glucose quantities so that they could be able to live a more proactive life.

It was believed to be the most appropriate company to represent this highly manufactured equipment that was hoped to save many lives since they operated simultaneously with physicians from various parts of the world who also worked hard to help diabetic people live full and active lives.

Among their recent technological developments are medical supply services to their patients, analytical equipment, and automatic machines (Medtronic.com, 2010).

Discussion

The number of diabetic patients in the world is noted to be increasing at an alarming rate. This has made researchers to come up with products that can help in doing away with the mechanisms to contain the users. The rate of diabetes varies widely from children to adults. In 2006, mortality report ranked diabetes as the seventh cause of death. Diabetes is grouped into three types: type 1, type 2 and gestation diabetes.

Gestation diabetes affects only expectant women at the 28^th week though its prescription does not signify that a woman had diabetes before conception or will have it after delivery. Type 1 diabetes is common in children and young adults. It is also called juvenile diabetes. Type 2 diabetes occurs when the body fails to release enough insulin or when the cells disregard the released insulin (American Diabetes Association, 2010).

The Quik Fik instrument has been proven to be very effective in containing diabetes since it has an insulin pump with true glucose detection ability. It alerts the patient to check his or her glucose level by beeping.

The person monitors the glucose quantities by drawing small amounts of blood from their fingers and put it on the testing part of the device. It then tells the patient how much glucose the body requires. The device could be used at any stage and at any age.

The countries were chosen based on different issues such as diabetic pace in each country, purchasing ability, and the availability of machinery, if they could export and invest it (Sands & McPhil, 2003).

A research by Khoury, Martel and Yourougou (1994) argues that it is important to choose the countries with the largest cases of diabetes because they have the most need and demand for the product. This helps in making concise deduction as the product will be used most frequently and the data collected will be consistent (Khoury, Martel & Yourougou, 1994).

Conclusion

The objectives of the group could be met and the device effectiveness was realized. The counties chosen were Mexico, Slovakia, Greece and the United Kingdom. United Kingdom was chosen because it has a concrete economy and had a high capability of collecting data that enabled Medtronic Inc to implement long term changes for success in the equipment.

Reference List

American Diabetes Association. (2010). Diabetes basics. Web.

Khoury, N., Martel, J., &Yourougou, P. (1994). A Multi-criterion approach to country selection for global index funds. Global Finance Journal, 5(1), 17.

Medtronic.com (2010). About Medtronic. Web.

Sands, J., & McPhil, J. (2003). Choice criteria of listed Australian public companies for selecting an auditor: an exploratory study. International Journal of Business Studies, 11(1), 19-133.