Category: Diabetes

Diabetes and Drug Treatments

Differences between Types of Diabetes

The first type of diabetes is Type 1 diabetes, which affects approximately 5-10 percent of all people diagnosed with this disease. This is an autoimmune disease most frequently met in children and young people under 20. The pancreas of such patients is unable to produce insulin, or its quantity is insufficient. The cause of the condition is unclear. There are scholars who believe that Type 1 diabetes is genetic, and the cells of the pancreas are not developed properly – therefore, their functioning is impaired.

However, there are also those who think that the major cause of the condition is a virus that affects the pancreas, destroying its cells. The disease is incurable, and patients who suffer from it need insulin shots or a pump for life (coupled with proper nutrition to prevent blood sugar fluctuations) (Atkinson, Eisenbarth, & Michels, 2014). This type is sometimes referred to as juvenile diabetes.

The second type, Type 2 diabetes, is not inborn and is typically found in elderly or overweight people (adult-onset). Yet, the number of cases of children and young people diagnosed with this type is on the rise, mainly due to fast food and inactivity. This is the most frequently met of all types of diabetes (90% cases). The key difference from the previous type is that the pancreas of patients produces insulin (although its amount can also be insufficient), but the body cannot use it in a proper way.

Furthermore, unlike Type 1, Type 2 diabetes is a lifestyle disease as it mostly appears in obese people who lead a sedentary life. This implies that it can be prevented (Kahn, Cooper, & Del Prato, 2014). However, it must be noted that heredity and age also range among the risk factors.

The third type is gestational diabetes, which affects pregnant women (usually during the second trimester) and is met in 4% of all cases of diabetes. Unlike the types described above, this condition disappears after the baby is delivered (although it is likely to appear in the next pregnancy). The older the woman is when she gets pregnant – the higher the risk of developing gestational diabetes. This condition also increases the patient’s risk of having Type 2 diabetes (Moyer, 2014).

Treatment of Type 2 Diabetes

Metformin is one of the most common drugs prescribed for patients suffering from Type 2 diabetes. For proper preparation for metformin administration, the patient needs to lose weight and become more physically active since otherwise, blood sugar cannot be lowered. They also need to be tested for glycosylated hemoglobin, blood glucose, hematologic parameters, and renal function and informed about the risk of lactic acidosis. The administration starts from 850 mg once a day or 500 mg twice a day (the response is visible at doses above 1500 mg). The medication is given with meals (Lalau, Arnouts, Sharif, & De Broe, 2015). The diet must be plant-based, high in fiber, and low-fat to ensure due blood sugar control. Simple sugars must be excluded. Excess of body iron is also to be avoided.

Short-term effects of Type 2 diabetes include increased thirst, fatigue, frequent need to urinate, pain in the feet and hands, etc. In the long term, the disease damages all body systems. Diabetes leads to coronary heart disease, elevated blood pressure, diabetic retinopathy, sexual dysfunction, digestive problems, slow wound healing, sexual dysfunction, high cholesterol, diabetic nephropathy, etc. Since the body of the affected is unable to use insulin properly, diabetes medications are aimed to increase its sensitivity to insulin. As a result, the hormone is used more effectively (Kahn et al., 214). Furthermore, they prevent the liver from excessive production of glucose.

Fibromyalgia

Fibromyalgia is a condition that causes musculoskeletal pain, memory loss, fatigue, mood issues, headache, depression, irritable bowel syndrome, anxiety, and sleep disturbances, which may result from surgery, trauma, psychological stress, or infection. The disorder is more commonly met in women. Other risk factors include family history (an individual is more likely to develop the condition if a relative has it) and other disorders (such as rheumatoid arthritis, osteoarthritis, etc.) (Clauw, 2014). Fibromyalgia is currently incurable but can be relieved with relaxation, exercise, and other stress-reducing measures.

The disease is managed by different types of medications. First and foremost, pain medications are administered to deal with muscle spasms, pain, and fatigue. Antidepressants (duloxetine and milnacipran) are block pain signals. Patients can also be recommended to take serotonin inhibitors. Anti-epileptics are required to slow down nerve signals (lyrics and Neurontin are often prescribed for this purpose).

Benzodiazepines relax muscles, help relieve tension, and improve the quality of sleep (valium is the most common one). The same function is performed by muscle relaxants (such as Flexeril and cycloflex). Non-narcotic analgesics (tramadol) kill pain; however, they are not as strong as narcotic analgesics (opioids), which are used only when other drugs are ineffective (Häuser, Walitt, Fitzcharles, & Sommer, 2014). Finally, over-the-counter painkillers can be added to other types of drugs.

Gender is one of the major factors that impact the effects of medications. As has already been mentioned, the disorder is more common in women. They have more symptoms, and their discomfort lasts for longer periods, which requires an increased dosage and prolonged treatment. Women have up to 18 tender points (as compared to 6 points in men). This accounts for the fact that over-the-counter painkillers are often ineffective for female patients. They are also more sensitive to antidepressants and are likely to develop side effects (Clauw, 2014). One of the ways to reduce them is doing yoga, which teaches relaxation techniques, increases muscle strength, and helps with headaches.

References

Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82.

Clauw, D. J. (2014). Fibromyalgia: A clinical review. Jama, 311(15), 1547-1555.

Häuser, W., Walitt, B., Fitzcharles, M. A., & Sommer, C. (2014). Review of pharmacological therapies in fibromyalgia syndrome. Arthritis Research & Therapy, 16(1), 201. Web.

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

Lalau, J. D., Arnouts, P., Sharif, A., & De Broe, M. E. (2015). Metformin and other antidiabetic agents in renal failure patients. Kidney International, 87(2), 308-322.

Moyer, V. A. (2014). Screening for gestational diabetes mellitus: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 160(6), 414-420.

When diabetes enters the doors of someone’s life the life of this person changes dramatically. Diabetes is a disorder of metabolism. It is characterized by inappropriately high blood sugar which is the result of either low level of the hormone insulin or of abnormal resistance to insulin’s effects. The percentage of people in the USA suffering from the disease is rather high: 7.0 percent of the population has diabetes, of a serious, lifelong condition. This comprises 20.8 million, among this number 14.6 million have been diagnosed and 6.2 million have not yet been diagnosed. All those people wait for the effective cure from the disease that tortures them. But unfortunately, we may state the fact that there is no such a cure for diabetes.

As diabetes is a disease in which the body does not produce or properly use insulin, it is a diffused opinion that injecting insulin is a cure for diabetes. Indeed, insulin allows a diabetic to survive, but the consequences of the blood sugar level controlled in such a way has may turn to be really devastating ones. The thing is that a diabetic’s insulin injections cannot be appropriately adjusted to maintain safe sugar level unlike the precise matching of blood sugar and insulin levels that occur in the sound body.

There are two possible side-effects of injecting insulin. When it drives blood sugar level too low, the diabetic’s reactions include confusion, loss of consciousness, coma, or even death. The second type of the consequences that injecting insulin might have is when the blood levels rise. The diabetic is amendable to eyes, kidneys, nerves and heart diseases. It comes out that insulin is not a cure for diabetes, as it fails to restore the person’s ability to adjust insulin production to match the uncontrollable variations of sugar that come from a normal life.

The problem of cure for diabetes should be regarded in terms of different types of the disease. Actually, there are three of them. The two principal forms of diabetes are types 1 and 2.

Type 1 diabetes refers to childhood-onset diabetes, juvenile diabetes and insulin-dependent diabetes. Type 2 diabetes embraces adult-onset diabetes, obesity-related diabetes and non-insulin dependent diabetes. The so-called type 3 diabetes is also known as gestational diabetes. It may develop late in pregnancy and either disappear after the birth of the baby or progress into the type 2 diabetes.

Considering the first type of the diabetes we should say that there are numerous ongoing researches on various approaches to cure it. But there is no sufficient cure found. The disease is expected to be cured by replacing the pancreas or the beta cells. Transplants do produce insulin but the reaction of the immune system for them leaves much to be desired. Moreover, the transplants generally remain on long-term immunosuppressive drugs and the immune system will work out a host versus graft response against the transplanted organ. Thus, the main objective of the research is to develop the transplant therapy so that it does not harm the human’s body.

Most scientists believe that curing type 1 diabetes means causing endogenous ability of the body to react to the level of blood glucose by means of producing insulin and their attempts do not go behind this aim. Whereas other approaches such as closed-loop integrated glucometer or insulin pump products may also turn beneficial. They may sufficiently increase the quality of life of those who suffer from diabetes type 1 and may be regarded as artificial pancreas. We are inclined to believe that research should be conducted in this sphere that seems to be a much promising one.

As for the second type of diabetes, scientists claim that it can be cured by bariatric surgery known as gastric bypass. In the process of this therapy the stomach’s size is reduced and the small intestine changes its direction to minimize calorie intake. Though this surgery has been successfully performed, it cannot be applied to all patients as the weight loss is not healthy for all.

Fortunately, the gestational diabetes can be cured by means of a simple diet that a pregnant woman keeps on. The cure for this diabetes type is the best explored.

Scientists state that diabetes has reached pandemic levels; therefore immediate measures are to be assumed. The cure for diabetes should be characterized by the following:

• The source of islets should not depend on human donors, but must be abundant;
• The use of the suppressing drugs should be reduced to minimum;
• The islets should not introduce any pathogens;
• The risk and the complexity of the transplantation procedure should be reduced to minimum.

Besides the approaches to the diabetes cure cited above there are also gene therapy approach, stem cells approach, spleen cells approach, nanotechnology approach, aspirin with electrophoresis approach and a lot of others which are aimed at curing the disease. Contributing to the problem, all of them have a rather one-sided nature which does not influence positively its solution.

Works Cited

1. “Beta Cell Biology Consortium.” Environmental Health Perspectives 109.2 (2001).
2. “Diabetes.” Ebony. 1999: 111.
3. Aitken, Murray, et al. “A License to Cure.” The McKinsey Quarterly (2000): 80.
4. Chappell, Kevin. “A Surgical “Cure” for Diabetes? Nine out 10 Gastric-Bypass Patients with the Disease Report Dramatic Drops in Blood Sugar Levels, but Some Doctors Warn about Taking Such a Drastic Step.” Ebony. 2007: 84+.
5. Chappell, Kevin. “Diabetes Management Goes High-Tech; New Devices, Personalized Care Help to Control Deadly Disease.” Ebony 2006: 158+.
6. Chappell, Kevin. “Diabetes Treatment, Research & Cure.” Ebony. 2005: 126+.
7. Gavin, James R. Iii. “Diabetes.” Ebony. 2000: 52.
8. Randal, Judith. “Insulin Key to Diabetes but Not Full Cure.” FDA Consumer 1992: 15+.

Introduction

Long-term conditions consist of chronic illnesses that cannot be cured, although they can be managed through medication (Carrier 2015). In the United Kingdom (UK), long-term conditions undermine the health status of at least 15 million people. Hence, the need to improve the quality of healthcare provided to the population is inevitable. The leading long-term conditions in the UK include diabetes, arthritis, asthma, persistent obtrusive pulmonary syndrome, and hypertension. The prevalence of long-term illnesses is usually higher among older people compared to younger ones. In this respect, the prevalence of chronic illnesses among individuals above 60 years old is at an alarming 58% compared to the mere 14% among individuals below 40 years old (Wilson & Mayor 2006). Further, older people in the lower social classes are more vulnerable to long-term illnesses compared to their rich counterparts since the prevalence currently stands at 6-% and 30% respectively.

The National Health Service (NHS) England has put in place measures to facilitate the management of long-term care in the country, especially in older people. Currently, NHS focuses on the instillation of relevant skills that assist people who are suffering from long-term illnesses to manage their health (Newbould et al. 2012). Further, the health body considers the personal needs of individuals affected by long-term diseases in developing care plans (Costello 2009). Diabetes is one of the most worrying long-term conditions in the UK. England has recorded at least a million cases of people diagnosed with diabetes (González et al. 2009). Similar to the case in other countries, the risk of developing diabetes in the UK increases with age. In this respect, the need to enhance the efficiency of treating diabetic patients in the UK is crucial for improving the well-being of the population affected by the long-term condition (McVeigh 2009). Important to note, diabetes is one of the long-term conditions that have put the older population in the UK under the end of life care. As such, this paper provides a critical exploration of the care and treatment of a person with diabetes.

Diabetes: A Long-term Condition

The diabetes condition occurs due to the inability of the body to generate or respond to insulin hormones, thus leading to the abnormal breakdown of carbohydrates, as well as heightened levels of glucose in the blood and urine. The failure to treat high glucose levels can result in the development of complications that threaten the health status of an individual considerably. Type 1 and Type 2 diabetes constitute the two main sorts of long-term conditions. About 90% of individuals diagnosed with diabetes have the Type 2 condition, while the Type 1 sort is reported by the remaining 10% (Cowie et al. 2009). Nonetheless, the two categories of diabetes are critical. Thus, they require proper treatment and management.

The pancreas generates the insulin hormone that is crucial for the effective functioning of an individual’s system. The breakdown of food containing carbohydrates to extract glucose requires insulin to move it to the cells. The cells require glucose to generate energy for a person. Therefore, to keep the body energised unceasingly, the efficient functionality of insulin is significant for maintaining the well-being of a person (Wilson & Mayor 2006).

Several symptoms suggest the development of diabetes on an individual. Early detection of the symptoms of diabetes is crucial for timely medical interventions that can foster the effectiveness of managing the long-term condition. The common symptoms of diabetes include frequent urination, especially at night, increased hunger and thirst, unusual fatigue, effortless weight loss, skin infections, and nausea. Additionally, other symptoms of diabetes include blurred vision and slow healing of wounds (Posnett & Franks 2008).

Diabetes as a long-term illness has a considerable effect on the psychological, physical, and material well-being of an individual besides their family. Adversely, diabetes can lead to the development of other health conditions, including stroke, cardiovascular disease, kidney failure, blindness, and amputation (González et al. 2009). Therefore, the essence of mitigating the prevalence of the long-term condition in countries such as England is important for improving the wellness of the population, a move that can also help to cut healthcare costs.

Notably, proper preventive mechanisms have the potential of hindering the development of Type 2 diabetes while at the same time delaying its onset. Further, the efficient management of the diabetes condition increases an individual’s life expectancy. The need to engage in the proactive, preventive, and patient-centred management of diabetes also reduces the chances of developing related complications. Important to note, self-management is one of the fundamentals of managing the long-term condition effectively (Carrier 2015).

The Prevention of Diabetes

Between the two sorts of diabetes, Type 2 diabetes is on an alarming increase in the UK. Currently, 85% of the people diagnosed with diabetes have the Type 2 condition. Type 1 diabetes claims 15% of the diagnosed population (Newbould et al. 2012). In this concern, the NHS has put in place measures that seek to prevent the prevalence of the two types of diabetes. Additionally, the NHS also focuses on the reduction of inequalities that influence the risk of developing diabetes. The health agency also monitors the effectiveness of various strategies aimed at reducing the prevalence of the life-long condition.

Undoubtedly, it is not possible to modify some of the diabetes risk factors, including family background, advancing age, and ethnic origin. For this reason, the NHS concentrates its preventive efforts on the modifiable risk factors, for instance, obesity and being overweight, physical inactivity, and abnormal body fat distribution (Wilson & Mayor 2006). In this case, the NHS, through its various programmes, has raised awareness regarding the necessary measures to take to prevent and reduce the cases of people developing diabetes. By so doing, the agency underscores the essence of self-management to reduce the chances of developing Type 2 diabetes.

One of the key interventions towards the prevention and reduction of the diabetes condition entails curbing and minimising the prevalence of obesity and overweight cases, as well as central obesity (Newbould et al. 2012; Margerson & Trenoweth 2010). The preventive measures usually prioritise vulnerable populations that have a great chance of developing diabetes. In the UK, the population vulnerable to the prevailing long-term illness includes minority ethnic communities. Through this preventive approach, the NHS encourages the general population to not only embrace healthy dietary habits but also engage in physical activity regularly (Allender et al. 2007). In this regard, strategies such as empowering groups that are vulnerable to diabetes while influencing them to change their lifestyles form some of the crucial preventive mechanisms that can help to reduce the incidence of diabetes.

To foster the effectiveness of the preventive measures, healthcare professionals need to acquire continuous education regarding diabetes, a serious long-term condition. In particular, the NHS supports programmes that seek to educate primary care practitioners. Continuous education usually focuses on risk factors for the two types of diabetes. Education and training also address the relevance of modifying diabetes risk factors as a way of preventing the occurrence of the condition in the UK (González et al. 2009). Moreover, the education offered to primary care experts needs to enlighten them on the working interventions that prevent, treat, and manage overweight and obese people besides the need to increase physical activity (Allender et al. 2007).

The Identification of Individuals with Diabetes

The NHS emphasises the importance of early identification of people with diabetes. In considerable instances, people usually do not know they have diabetes until the adverse health implications start to emerge. In this light, early detection of the long-term illness can curb the onset of related complications. For instance, early identification of Type 1 diabetes reduces the deaths caused by diabetic ketoacidosis (DKA) among children. Therefore, for the sake of fostering early identification of diabetes, the NHS has put in place measures, including raising awareness regarding the symptoms and signs of the long-term condition, regular testing and follow-up of high-risk populations, and opportunistic screening (Wilson & Mayor 2006).

The NHS executes programmes aimed at improving awareness about the signs and symptoms associated with diabetes. The initiatives normally seek to raise the awareness of both the general public and healthcare experts since they are the main stakeholders in managing the diabetes menace in societies such as the UK. Hence, the NHS facilitates the early identification of individuals who have diabetes to foster timely health care services and interventions (Posnett & Franks 2008).

Further, the NHS encourages healthcare institutions in the UK to offer regular testing and follow-up of people predisposed to a high risk of developing diabetes (Posnett & Franks 2008). For this reason, as a management intervention, health organisations should participate in testing and following up of the vulnerable individuals, including the older persons and minority ethnic groups. Additionally, opportunistic screening of individuals exposed to several diabetes risk factors is also integral in facilitating the identification of formerly undiagnosed diabetes. Importantly, the early identification of ineffective glucose regulation is one of the proactive approaches encouraged by the NHS to manage the life-long condition.

Moreover, initiatives that are geared towards increasing the identification of diabetes in the general population prompt the NHS and partner agencies to engage in plans at the local level (Wilson & Mayor 2006). The local plans integrate a collaborative approach that requires stakeholders to play active roles that enhance the identification of diabetes as a strategy for mitigating the menace of long-term conditions in the UK. The key stakeholders that facilitate the identification of diabetes include NHS staff, primary and community health care staff, hospital staff, cardiology specialists and renal teams, and residential and nursing home staff. Other stakeholders include podiatrists, dentists, optometrists, and pharmacists. The collaboration of the high-risk population as an important stakeholder is equally crucial for reducing the cases of diabetes.

Clinical Care and Management of Diabetic Adults

The provision of clinical services to individuals with diabetes primarily pursues the maximisation of their quality of life entirely (Coulter, Roberts & Dixon 2013). The NHS also advocates for the delivery of quality care services to minimise the risk of triggering the long-term complications associated with diabetes (Carrier 2015). In this case, the NHS requires the health institutions in the UK to provide high-standard care in the entire lifetime of children and adults diagnosed with diabetes (Edge, James & Shine 2008).

Several clinical interventions facilitate the care and management of the diabetes condition among adults (Gately, Rogers & Sanders 2007). Healthcare facilities administer treatments that seek to enhance the control of blood sugar. The clinical intervention is crucial among people diagnosed with either Type 1 or Type 2 diabetes since it curtails the onset of microvascular complications related to the long-term condition (Wilson & Mayor 2006). Improvement of blood sugar regulation also reduces the chances of a diabetic patient to develop cardiovascular disease.

Further, healthcare professionals could apply drugs or treatments that seek to regulate the heightened blood pressure of an individual diagnosed with diabetes, as well as co-existing hypertension (Cowie et al. 2009). The caring approach is essential for lessening the risk of developing related health issues, including microvascular complications and cardiac disease. The administration of medical intervention geared towards controlling the blood pressure of an individual affected directly by diabetes aims at curbing the emergence of other chronic complications that could worsen the health of the patient.

The treatment of adults diagnosed with diabetes also requires the health care provider to pursue the patient to consider ceasing smoking since the habit heightens their chances of acquiring a cardiovascular illness or microvascular complications (Carrier 2015). Notably, the NHS encourages the general population to take part in managing the long-term conditions that undermine the improvement of their health status. Thus, influencing the affected population to change its lifestyle habits to improve the status of health is one of the key strategies towards fostering the efficiency of managing long-term conditions.

Moreover, as a management strategy, health care professionals encourage people with diabetes having high cholesterol levels to engage in practices that cut the cholesterol level in their body (Sutherland & Hayter 2009). The treatment approach aims at preventing the emergence of other long-term conditions, especially cardiovascular disease. Nonetheless, there is a need to enhance the quality of diabetes care in the UK since the current state shows an increase in its prevalence among different sections of the population. In this respect, constant recall and review of adults with diabetes is the right step towards improving the quality of care and management of the long-term condition.

Clinical Care and Management of Diabetic Children

On the other hand, the NHS has put in place measures that ensure the provision of high-standard care and management of children with diabetes in the UK. Importantly, the clinical services administered to kids take into consideration the special needs of the children patient group (Wilson & Mayor 2006). Amid the low prevalence of diabetes among children, the administration of clinical interventions to children facilitates the ability of the patients to effectively manage the issue from a young age through adulthood (Edge, James & Shine 2008). Therefore, the NHS underlines that the transition from paediatric diabetes care and management to adult diabetes services needs to be smooth, thus fostering continued treatment to boost the life expectancy of the individual (Marmot & Wilkinson 2006).

The NHS collaborates with the education sector in facilitating the clinical care and management of children with diabetes in the UK. For this reason, the Department of Health (DH) in the UK encourages education staff to acquire training about the identification of new-onset diabetes among children attending school (Crossland & Dobrzanska 2007). The early recognition of diabetes among children plays a considerable role in preventing the advancement of the condition to diabetic ketoacidosis. Notably, diabetic ketoacidosis is a serious complication of the long-term condition that can lead to death. Therefore, for the sake of prolonging the life expectancy of children experiencing the diabetic condition, education staff and healthcare professionals need to engage in efforts that facilitate the identification of the long-term condition at an early stage before advancing to a level that is difficult to manage (Sutherland & Hayter 2009).

Further, efforts such as the clinical care and management of children with diabetes have seen the NHS collaborate with small intervention groups (Crossland & Dobrzanska 2007). Notably, small intervention groups, including the young people with or without their parents who can advocate for strategies that detect the long-term condition at an early stage, have seen considerable support from the NHS. Such initiatives seek to address practical issues that revolve around the management of diabetes among children. Such forums provide opportunities for guiding and supporting the clinical care approaches, thereby enhancing the acquisition of knowledge regarding the essence of efficient blood sugar control, self-care, and management of the condition (Gately, Rogers & Sanders 2007).

Clinicians usually provide care that is geared towards facilitating the effective regulation of blood sugar to boost the physical growth and development of young people with diabetes (Sutherland & Hayter 2009). Importantly, medical interventions focus on reducing the development of long-term and acute complications related to diabetes. Besides, the NHS oversees the planned transfer of the care and management interventions from the paediatric to adult services. The smooth transition is integral in promoting the efficiency of self-care, as well as enhancing the realisation of desirable outcomes among people affected by the long-term condition.

Notably, the entire healthcare organisations in the UK engage in the assessment of diabetic children and young people. Further, healthcare providers seek the continuous care and management of children, as well as young people with the prevailing long-term condition (Russell et al. 2009). The facilities also put efforts that are geared towards identifying and following up young people and children who are not attending clinical care and management sessions. Moreover, the NHS facilitates the provision of suitable support to young people with diabetes in boarding facilities and care homes among other residential settings.

Improving the Care and Management of People with Diabetes in the UK

Through the NHS, the UK has shown a commitment to improving the delivery of services to people with diabetes (Posnett & Franks 2008). Notably, the health agency focuses on improving the various care and management aspects, including prevention, structured education, care process recommendations, observation of treatment standards, and empowerment. The NHS seeks to cut the rising prevalence of diabetes in the UK. As such, Public Health England implements the preventive strategies recommended by the NHS by carrying out campaigns that seek to bolster prevention and awareness of chronic illnesses, including diabetes (Khunti et al. 2007). In this respect, the NHS Diabetes Prevention Programme and the NHS Health Check constitute the major initiatives implemented to facilitate the prevention of the long-term condition in the UK.

Agencies such as the National Institute for Health and Care Excellence (NICE) emphasise the need for improving patient education in the UK to raise awareness on the proper ways of managing the condition (Russell et al. 2009). Undoubtedly, structured education plays an integral role in minimising the chances of developing complications related to diabetes. The education programmes are important towards improving the care and management of the long-term illness by bolstering knowledge, facilitating the control of blood glucose, underlining the essence of dietary and weight management, psychological health maintenance, and promoting physical activity (Dyson et al. 2011).

The Committee of Public Accounts has also endorsed health care providers in the UK to administer to at least 80% of diabetic patients with the nine recommended care processes to improve the care and management of the long-term illness by March 2018 (Khunti et al. 2007). The recommended processes incorporate a quality improvement approach to diabetes services by reinforcing the aspects of screening, identification, treatment, and follow-up. The recommendations are in line with the treatment standards developed by the NICE. The improvements have also seen more patients admitted in hospitals receive foot examination, reduction of medical errors, and the effective control of blood sugar levels.

Conclusion

Diabetes is one of the long-term conditions that affect a considerable population in the UK. To improve the care and management of people with diabetes, the NHS, among other relevant agencies, offers support programmes to healthcare professionals and other stakeholders who are affected by the health issue. Nonetheless, efforts that are geared towards the prevention, identification, and treatment of people with diabetes required reinforcement to realise a proactive and high-quality approach to attain greater success in combating the prevalence of the public health issue in the UK.

Reference List

Allender, S, Foster, C, Scarborough, P & Rayner, M 2007, ‘The burden of physical activity-related ill health in the UK’, Journal of Epidemiology and Community Health, vol. 61, no. 4, pp.344-348.

Carrier, J 2015, Managing long-term conditions and chronic illness in primary care: A guide to good practice, Routledge, London.

Costello, J 2009, Caring for someone with a long-term illness: Support for family and friends, Manchester University Press, Manchester.

Coulter, A, Roberts, S & Dixon, A 2013, Building better services for people with long- term conditions, The King’s Fund, London.

Cowie, L, Morgan, M, White, P & Gulliford, M 2009, ‘Experience of continuity of care of patients with multiple long-term conditions in England’, Journal of Health Services Research & Policy, vol. 14, no. 2, pp. 82-87.

Crossland, D & Dobrzanska, L 2007, ‘Case management: a collaborative approach between health and social services’, Primary Health Care, vol. 17, no. 7, pp.18-20.

Dyson, P, Kelly, T, Deakin, T, Duncan, A, Frost, G, Harrison, Z, Khatri, D, Kunka, D, McArdle, P, Mellor, D & Oliver, L 2011, ‘Diabetes UK evidence‐based nutrition guidelines for the prevention and management of diabetes’, Diabetic Medicine, vol. 28, no. 11, pp.1282-1288.

Edge, J, James, T & Shine, B 2008, ‘Longitudinal screening of serum lipids in children and adolescents with Type 1 diabetes in a UK clinic population’, Diabetic Medicine, vol. 25, no. 8, pp. 942-948.

Gately, C, Rogers, A & Sanders, C 2007, ‘Re-thinking the relationship between long-term condition self-management education and the utilisation of health services’, Social Science & Medicine, vol. 65, no. 5, pp. 934-945.

González, E, Johansson, S, Wallander, M & Rodríguez, L 2009, ‘Trends in the prevalence and incidence of diabetes in the UK: 1996–2005’, Journal of Epidemiology and Community Health, vol. 63, no. 4, pp.332-336.

Khunti, K, Gadsby, R, Millett, C, Majeed, A & Davies, M 2007, ‘Quality of diabetes care in the UK: comparison of published quality‐of‐care reports with results of the Quality and Outcomes Framework for Diabetes’, Diabetic medicine, vol. 24, no. 12, pp.1436-1441.

Margerson, C & Trenoweth, S 2010, Developing holistic care for long-term conditions, Routledge, Abingdon.

Marmot, M & Wilkinson, R 2006, Social determinants of health, Oxford University Press, Oxford.

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Introduction

The Chronic Care model is a framework that describes the routine delivery of care designed to improve patient health outcomes; in the case with mHealth, the model can be used to analyze the possibility of and barriers to implementation, as it outlines the basic concepts needed for successful intervention (Mallow et al. 2014). A study by Mallow et al. (2014) aimed to apply the Chronic Care model to review the implementation of mHealth as a treatment method for type II diabetes in rural areas of the United States.

The purpose of this essay is to reflect on the use of the model by Mallow et al. (2014) and to evaluate the possibility of applying the same approach to review the implementation of mHealth to improve diabetes care in the remote areas of UAE.

The Chronic Care model

The Chronic Care model is based on the assumption that delivery of care is determined by six distinctive components: the health system, self-management support, community support, decision support, clinical information systems, and delivery system design (Mallow et al. 2014).

All of the above factors have a significant influence on treatment outcomes. The Chronic Care model is particularly relevant to conditions where patient health depends both on the provision of treatment and on patient commitment, including cardiovascular diseases and diabetes. When applied to mHealth, the model helps to provide a critical overview of the factors that would affect the implementation of the scheme.

For instance, community resources and policies might affect the patients’ use of mHealth as they influence the patients’ information-seeking behavior (Mallow et al. 2014). The use of evidence-based practice and universal treatment protocols, on the other hand, can help to deliver high-quality care via mHealth technologies (Mallow et al. 2014). Overall, using the Chronic Care Model as the basis for evaluating and implementing mHealth initiatives can help to improve patient health outcomes and overcome the barriers to successful implementation.

In the UAE, diabetes is a widespread health issue: “In 2014, the International Diabetes Federation (IDF) reported that 19% of the UAE population of almost 9.5 million people had diabetes, the 16th highest rate in the world” (GSMA 2015, p. 2). The UAE is characterized by high internet penetration and extensive use of digital communication technologies, which makes it a suitable target for the implementation of mHealth technologies (GSMA 2015).

Nevertheless, similarly to the United States, the UAE presents certain barriers to the use of mHealth technologies. For example, the UAE lacks the universal use of the evidence-based practice, which might affect the application of mobile health initiatives (Albarrak, Abbdulrahim & Mohammed 2014). Moreover, there are also obstacles to obtaining approval for healthcare services from the Ministry of Health and cooperation with mobile operators working in the UAE (GSMA 2015).

Therefore, the implementation of mHealth services in the UAE should be part of a government scheme for improving health care provision, which would also include the improvement of evidence-based practices. Thus, applying the Chronic Care Model to the adoption of mHealth in the UAE would help to determine the possible constraints and opportunities affecting the implementation of the initiative.

Conclusion

Overall, Mallow et al. (2014) provide a useful example of how the application of the Chronic Care model could help to identify barriers to implementation of mHealth programs and improve their effectiveness in rural areas. The UAE could greatly benefit from the use of mHealth technologies to assist in the treatment of diabetes in remote communities. Therefore, applying the Chronic Care Model to the implementation of mHealth in the UAE would help to plan and introduce the intervention successfully.

Reference List

Albarrak, AI, Abbdulrahim, SAA & Mohammed, R 2014, ‘Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai’, Saudi Pharmaceutical Journal, vol. 22, no. 3, pp.207-212.

GSMA 2015, Mobile: a key enabler of public health strategies in the Gulf. Web.

Mallow, JA, Theeke, LA, Barnes, ER, Whetsel, T & Mallow, BK 2014, ‘Using mHealth tools to improve rural diabetes care guided by the chronic care model’, Online Journal of Rural Nursing and Health Care, vol. 14, no. 1, pp. 43-65.

Social justice is a critical concept in public health because it helps to ensure that people from various vulnerable populations can achieve better health. Nurse practitioners have an essential role in promoting social justice since they work closely with patients and other care providers. The present paper will discuss the contribution of the project to social justice and social change, as well as the health scholar-practitioners’ role in promoting positive change in healthcare.

The project focuses on adults aged 45-64 years who live in Bronx, NY and have type 2 Diabetes. There are two main factors that make this population vulnerable. First, according to Stringer (2015), Bronx has a relatively high share of uninsured persons. The lack of insurance creates critical barriers to obtaining proper healthcare, thus contributing to people’s risk of developing a variety of medical conditions.

Secondly, an established diagnosis of type 2 diabetes contributes to the vulnerability of this population. High blood glucose as a result of diabetes can lead to other health issues, including heart disease and stroke (U.S. Department of Health and Human Services, 2017). Poor access to care can also delay the treatment of diabetes mellitus and lead to patients developing complications of this condition, including kidney damage and diabetic foot ulcers.

The project will seek to improve social justice by identifying gaps in care for this vulnerable population and making recommendations for addressing them. For instance, if patient education is found to be a significant factor affecting diabetes management in the defined population, the project will help to bring this issue to attention and encourage care providers to improve patient education. Consequently, the project will also contribute to social change by spreading awareness about the influence of diabetes on the vulnerable population. This could help to support policy initiatives designed to improve access to care and achieve better health outcomes in adults with diabetes.

Nurses have a crucial role in leading positive change in healthcare. According to the Code of Ethics of the American Nurses Association (2015), patient advocacy and leadership should be among the primary values for nurses. Nurse practitioners often work more closely with patients than other care providers, which offers them insight into common healthcare issues affecting vulnerable populations. Nurses also have connections with professional organizations and play an important part in interprofessional teams, thus having a unique experience with the American healthcare system. This knowledge and experience can be used to determine focus areas policy initiatives targeting crucial healthcare issues.

However, for scholars-practitioners, practice experience is not the only thing that affects their role in leading positive change. They also have access to scholarly resources and can conduct studies exploring significant population health problems. This, in turn, can inform their position in leading positive social change. For example, research can provide evidence of links between poor health literacy and health expenditures.

Using this information as part of social change initiatives is essential because it would encourage policymakers to take action. Therefore, scholars-practitioners combine data from studies and their clinical experience to provide recommendations and advocate for positive social change in healthcare.

Overall, the project will contribute to social justice and social change by studying issues pertaining to the chosen vulnerable population. The project relates to scholar-practitioners’ role in leading social change, as it would provide information and evidence needed to inform policy initiatives and provide better patient care. As discussed above, scholars’ practitioners have a unique position in promoting social justice, as they can combine their practical experience and research to inform positive change.

References

American Nurses Association (ANA). (2015). Code of Ethics for nurses. Web.

Stringer, S, M. (2015). More than 962,000 New York City residents lack health insurance. Web.

U.S. Department of Health and Human Services. (2017). Diabetes, heart disease, and stroke. Web.

The discussed community of adults between the ages of 45 and 64 living in Williamsbridge, Bronx has a rising problem if type 2 diabetes. The majority of interventions for this problem include educational programs that target people’s dietary choices, physical activity, and health knowledge (Powers et al., 2017). However, while these initiatives have proven to be effective in lowering people’s glucose intake and decreasing their risk of obesity, diabetes, and cardiovascular problems, they failed to acknowledge the socioeconomic barriers of some communities.

In the Bronx, many people live under the poverty line, which significantly restricts their access to healthy food and medical care. Therefore, they may feel discouraged to adhere to interventions that are not tailored to their specific problems. A program that promotes health through dietary change should address the socioeconomic specificities of communities in the Bronx by offering educational classes that provide affordable alternatives to unhealthy but cheap foods.

Evidence-Based Behavior Change

Current evidence suggests that dietary choices substantially impact people’s development and management of type 2 diabetes. According to Franz, Boucher, Rutten-Ramos, and VanWormer (2015), change in one’s nutrition should become the main focus of patients who need to delay the onset of diabetes. The authors note that diets based on calorie restriction, fasting, unbalanced consumption of lipids and carbohydrates do not have a prolonged effect on the weight of patients. Moreover, such programs do not provide individuals with nutrients necessary for healthy processes in the body.

Therefore, weight loss should not be the sole reason for dietary recommendations as it is not the cause of the problem but a possible symptom. Healthcare providers should make sure that patients understand how their food choices may affect their well-being.

Intervention

Interventions that attempt to improve the nutrition of patients often include plant-based and Mediterranean diets. Dunkley et al. (2014) find that such advice is often neglected by individuals who do not have an opportunity of changing their choice of products due to economic constraints. For example, some people may live in a food desert or have a low income that cannot be spent on expensive foods. In the Bronx, many families live under the line of poverty which means that their diet is dictated by the products that they can afford.

The proposed educational intervention uses nutritional information about foods to teach people how to create specific dietary plans that lower the glucose and lipid intake without significantly affecting one’s expenses. This plan should incorporate the research about the harm of sugary drinks and meal plans that utilize affordable products (legumes, whole grains, seasonal vegetables and fruit). The educational material should be presented in an accessible form that underlines the fact that weight loss is not the primary goal that will result in improved health.

Outcomes

The intervention that aims to educate people about nutrition is expected to improve people’s dietary choices. One of the central goals is to reduce the intake of glucose by highlighting the effects of sugary drinks and processed foods. Thus, people’s blood glucose levels (HbA1c) can be considered a measurable outcome (Chen et al., 2015). Another possible measure is people’s BMI, although it is not as directly connected to the development of type 2 diabetes as HbA1c. Other conditions (blood pressure, obesity, and cardiovascular problems) that may be viewed as comorbidities should also be analyzed as a result of this intervention. Finally, the lowered rate of type 2doabetes in the population is the central goal of the intervention plan.

Conclusion

The communities of Williamsbridge have socioeconomic constraints that render many initiatives ineffective. Thus, medical professionals should design a program that incorporates financial limitations of the people at risk and provides them with a viable plan of action. The suggested intervention uses nutritional data that improves people’s dietary choices by educating people about unhealthy drinks and foods. Moreover, it provides them with meal plans that utilize seasonal and affordable alternatives. Finally, it underlines the fact that weight loss and drastic measures do not lead to positive health outcomes, but moderation and mindful consumption may help.

References

Chen, L., Pei, J. H., Kuang, J., Chen, H. M., Chen, Z., Li, Z. W., & Yang, H. Z. (2015). Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism, 64(2), 338-347.

Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., & Khunti, K. (2014). Diabetes prevention in the real world: Effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: A systematic review and meta-analysis. Diabetes Care, 37(4), 922-933.

Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447-1463.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H.,… Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.

Introduction

The problem that was identified as endangering the health of the selected population is type 2 diabetes. Statistics show that more than 10% of all adults living in New York have been told that they had diabetes in 2017 (America’s Health Rankings, 2017).

In the Bronx, adults from 45 to 65 years old are one of the groups most affected by type 2 diabetes. The community of the Bronx is defined by a diversity of ethnic groups with the prevalence of people who identify as Hispanic and African American (NYAM, 2014). Thus, the culture of the region is primarily influenced by these communities, including their religious and social ideologies. Currently, the problem of type 2 diabetes is considered to be an epidemic in the United States, and this issue has a significant impact on the African American community of the Bronx.

Health Problem and Population

They discussed health issue is type 2 diabetes – an acquired condition that is characterized by insulin resistance or insufficiency. According to the CDC (2018), the majority of people with diabetes have the second type, with people older than 45 being the largest affected group. Diabetes is a serious chronic disease that cannot be fully treated but can be managed. Moreover, some activities and behaviors are thought to reduce the risk of developing the condition. For example, healthy eating and exercise are strongly connected to type 2 diabetes and obesity, one of the risk factors (Albu et al., 2017). Another possible patient factor is race – non-white Americans are more likely to develop type 2 diabetes than white people (Menke, Casagrande, Geiss, & Cowie, 2015).

The population explored in this paper is represented by African American adults from 45 to 65 years old who live in the Bronx. In this community, diabetes is considered to be one of the most pressing problems for people of all ages (NYAM, 2014). In the Bronx, African Americans have higher rates of mortality, hospitalizations, and complications for diabetes than other groups, as can be seen in Table 1. The statistics for New York City and State reveal similar results, with the Bronx being a large contributor to such high numbers (NYAM, 2014).

Table 1. Diabetes Indicators in the Bronx, New York City, and State by Ethnicity/Race.

(“Bronx County health,” 2016; “New York City health,” 2016; “New York State health,” 2016).

The statistics also reveal a connection between diabetes development and socioeconomic factors. Type 2 diabetes is prevalent in people with the lowest incomes and low levels of education (America’s Health Rankings, 2017). It can be suggested that these individuals cannot have access to medical care and good products which can help prevent or manage the disease. The link between these findings and the population of the Bronx is strong as well. In the Bronx, more than 200,000 people are uninsured, constituting almost 10% of all people without health care insurance in the New York State (NYAM, 2014). Many of these people cannot afford medical assistance because they live below the poverty line.

Conclusion

The problem of diabetes is well documented on such health websites as the CDC, America’s Health Rankings, and New York Health. Their findings suggest that non-white adults over the age of 45 are at risk of developing type 2 diabetes, especially if they do not have financial resources to access health care. The population of the Bronx is primarily defined by such groups as African Americans and Hispanics. The communities living in this borough have a higher rate of diabetes than those living in the city and the state. The connection between people’s economic constraints and their living conditions explains why this type of diabetes is widespread in the community.

References

Albu, J. B., Sohler, N., Li, R., Li, X., Young, E., Gregg, E. W., & Ross-Degnan, D. (2017). An interrupted time series analysis to determine the effect of an electronic health record–based intervention on appropriate screening for type 2 diabetes in urban primary care clinics in New York City. Diabetes Care, 40(8), 1058-1064.

America’s Health Rankings. (2017). Diabetes in New York. Web.

Bronx County health indicators by race/ethnicity, 2012-2014. (2016). Web.

Centers for Disease Control and Prevention [CDC]. (2018). Type 2 diabetes. Web.

Menke, A., Casagrande, S., Geiss, L., & Cowie, C. C. (2015). Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA, 314(10), 1021-1029.

New York Academy of Medicine [NYAM]. (2014). New York City health provider partnership: Bronx community needs assessment. Web.

New York City Department of Health and Mental Hygiene. (2006). Diabetes is epidemic. Health Bulletin, 5(4). Web.

New York City health indicators by race/ethnicity. (2016). Web.

New York State health indicators by race/ethnicity. (2016). Web.

Introduction

Diabetes is a long-term condition associated with significant changes in lifestyle and quality of life. Due to its numerous social and psychological implications, it requires multifaceted care in order to be successfully treated. The following paper critically explores the components of long-term care and their impact on the quality of life of patients.

Aetiology and Disease Progression

Diabetes is a condition caused by abnormal levels of blood sugar. Two types of diabetes are commonly recognised, referred to as Type 1 and Type 2 diabetes. The causes and symptoms of the conditions are relatively similar, which complicates the differentiation between the two (Diabetes.co.uk, n.d.). However, a set of common characteristics exists that can be used to determine each type. For instance, Type 2 diabetes is more often diagnosed in older populations, is commonly associated with excessive weight and high blood pressure, and is treated with lifestyle changes, as well as medication (Diabetes.co.uk, n.d.).

There are also several aetiological differences that are more difficult to spot without professional medical assistance. Most prominently, Type 1 diabetes is caused by insulin deficiency, whereas Type 2 is characterised by insulin resistance, with relative deficiency playing a secondary role (BMJ Best Practice, 2017). Type 2 is also aggravated by ageing and lack of physical activity, which allows for treatment via the introduction of a healthy lifestyle and diet (BMJ Best Practice, 2017).

Since insulin resistance can be lowered through weight reduction which, in turn, decreases the severity of the condition, it is also often incorporated into the long-term care of patients with Type 2 diabetes. These differences also impact on the progression of the disease. As the body is able to produce more insulin to account for the resistance, Type 2 diabetes does not produce visible symptoms. For a person with the disease, this means that it can remain undetected for a long period of time. Unfortunately, such a scenario also means that a person cannot address the condition at a stage where it could be alleviated by simple lifestyle changes such as exercise and a healthy diet.

Consequently, by the time the condition is identified, such intervention would likely be insufficient and the person would require the introduction of medication such as injections (Curry, 2015). The condition worsens over time as the insulin resistance prompts the beta cells to generate more insulin, leading to their eventual failure. In this case, the injection provides necessary recovery time for the cells and prevents, or, at the very least, delays, their failure. Currently, the effects of treatment are transient, and while evidence exists that the condition is reversible, no reliable method has yet been established (Curry, 2015).

Psychological and Social Implications

Living with a long-term condition like Type 2 diabetes presents an individual with numerous challenging issues. The psychological and social implications created by the condition need to be acknowledged in order to ensure the effectiveness of treatment and account for any possible gaps in care.

The most evident psychological aspect of diabetes care is depression. A systematic review by Roy and Lloyd (2012) revealed that the rate of depression is much higher in individuals who suffer from diabetes, with a threefold increase among Type 1 diabetes, and an almost twofold increase in Type 2 sufferers. While the exact mechanism behind this relationship is yet to be established, the most likely reason is the decrease in quality of life associated with the chronic nature of the condition.

The majority of diabetes-associated effects decreases life expectancy and imposes serious limitations on lifestyle, the need for medication administration being the most recognised one. Since depression is also known to have a detrimental effect on the quality of life, the vicious circle scenario is possible, where negative effects become self-sustained (Roy and Lloyd, 2012). Finally, because certain unhealthy lifestyle choices, such as overeating, contribute to the development of the disease, it is possible that depression may aggravate the effects of diabetes, which is especially dangerous for individuals who already have Type 2 diabetes in the early phase but are still unaware of it and are not seeking treatment (Roy and Lloyd, 2012).

A follow-up study by de Groot et al. (2015) largely confirmed the findings of the previous researchers with some notable additions. Specifically, their findings suggest that patients suffering from both Type 2 diabetes and depression are less likely to be successfully treated with antidepressant medication and experience more complications with regards their overall care (de Groot et al., 2015).

According to Chew, Shariff-Ghazali, and Fernandez (2014), the efficiency of the provision of psychological support also decreases due to the additional challenges posed by the disease. At the same time, such deterioration of the psychological climate makes long-term care less effective due to the lower involvement of the patients, self-regulation, and self-cognition (Chew, Shariff-Ghazali and Fernandez, 2014). Simply put, the depression makes it more difficult for the impacted individuals to participate in long-term care and, by extension, lowers their chances of recovery.

The compromised emotional climate, combined with numerous new requirements (such as medication administration), can become an additional strain for the impacted individuals and their family members and lead to several social implications. A study by Mayberry and Osborn (2012) revealed that the support demonstrated by family members had a direct relationship with successful glucose control and medication adherence.

By contrast, patients who are subject to non-supportive behaviour of their relatives have more difficulties in maintaining a medication intake schedule and fail to measure blood glucose levels regularly. Taking into account the fact that some of the components of long-term care, such as injections and constant monitoring of blood glucose, are already difficult to maintain without disrupting established routines, it becomes apparent that unsupportive family can seriously lower the chances of successful treatment and, indeed, contribute to the worsening of the condition. A similar conclusion was made by Palladino and Helgeson (2012) after reviewing the results of the qualitative studies of adolescents with Type 1 diabetes.

The review results indicated an adverse effect of Type 1 diabetes self-care practices, such as injection self-administration, on relationships with peers. On numerous occasions, teens with the condition reported that their peers’ attitude could influence the effectiveness of self-care. While the study found no conclusive quantitative data to confirm these findings, it is reasonable to assume that the reported perception would be sufficient to disrupt both the efficiency of long-term care and social life, at least in some cases (Palladino and Helgeson, 2012).

The report issued by the Work Foundation further expanded the list of social issues pertinent to long-term conditions. The focus of the report was on the labour market, but several of the findings display an evident link to the social domain. For instance, people with long-term conditions retire earlier, note often going to work feeling ill, and report more difficulties in career growth and finding employment opportunities (Bajorek, Hind and Bevan, 2016).

By extension, their self-fulfilment opportunities are understandably limited. The decreased quality of life discussed above further limits employment options and decreases productivity and satisfaction (Bajorek, Hind and Bevan, 2016). For diabetic patients, in particular, the barriers to employment also minimise the possibilities of a healthy lifestyle and social interactions, contributing to an overall negative effect.

It is worth mentioning that the situation is not always acute. Many individuals with diabetes report little complications associated with the condition. In some cases, the insulin injections could be performed discreetly with little disruption of social interactions. Nevertheless, in all cases, a certain amount of skill is required to reach the level of proficiency and experience allowing for seamless self-care. In addition, these accounts do not provide a complete picture, and it is reasonable to expect that such alignment of care with social life is more uncommon.

Care and Treatment of Diabetes

The complexity of implications posed by long-term conditions, combined with the wide impact they have on a person’s life, requires an equally comprehensive approach to care. Numerous practices and approaches have been put forward in an attempt to account for these multiple impacts, ranging from professional guidelines to political directives.

Person-Centred Care

Currently, person-centred care is one of the most widely accepted and readily recognised components of long-term care. Interestingly, despite its wide adoption, the concept lacks a precise definition. This can be partially attributed to the fact that the concept is currently in the early stages of development and differs significantly across the areas of application depending on the individual preferences of each patient. Patient-centred care can be loosely defined as consisting of offering compassion and respect, ensuring personalised and coordinated care, and enabling individuals to recognise and utilise their strengths and abilities.

The NICE guidelines on the management of diabetes in adults acknowledge these components by pointing out that they were formed using the data from studies performed on younger adults (NICE, 2017). While there are reasons to expect some flexibility, enabling the application of the guidelines to wider age groups, a certain degree of caution is to be exercised in dealing with the older population (NICE, 2017).

This point is further emphasised in the first recommendation, where some of the most likely areas of individualisation are identified. These include personal preferences, the presence of other long-term conditions, reduced life expectancy, and various disabilities, such as visual impairment (NICE, 2017). In practice, the administration of insulin injection would create an additional challenge for an individual whose vision is in decline, so it would be necessary to account for this fact in their treatment plan. The principle is also partially visible in other recommendations, such as with dietary advice, where individualised nutritional advice is recommended, or in the complications section, where additional attention is advised in monitoring certain conditions, with specified deadlines for a referral to respective specialists (NICE, 2017).

For diabetes sufferers, such an approach would ensure a timely response to adverse health conditions and maintain, more effectively, consistent quality of life. Importantly, such an approach would also safeguard their rights as laid out in the NHS Constitution for England. For instance, person-centred care will ensure that patients are making informed decisions about their disease (or, in the case of patients under 16 years of age, that their family can provide adequate support to help their child with any decisions).

Person-centred care has been shown to improve patient outcomes on several occasions. In a study by Eaton, Roberts, and Turner (2015) the implementation of personalised care in 31 practices in Tower Hamlet, London, has yielded an increase from 52% to 82% in involvement in care. The outcomes of the patients improved after the introduction of the approach, and overall employee satisfaction also increased. Interestingly, such an approach does not necessarily result in increased expenditure, since additional time necessary for personalised care can be obtained through reorganisation of the practice (House of Commons Health Committee, 2014).

There is also evidence that person-centred care can, in some cases, provide necessary relief from tightly-controlled care plans. In some cases, such as when the declining diabetes condition opens up the possibility for more relaxed glucose goals, the person-centred approach provides the necessary relief of self-care burden, whereas in a more health-threatening scenario the intensification can be introduced to achieve the desired outcome (Hackel, 2013).

Simply put, the person-centred approach increases the flexibility of a long-term care plan and can decrease the intensity of treatment in cases where excessive rigour and tight control is unnecessary without creating a threat to patients’ health. By extension, it is possible to view this opportunity as a way to alleviate pressure from the patient and minimise some of the psychological and social implications discussed in the previous chapter.

Self-Management

Another important aspect of long-term care is self-management. As was discussed above, the condition requires constant care and, in most cases, the administration of medication. This requires a significant allocation of resources from care providers and disrupts established daily activities. Self-administration, on the other hand, requires commitment and a certain level of understanding that is rarely achievable without the patients’ active involvement in care delivery.

However, medication is not the only factor requiring self-management. Shrivastava, Shrivastava, and Ramasamy (2013) identify seven behaviours associated with positive outcomes – healthy diet, physical activity, responsible medication administration, blood sugar monitoring, coping skills, problem-solving skills, and risk avoidance. Notably, only the first four of these behaviours are apparently linked to medical practices, while the latter three exhibits an indirect connection. Nevertheless, all seven contribute to improved disease management, reduced complications, and an enhanced quality of life. Unfortunately, despite the evident benefits, these behaviours are not adhered to consistently and require the promotion on the part of clinicians in order to be observed.

The most evident way of promoting self-management is through patient education. NICE guidelines specifically mention the development of diabetes self-management skills in their education section (NICE, 2017). According to the Health Foundation, the strategies for self-management promotion can be broken down into four core categories: technical skill, self-efficacy, information provision, and behaviour change (de Iongh, Fagan and Fenner, 2015).

For instance, self-administered insulin injections would require technical proficiency, whereas the success of searching for additional information online would depend on both technical skills and information provision. Self-management can be facilitated through generic educational events which provide generalised information on long-term care, or through diabetes-specific courses that would focus on specific issues such as the ability to estimate food intake times with regard to insulin injections when eating out.

Motivational Interviewing

As is evident from the information above, self-care is a cornerstone to the effective long-term care of people with diabetes. Thus, numerous counselling practices have been looked into in an attempt to promote it. One such practice, motivational interviewing (MI), has yielded consistently positive results. Interestingly though, the exact effect of the practice is not yet clear. A study by Li et al. (2014) established a significant improvement in the Homeostatic Model Assessment-Insulin Resistance scores, as well as the elevation of self-management activities rating in the patients subjected to MI, but did not detect improvements in BMI scores and HbA1C levels.

On the other hand, a randomised controlled trial by Račić et al. (2015) identified improvements in both fasting blood glucose levels and HbA1c levels, as well as a positive effect on blood pressure. Nevertheless, it is generally agreed that the straightforward nature of counselling practice, as well as its orientation towards identification and resolution of ambivalence in patients, is primarily responsible for its high efficiency (Mitchell, 2012). The emphasis on the promotion of autonomy empowers the patients to adopt a proactive stance and increases their independence. Another important aspect of motivational interviewing is the possibility to improve health outcomes without pharmaceutical intervention or any significant change in daily routines.

Partnering

The far-reaching implications associated with long-term care have led to the introduction of the partnership concept. From this perspective, the collaboration between a care provider and a patient (commonly referred to as person-centred care) is viewed as a partnership, where the power and responsibilities are shared in an attempt to achieve the desired outcome. For the patient, such redistribution of responsibilities communicates equality and, by extension, communicates trust. However, at least two more partnering dimensions are needed to reach the desired level of improvement. First, partnering with other providers is recommended.

When facilitated with providers from other professional disciplines, such partnerships diversify the capacity of the organisation (World Health Organization, 2005). From the patients’ perspective, such a move introduces options that are otherwise unavailable and synchronises the efforts of different departments. As a result, long-term care becomes more consistent and focused on specific goals. In addition, the providers become more informed and are able to coordinate their actions.

Second, partnering with communities is defined as a separate category. Aside from the better connection to the families of the patients, it offers a better understanding of the cultural and social environment, which adds to the overall effectiveness of care. Such cooperation provides access to community organisations such as faith-based groups, local government, and media representatives, which further broadens the possibilities of care providers.

Assistive Technology

The development of informational technology in recent decades has provided additional opportunities for long-term care. For patients with diabetes, two main directions can be identified. First, communication technology has become more advanced. According to Lindberg et al. (2013), it enhances the convenience and reliability of communication between people with the condition, their families, and the healthcare professionals. For the former, such enhancement offers better security (since patients can easily and reliably contact their providers in an urgent situation) and access to information (as they can conveniently request clarification or further assistance).

Second, the technology known as telemedicine has reached a level of convenience and accessibility that allows its widespread adoption. For people with diabetes, it offers enhanced monitoring capabilities, where readings of blood glucose levels are automatically gathered, logged, and sent to a provider if necessary. Aside from the purely medical applications, such technology also allows lifestyle monitoring, which is especially important for elderly patients with Type 2 diabetes since it offers a cost-effective automated assistance solution. It is also worth noting that the automated nature of the assistive technology contributes to the safety of patients by eliminating human error – there is a smaller risk of patients with declining memory missing an important change in their physical condition.

Conclusion

Diabetes is a condition that requires comprehensive long-term care due to its aetiology. Both types of condition require significant changes in lifestyle and introduce the patient to several medical practices that can be challenging for them, both psychologically and socially. To account for this, long-term care follows a person-centred approach, emphasises self-management, utilises assistive technology, and encourages partnerships between community and care providers. The combined effect of these components ensures the successful mitigation of adverse health effects without compromising the quality of life of the impacted individuals.

Reference List

Bajorek, Z., Hind, A. & Bevan, S. (2016) The impact of long term conditions on employment and the wider UK economy. Web.

BMJ Best Practice (2017) Type 2 diabetes in adults – aetiology. Web.

Chew, B. H., Shariff-Ghazali, S. and Fernandez, A. (2014) ‘Psychological aspects of diabetes care: effecting behavioral change in patients’, World Journal of Diabetes, 5(6), pp. 796-801.

Curry, A. (2015) Type 2 diabetes progression. Web.

de Groot, M., Doyle, T., Averyt, J., Risaliti, C., and Shubroo, J. (2014) ‘Depressive symptoms and type 2 diabetes mellitus in rural appalachia: an 18-month follow-up study’, The International Journal of Psychiatry in Medicine, 48(4), pp. 263-277.

de Iongh, A., Fagan, P. and Fenner, J. (2015) A practical guide to self-management support: key components for successful implementation. Web.

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Eaton, S., Roberts, S., and Turner, B. (2015) ‘Delivering person centred care in long term conditions’, BMJ, 350, pp. 181-185.

Hackel, J. M. (2013) ‘Patient-centered care’for complex patients with type 2 diabetes mellitus—analysis of two cases’, Clinical Medicine Insights: Endocrinology and Diabetes, 2013(6), pp. 47-61.

House of Commons Health Committee (2014) Managing the care of people with long–term conditions. Web.

Li, M., Li, T., Shi, B. Y., and Gao, C. X. (2014) ‘Impact of motivational interviewing on the quality of life and its related factors in type 2 diabetes mellitus patients with poor long-term glycemic control’, International Journal of Nursing Sciences, 1(3), pp. 250-254.

Lindberg, B., Nilsson, C., Zotterman, D., Söderberg, S., and Skär, L. (2013) ‘Using information and communication technology in home care for communication between patients, family members, and healthcare professionals: a systematic review’, International Journal of Telemedicine and Applications, 2013, pp. 1-31.

Mayberry, L. S. and Osborn, C. Y. (2012) ‘Family support, medication adherence, and glycemic control among adults with type 2 diabetes’, Diabetes Care, 35(6), pp. 1239-1245.

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NICE (2017) Type 2 diabetes in adults: management. Web.

Palladino, D. K., and Helgeson, V. S. (2012) ‘Friends or foes? A review of peer influence on self-care and glycemic control in adolescents with type 1 diabetes’, Journal of Pediatric Psychology, 37(5), pp. 591-603.

Račić, M., Katić, B., Joksimović, B. N., and Joksimović, V. R. (2015) ‘Impact of motivational interviewing on treatment outcomes in patients with diabetes type 2: a randomized controlled trial’, Journal of Family Medicine, 2(1), pp. 1-6.

Roy, T. and Lloyd, C. E. (2012) ‘Epidemiology of depression and diabetes: a systematic review’, Journal of Affective Disorders, 142, pp. 8-21.

Shrivastava, S. R., Shrivastava, P. S. and Ramasamy, J. (2013) ‘Role of self-care in management of diabetes mellitus’, Journal of Diabetes & Metabolic Disorders, 12(1), pp. 14-21.

World Health Organization. (2005) Preparing a health care workforce for the 21st century: the challenge of chronic conditions. Web.

Introduction

Type two diabetes’ prevalence is known to increase with age and in young people, it is known to account for about 3% of all the other types, and in the U.S.A as high as 45% of the cases of patients suffering from diabetes due to type 2 which amount to about 16 million individuals. Reports indicate ever-increasing cases of type 2 diabetes between the ages of 18-40 years especially in ethnic groups with higher risks of type 2 diabetes. High risks are determined by family history, presence of metabolic syndrome like abdominal obesity but research indicates that high prevalence and symptoms of type 2 diabetes are greatly reduced by a well-controlled diet and enough exercise among the people exposed to these risks.( Kanerva,2004pp43-45)

Attitudes and beliefs among patients suffering from type 2 diabetes

Research data indicates most victims believe that diabetes mellitus also known as type 2 diabetes is greatly caused by the presence of the disease in the family history, high intake of food rich in sugar and fat while at the same time engaging in a very little exercise. Other factors that precipitate the condition are experiences of strong emotions like fright, acute anger, prolonged sadness as well as depression.

Most patients who participle in the oral interview express their belief in the importance of strictly following the recommendations designed by the doctors regarding diets and regular exercise, medication administered orally, herbal therapies such as aloe Vera and prickly pear cactus. Such information is important in designing interventions aimed at reducing the heavy burden of type 2 diabetes worlds wide. Most respondents in the study of perceived barriers concerning self-management of type 2 diabetes express feeling that the disease is a serious condition and its long-term complications can greatly be reduced if they controlled it through self-management activities.

In the study, personal models, as well as barriers, make a significant prediction regarding levels of self-management of diet, glucose testing, and exercise after the influence of demographic as well as medical history is controlled. The majority of the respondents amounting to 24% agree that there is a lot of benefit in taking medication and this belief is strongly associated with willingness to adhere to regular medication.

About 13% of the respondents have a negative belief and argue that regular intake of the medication can cause side effects which would include weight gain and that any change to their daily routine would only increase their difficulty to regularly take their diabetes medicines. These beliefs are important in informing intervention development, implementation of research findings as well as evaluation in studies that are randomized and controlled. (Philip, 2003pp33-39)

Practice in relation to exercise

controlled physical activity, appropriate endurance as well as resistance training are key therapeutic modalities for patients with type 2 diabetes but unfortunately, the majority of the patient underutilize it and this contributes to fast deterioration of tolerance to favorable changes in levels of glucose and sensitivity of insulin. Even when the patient has had a physical activity the tolerance can still deteriorate after 72 hours from the last session.

Most victims do not manage in achieving the recommended 1000 Kcal wk and have a lower level of fitness. They lack the information that exercise intensity requires to be maintained at a comfortable level at the beginning and then progressed cautiously until the patient improves intolerance. Lack of resistance training by the patients due to lack of understanding reduces their potential in improving muscle strength and reduces their body flexibility and therefore increases risks for cardiovascular diseases as well as a decline in glucose tolerance.

Most obese patients with type 2 diabetes exhibit a decline in blood glucose shortly after mild-to-moderate physical activity but the magnitude of the decline depends on the duration and intensity of the exercise which is attributed to a gradual increase in glucose utilization in the muscles during the exercise. Most patients who respond well to prescribe programs believe in benefits associated with physiological as well as psychological aspects of regular exercise because of the effect it has in reducing stress, depression.

The belief is that regular exercise heightens one’s self-esteem and plays a role in reducing emotional perturbation that is attributed to stressful events in their daily life but unfortunately these beliefs rarely receive much attention from the majority although they have a lot of benefits as far as self-management of the disease is concerned. Research indicates that management of type2 diabetes is stressful especially between the ages of 18-40 years one of the reasons being a reduction of activity as the individual gradually gets out of the teenage years when most individuals are known to be naturally very active.( Bolden,2006pp41-48)

Dietary habits

Among those who suffer from this condition of type 2, diabetes the majority have dietary habits that contribute to the development of a fatty liver which consequently increases the early development of diabetes mellitus. Most of them are obsessed and register a significantly high intake of diets with high content of fat and sugar compared with those without fatty liver especially conventionally in between meals as well as food rich in lipids and consumption of alcohol especially among non-aged.

Most of the participants usually have their diabetes well controlled when they start the program on dietary habits because they are able to change food habits and consequently register improvement in metabolic control. However, it is not everyone who engages in the dietary study who manages to change his food habits and some even literally disagree with the advice. Those participants who agree to take a fat-modified and fiber-enriched diet register a significant loss in body weight even after one week. (Dupre, 2001pp26-32)

An attitude of the patient with diabetes toward the disease

Research studies indicate a direct relationship between the condition of type 2 diabetes and the emotional health of the victims because when an individual with the condition is diagnosed he tends to feel hopeless and also upset and this is worsened when the victim starts experiencing difficulty in the management of the condition which eventually leads to the feeling of depression and anxiety. The patients who participate in the interview believe that when they are stressed out or directly sad this affects their blood sugar.

Among the factors cited by the most participant as the major contributors of the effect of emotions and diabetes are family stressors as well as those from society in general and therefore it is important for the patient with diabetes to be diagnosed of their emotional health to help in screening for stress and depression because this helps in eliciting preferences about their treatment when indicated. (Wayne, 2003PP19-26)

Conclusion

a clinically based study of young adults who have diabetes register varying beliefs and attitudes towards controlled management and this affects their perception towards the patterns and intensity of exercise and recommended diet especially if they are not informed of the benefits associated with these control measures. The diagnosis of the condition also is not met with a positive attitude by a majority of the victims and this demands a counseling session for the patients so that they can adhere to the doctors’ program. (Parker, 2004PP23-28)

References

Parker M. (2004): reflections on life with diabetes: virtualbookworm. pp. 23-28.

Dominic A. (2000): a memoir of growing up with diabetes: Simon and schuster pp. 14-19.

Kanerva J. (2004): Fathers’ journey into the world of diabetes: Trafford publishing pp. 43-45.

Philip M. (2003): Adults’ diabetes: icon health publications pp. 33-39.

Bolden T. (2006): my journey to better health: atria books pp. 41-48.

Dupre J. (2001): early prevention of diabetes mellitus: Bcdecker pp. 26-32.

Wayne D. (2003): diabetes mellitus: icon group international pp. 19-26.

Selected Country

The problem of diabetes affects people worldwide, causing irreparable damage to their health and reducing the quality of their lives. Australia is one of the countries where the rates of diabetes are among the highest, with the number of patients having reached 159,000,000 in 2017 and continuing to grow at an alarming 15% rate (International Diabetes Federation, 2017). Therefore, it is crucial to develop a nursing strategy for managing the problem by building awareness and increasing the extent to which a nursing strategy that can reach the residents of remote areas.

Three Reasons for High Percentage of Diabetes Patients

The issue of diabetes has been spinning out of control in Australia lately, requiring an immediate response and reducing the chances of patients maintaining the quality of their lives at the desired level. There are currently several opinions regarding the problem of diabetes in Australia. To explore the issue, one should keep in mind the difference between type I and type II diabetes. While the former is defined as autoimmune and occurs most often in children, type II diabetes occurs once insulin production stops in a patient’s body (International Diabetes Federation, 2017). In Australia, type II diabetes is prevalent (Dunbar, 2017).

In the target demographic, diabetes leads to a higher death rate due to the comorbid issues associated with respiratory problems, cardiovascular disease, and other concerns (Dunbar, 2017). Three types of reasons for diabetes to have become a major public health issue in Australia have been identified.

Socioeconomic concerns remain an important factor that affects the rise in the number of diabetes patients. The inability to assist indigenous populations living in remote areas is the first reason for diabetes to remain a threat to Australians (Ferguson et al., 2017). Therefore, it is crucial to expand the existing nursing and healthcare services to cater to the needs of disadvantaged communities.

The levels of health education and overall health awareness among indigenous Australians and vulnerable groups, in general, also represent a major reason for concern. Due to the lack of awareness and low levels of health education among the representatives of the specified groups, the threat of developing type II diabetes and failing to address type I diabetes becomes extraordinarily high (Dunbar, 2017). The problem of poor health education is also common for economically disadvantaged Australian communities, in general.

The third reason for the disease to affect such a large number of people in Australia is the change in their habits. With new technological advances that have made it possible for many Australians to maintain a sedentary lifestyle, the propensity among the specified de3mographic to acquire diabetes type II has risen greatly (Ferguson et al., 2017). Unhealthy dieting habits have added to the problem, causing diabetes type II to affect increasingly more people every day (Ferguson et al., 2017). Therefore, an improved program for reducing the threat of diabetes will need to address the lifestyle issue.

Three Positive Activities (A Public Health Nurse Perspective)

To influence the described situation on a nursing level, one should introduce people to important knowledge about diabetes, its symptoms, causes, and management methods. A mass awareness campaign aimed at both indigenous Australians and the rest of the communities has to be created to affect the issue. As a public health nurse, one must educate the target population about the means of avoiding diabetes type II development, the management of type I and II diabetes, and the ways of locating health resources. In addition, a public nurse will need to encourage diabetes self-management among patients (Dunbar, 2017).

Thus, a nurse will be able to foster a positive attitude among patients and promote health education. Finally, a nurse should encourage patients to reconsider their dietary practices (Ferguson et al., 2017). With the application of the described techniques, a public health nurse will improve the future prognosis for the diabetes situation in Australia.

References

Dunbar, J. A. (2017). Diabetes prevention in Australia: 10 years results and experience. Diabetes & metabolism journal, 41(3), 160-167. Web.

Ferguson, M., Brown, C., Georga, C., Miles, E., Wilson, A., & Brimblecombe, J. (2017). Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia. Australian and New Zealand Journal of Public Health, 41(3), 294-298. Web.

International Diabetes Federation. (2017). IDF diabetes atlas. Web.