Category: Diabetes

Definition

Type1 diabetes occurs when the bodys own immune system destroys the insulin-producing beta cells found in the pancreas (National Institute of Diabetes and Digestive and Kidney Diseases). In such cases, the bodys immune system reverses its action on attacking various cells within the body, instead of fighting against disease causing pathogens. This makes it difficult for the transfer of sugar into the cells of those suffering from type 1 diabetes due to absence of insulin.

Such scenario causes severe build-up of sugar within the blood stream, hence making the body cells deprived of nutrients, which leads to weakening of other bodily functions due to lack of nutrients. However, there is need for through understanding of the immune-detailed process, resulting in type 1 diabetes before application of any kind of therapy. Such processes involve accurate identification of the children suffering from the disease (American Diabetes Association).

Pathogenesis of type 1 diabetes

Causes of type 1 diabetes can be linked to human leukocyte antigen (HLA), capable of contributing to favorable conditions for the disease development within the body. However, genotypes which combine the two susceptibility haplotypes DR4-DQ8 and DR3-DQ2 are identified to be at the greatest risk of contracting type 1 diabetes.

The haplotypes are prevalent among children under the age of 10. At the same time, those who are close to affected children are at high risk of contracting type 1 diabetes based on genetically motivated make-up. Besides such presence of insulin genes in the body, chromosomes can also contribute to the disease. The diseases susceptibility is associated with shorter forms of variable number tandem repeated within the insulin promoter which is contrary to longer forms capable of natural protection (Shulman and Daneman 680).

Issues related to increased expression of mRNA within the thymus of those identified to have longer protective repeats present one of the most potential mechanisms required in type 1 diabetes. Studies have identified over ten loci, related to the disease, in which the genes associated with activation of T-cell have been identified (National Institute of Diabetes and Digestive and Kidney Diseases).

Studies on genetics have defined crucial reasons behind large and well-characterized populations in the process of identifying susceptibility genes for type 1 diabetes. Some genes are known to have less impact on the susceptibility of the disease and used in providing clues for future preventive measures.

Vitamin D and intercellular adhesion molecule gene are utilized for the purposes of providing body protection against the disease. Children diagnosed with rickets at the early stages of life are identified to have high risks of contracting type 1 diabetes at the later stages of their life (National Institute of Diabetes and Digestive and Kidney Diseases).

Type 1 diabetes is the most prevalent disease in young children. This form is considered to appear as a result of environmental changes children are subjected to at early stages of life. The process seems too rapid to be associated with genetic alterations. The cause is further explained by the concomitant widening on the HLA risk profile caused by increased environmental pressures on susceptible genotypes (National Institute of Diabetes and Digestive and Kidney Diseases).

These are caused by disease causing pathogens, specifically identified as rubella. Young children under the attack of congenital rubella are considered to have high chances of contracting type 1 diabetes. Exposing children to dirty environment full of microbes and pathogen leads to innate immune responses containing some allergic reactions to the disease casing organisms (National Institute of Diabetes and Digestive and Kidney Diseases).

Clinical manifestations

Type 1 diabetes takes longer time to manifest due to the fact that the process of destroying insulin-producing beta cells is always long and insidious. This leads to accumulation of insulin production leading to sudden appearance of type 1 diabetes. However, warning signs of type 1 diabetes seem numerous.

These include frequency in urination among children, uncontrolled thirst for sweet things, including cold drinks, dire weakness of the body tissues and muscles also leading to extreme fatigue, blurred vision and frequent cases of irritability and acute symptoms involving nausea and vomiting. In some cases, it is possible to identify some other warning symptom, such as deep and rapid breathing, experiences of dry skin and mouth, frequent stomach pains and flush looking face (National Institute of Diabetes and Digestive and Kidney Diseases).

Laboratory diagnosis

Type 1 diabetes is rarely diagnosed, especially among young adults. According to research, the disease increases its presence from birth to adolescence between age eleven and twelve. The disease is at times linked to heredity though some patients normally have no disease family history.

Patients medical history is a requirement of the diagnosis process alongside clinical features (American Diabetes Association). Such clinical features include examination of urine for glucose levels, checking of blood pressure, thorough examination of certain body parts, especially the feet, etc. Foot sores are at times ignored owing to senselessness within the feet nerves.

Detailed analysis of the blood is required to establish the level of glucose in patients blood. However, glucose tolerance tests which are normally performed involve taking lots of water with 75 grams of glucose, and then blood is tested two hours after the dose has been taken.

In such a case, impaired glucose tolerance is indicated with levels ranging from 140mg/dL to 200mg/dL (American Diabetes Association). Diagnosis is done through laboratory testing by undertaking such processes as suppressing blood glucose level. The performance of random blood glucose level is carried out to detect levels higher than 200 mg/dL and accompanied by increased thirst, fatigue and frequent urination.

Another test used is referred to as oral glucose tolerance test and hemoglobin A1C test. Levels of hemoglobin which are less than 5.7% are normal, while those between 5.7% and 6.4% indicate signs of pre-diabetes where any level higher than 6.4% identifies presence of diabetes (American Diabetes Association).

Latest treatments

Those diagnosed with type 1 diabetes should adopt the habit of taking insulin on a daily basis. This is since insulin has the capability of lowering blood sugar level by making it possible for sugar to leave bloodstream and enter into cells. Insulin is injected under the skin since the doses are not available in pill form.

Health care providers normally give patients the necessary prescriptions on the type of insulin as well as the timing the dose is to be taken. The differences occur depending on speed of action and length of time the injection lasts in the body. However, there are cases when mixture of insulin is used for the purposes of obtaining the best blood glucose control. Injections should be administered from two to four times daily.

Basically, child injections require parental assistance unless the child is over 14 years old (Levitsky and Misra n.pag.). Those suffering from type 1 diabetes are advised to take meals about the same time daily, with the meal comprising almost the same kinds of foods. Undertaking regular exercises assists in controlling blood sugar level and also burning extra calories and fat within the body.

Prevention and prognosis of the disease

There are still no clear prevention measures against type 1 diabetes. However, the ongoing research provides clear perspectives on the direction toward therapeutic interventions required for the solutions. Physicians can apply various preventive measures as prescribed through proven research works, such as initiation of auto-immunity and making some adjustments on beta cell regeneration.

Other possible prevention measures involve identification and elimination of environmental risk factors surrounding children. There is also possibility of re-educating childrens immune system by exposing them to the so-called beta-cell antigens which are taken orally (National Institute of Diabetes and Digestive and Kidney Diseases).

Tolerance can as well be induced through insulin since it provides the required auto-antigen therapy. The immune system can also be regulated by the use of T-cells within the field of beta cell differentiation. As explained, objective regeneration of beta cells may provide other preventive strategy against type 1 diabetes which includes detailed distinction of pancreatic and non-pancreatic components.

The prognosis of type 1 diabetes focuses on the likely outcome of the disease. These comprise duration, complications of type 1 disease and the probable outcome. Proper medical attention ensures appropriate control of the disease. However, the disease may result in some complications, such as kidney disorders, eye infections and problems with the nerve fibers and circulatory system (American Diabetes Association).

Works Cited

American Diabetes Association. Standards of medical care in diabetes.Diabetes Care, 34(2011):S11-S61. Print.

Levitsky, Lynne L and Madhusmita Misra. Management of type 1 diabetes mellitus in children and adolescents. 2011. Web.

National Institute of Diabetes and Digestive and Kidney Disease. Your guide to Diabetes: Type 1and type 2. 2010. Web.

Shulman, RM and D Daneman. Type 1 diabetes mellitus in childhood.Medicine,38 (2010):679-685. Print.

Coping with type 2 diabetes (DT2) involves three major things. First, there is need for change in diet. A lot of fruits and vegetables is advised as opposed to high-sugar foodstuffs. However, for some who find it hard to drop the aforementioned, consumption is limited to periods of low blood sugar.

Secondly, it is important to exercise regularly as this will help burn out excess calories and keep the blood sugar level low. Some adopt regular exercise and good diet as a measure to keep blood sugar low in order to avoid the need of taking medicines (nytimes.com, 2009). Lastly, some attend diabetic classes to better understand and manage the disease (nytimes.com, 2009).

Constancy

People with DT2 need to permanently observe healthy eating habits and regular exercise explained above due to the chronic nature of the disease. They are also required to daily monitor their sugar levels and react as advised (nytimes.com, 2009). These enables them keep their blood sugar at normal level and thus prevent the development of adverse complications that come with high blood sugar.

Discouragement versus empowerment

Those diagnosed with the disease first experience a great deal of self-denial about their new health status (nytimes.com, 2009). This can be out of ignorance or fear. However, upon learning the facts about the disease from medical practitioners and personal efforts they shed this attitude and adopt new habits which lead to healthier lifestyles (nytimes.com, 2009). They gain attitudinal empowerment when they accept the reality and longevity of their new health status, the need for exercise, low-sugar diet, and regular medication.

Need for discipline, therapy, medication and diet

DT2 requires constant monitoring and intervention therapies. Personal discipline in observing doctors directives is important as most of the monitoring is carried out at home. For example, patients are required to daily set up, read and record their blood sugar levels sugar using an electronic monitoring kit (nytimes.com, 2009).

Therapy is vital as the symptomatic aspects of the disease worsen with time if there is no intervention of any kind. Medication is necessary to quickly lower blood sugar when it suddenly shoots up, a common occurrence in type 2 diabetes. Low-sugar diet rich in vegetables and fruits is necessary to manage blood sugar within safe levels and prevent debilitating symptoms.

Uncertainty of future

DT2 is said to be genetic and victims report the challenge of living with the knowledge that their offspring may also relive their experiences. There is also the fear of possible amputation of feet in the future given that it has been performed on some patients before. Many also despair about the possibility of early death (nytimes.com, 2009).

Pain

Pain is common in patients with type 2 diabetes. Patients have reported a burning sensation in the feet accompanied by sharp on-off pains (nytimes.com, 2009). In some cases headache and leg amputation have been reported (nytimes.com, 2009).

Experience of health professionals

From the podcasts, it can be discerned health professionals have difficulty breaking news of positive diagnosis to victims (nytimes.com, 2009). This is likely in the case of patients with little knowledge about the disease. Perhaps another challenge they face is getting the patients to drop negative attitude about the disease, observe medications and best practices such as healthy diet, regularly exercising and use of personal sugar monitoring kit.

Reference

NyTimes.com (Producer). (2009, August 9). Patient voices: Type 2 Diabetes [Audio podcast]. Retrieved from https://archive.nytimes.com/www.nytimes.com/interactive/2009/08/04/health/TE_DIABETES.html?emc=th&th

Background or Introduction

At the beginning of the article, the authors introduce the topic and the background information. The description of children and adolescents care details are given. Management of care is defined as an essential part of treatment that cannot be neglected by healthcare providers. It is also mentioned that diabetes could affect a human life from different perspectives including the fact that the choice of a lifestyle and self-management (de Beaufort et al., 2010).

The main goal of the project is to gather information about different practices healthcare professionals could offer to patients with diabetes and the changes that occur from the pediatric to adult diabetes care transition (de Beaufort et al., 2010). Such a project should help to clarify the evaluations and assessments to be performed in the future to improve the transition process and meet the needs and expectations of the patients and their families.

Review of the Literature

It is mentioned that optimal metabolic control and quality of life are the main purposes in the care of children and adolescents with diabetes (de Beaufort et al., 2010, p. 24). This information is taken from the article of Blum written in the middle of the 1990s. The studies of Weissberg-Benchell, Wolpert, Anderson, and Viner are also used to describe the general state of affairs that could be observed among the patients with diabetes. This review of the literature proves that the chosen topic has been already investigated by different people, and the importance of care for people with diabetes cannot be neglected.

Discussion of Methodology

Certain attention is paid to the methods used by the authors to answer the main question concerning the importance of the transition from pediatric to adult diabetes care. A questionnaire was used to identify the transition practices in different parts of the world (de Beaufort et al., 2010). The participants of the questionnaire were the members of the International Society for Pediatric and Adolescent Diabetes (ISPAD). It was decided to use e-mail as the main tool to gather opinions. 578 ISPAD members including physicians, nurses, psychologists, and dieticians were interested in the question of care of diabetes patients (de Beaufort et al., 2010). The same questionnaire was re-sent in four months to increase the response rate.

The essence of the method was as follows: a questionnaire with 21-items was sent to the participants of the study via e-mail. The questions include the information about the health discipline offered to the healthcare workers, the settings where the participants had to work, the age of patients they had to work with, and the specialist who had to take responsibility for the care of patients with diabetes. At the same time, the authors of the article tried to create questions about the transition process itself and the quality of care offered to children and adult patients. Finally, it was necessary to identify the common opinion about the most appropriate age when it was possible to promote the transition from pediatric to adult care and the best practices that could be offered.

Data Analysis

In the article under consideration, attention to the data analysis methods was not paid. Still, the results and discussions could be used to investigate the possible methods offered by the researchers. The analysis of the participants of the study was introduced. It was mentioned that the members were the citizens of 36 countries. 88 physicians and 16 nurses responded to the questionnaire. Some of the participants worked at university hospitals, and some of them worked at regional hospitals and national centers.

The analysis of the results showed that the age range of youth differed considerably. Most children (under the age of 12) were followed by a pediatric diabetologist or a pediatrician (de Beaufort et al., 2010). Young adults (children between 12 and 25 years) were under the control of pediatric clinics. Still, about 77% of medical centers did not have diabetes patients below 18 years. The suggestions about the transition age were framed between 14 and 25 years. Still, some centers supported the idea of 18-25 years of age.

Researchers Conclusion

It was reported that the transition was the practice that had to be initiated by the representatives of the pediatric unit. Such methods as a phone contact, a letter, and cross-over meetings were offered as the best approaches to promote and support the transition. In many centers, its members underlined that it was better to use several methods at the same time to make sure that the patients and the medical staff had enough information about the current state of affairs.

However, even being aware of such kind of importance, several hospitals and medical centers did not spend much time on the development of special transition programs. As a rule, such programs occurred at the local level and remained to be informal and personal (de Beaufort et al., 2010). Children with diabetes should be identified as a certain group of patients who need care and medical support. The researchers of the study use the quantitative method to prove that children around the whole world could be affected by diabetes, and they have to address the medical organization where appropriate help could be offered.

It is not enough to have some general medical center where children and adults with diabetes could be treated. It is necessary to make sure that medical organizations have enough people to develop appropriate transition programs and techniques to help children and their families to deal with diabetes. The development of such programs is a time-consuming activity, and people should be ready to spend their time and efforts to succeed in the transition from child to adult care.

Critique of Evidence

In general, the researchers conclusions are supported by the evidence offered in each section of the article. The authors aimed at describing the current situation when pediatric-adult care transition should occur. They gathered enough opinions, considered the citizens of different countries, and proved that the process of transition was not perfect and had to be improved considerably. Though no section aims at reviewing the literature available on the topic, the first paragraph of the article could serve as the introduction to the study and the analysis of the literature that could be used as the basis of the project.

Explanation of Human Subjects and Cultural Considerations

In the article, human subjects and cultural considerations are defined and protected because the authors decided to wait four months to make sure the participants weighed all pros and cons of their contributions to the study and provided enough information to conclude the worth of the transition process.

Strengths and Limitations

The strength of the article is the identification of the problems in the care transition process and the explanation of the improvements that could be offered to the medical centers in 36 countries. Still, there is also a limitation that includes the inability to understand how the authors analyze the information and combine the results of the questionnaire. The limited sample and sample size should also be mentioned for further researchers to correct this shortage.

Article in Nursing Practice

The article helps to understand that chronic disabilities require a specific way of treatment. Regarding special health care needs and transitions people experience from their childhood to the adult age, it is necessary to clarify the peculiarities of diabetes and the practices that could be offered by medical experts. Diabetes is a problem that bothers several people from different parts of the world, and transitional care has to be properly organized at any stage. The promotion of healthcare strategies and services is an integral part of the modern world, and the transition from the pediatric setting to the adult clinic should be organized in regards to the latest opportunities and patients needs.

References

de Beaufort, C., Jarosz-Chobot, P., Frank, M., Frank, M., de Bart, J., & Deja, G. (2010). The transition from pediatric to adult diabetes care: Smooth or slippery? Pediatric Diabetes, 11, 24-27.

Pathophysiology of Diabetes Mellitus

There are three types of diabetes mellitus: type 1, type 2 and gestational diabetes. Type 1 diabetes appears as a result of destruction of beta cells by the immune system. The deficiency of beta cells in the pancreas leads to inadequate insulin and presence of anti-islet cell antibodies in the blood system (Mandal, 2017).

Type 2 diabetes is caused by low levels of insulin and not total deficiency. This means that the body cannot produce sufficient insulin, a condition that leads to deficiency of beta cells and peripheral insulin resistance (Mandal, 2017). Peripheral insulin resistance is a state where there is high levels of insulin and absence of hypoglycemia in the blood.

Gestational diabetes is mainly caused by extreme levels of counter insulin hormones during pregnancy, which leads to high blood sugar and insulin resistance. This condition can damage insulin receptors (Mandal, 2017).

Pathophysiology of Diabetes Insipidus

Diabetes insipidus is caused by unstable antidiuretic hormone (ADH) levels. ADH is produced by the hypothalamus and stored by the pituitary glands. It regulates excretion of fluids from the blood stream by affecting the aquaporins, which control permeability of transmembrane vessels (Mandal, 2017).

Differences between Diabetes Mellitus and Insipidus

Diabetes mellitus is a pancreatic disorder, whereas diabetes insipidus is a hypothalamic disorder (Huether & McCance, 2017). This implies that the two diseases produce different effects on hormonal regulation. In case of diabetes mellitus, the hormone insulin is involved (secreted by the cells located in pancreas). When the condition emerges, it implies that the level of insulin either becomes too low, or the body is incapable of responding to it in a proper way. As for diabetes insipidus, anti-diuretic hormone (or vasopressin) is involved. It is produced by hypothalamus. The disease is characterized by either its deficiency or inability of kidneys to react to it.

There is an occurrence of ketone bodies in the blood of diabetes mellitus patients. These bodies are absent in diabetes insipidus patients. Urine in the case of diabetes mellitus is of normal concentration although it is very dilute in diabetes insipidus. Rise in blood cholesterol and glucose level which result to higher rates of excretion are clear in diabetes mellitus although they do not occur in insipidus (Hammer & McPhee, 2014). Mellitus is also characterized by excessive hunger which is unlike normal eating habits in diabetes insipidus.

Similarities between Diabetes Mellitus and Insipidus

Diabetes mellitus patients often experience excessive fatigue due to high or low levels of blood sugar while fatigue in diabetes insipidus result from inadequate hydration (Hammer & McPhee, 2014). Excessive thirsty in diabetes mellitus is caused by high glucose levels in the body while it is caused by lack of vasopressin in diabetes insipidus. Blurred vision in diabetes mellitus is a result of excess glucose while in diabetes insipidus it results from extreme dehydration (Diabetes insipidus vs mellitus, 2015).

Gender and Ethnicity Effects

Generally, men are at a higher risk of being diagnosed with diabetes than women. The major reason is that fat they have is stored in their inner organs (as compared to women whose fat is distributed on the surface). This implies that women can gain more fat before the condition becomes threatening to their health. However, the development of the disease is more complicated for women than for men, which results in higher death rates.

As for the effect of ethnicity, Mexican Americans, African Americans, Asian Americans, Native Hawaiians, American Indians, and Pacific Islanders are at a greater risk of diabetes, partially due to their propensity to be overweight. Treatment differences are not dramatic among genders and ethnicities.

In both females and males of diverse ethnicities and races, the treatment of type 1 diabetes usually includes insulin injections, low-carbon diet and regular physical activity (Mandal, 2017). Patients who are overweight and have high daily doses of insulin can also benefit from the intake of metformin as it helps to control blood sugar level more efficiently by improving glucose metabolism (Viollet et al., 2012).

However, the use of this drug is more common for the treatment of diabetes type 2, whereas the insulin is not used in this form of the disorder. Lifestyle modifications are recommended for the intervention of diabetes type 2 as well. Additionally, since this form of the disease is associated with increased blood pressure, patients can be prescribed with calcium channel blockers and ACE inhibitors that are effective in reducing hypertension and preventing organ damage (Ganesh & Viswanathan, 2011).

References

Diabetes insipidus vs mellitus. (2015). Web.

Ganesh, J., & Viswanathan, V. (2011). Management of diabetic hypertensives. Indian Journal of Endocrinology and Metabolism, 15(Suppl4), S374S379.

Hammer, G. D., & McPhee, S. J. (2014). Phathophysiology of diseases: An introduction to clinical medicine. (7th ed.). New York: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Mandal, A. (2017). Diabetes Pathophysiology. Web.

Viollet, B., Guigas, B., Sanz Garcia, N., Leclerc, J., Foretz, M., & Andreelli, F. (2012). Cellular and molecular mechanisms of metformin: An overview. Clinical Science (London, England : 1979), 122(6), 253270.

Patient Follow Up and Monitoring

Currently, there are many various types of equipment that can help diabetic patients care for themselves and monitor their health remotely. According to Gonder-Frederick, Shepard, Grabman, and Ritterband (2016), such devices as the blood glucose meter, insulin pump, and continuous glucose monitor were developed and refined for people to use (p. 577). Moreover, this technology allows diabetic patients to create a system where they are able to fully automatize the process of insulin delivery. The activities connected to the monitoring of patients are also becoming more and more computerized. Blood glucose (BG) meters help individuals to stay informed about their well-being, while insulin pumps help them to dose the injections and deliver the medicine on time.

Furthermore, different programs and applications allow diabetic patients to talk with physicians without visiting hospitals. For instance, Kennedy, Runge, and Brown (2016) state that existing and future devices give patients an opportunity to send the gathered information to their smartphones and computers, which then can be shown to physicians and medical establishments. Moreover, various mHealth applications can analyze data such as BG levels, injection schedules, and common patterns in order to predict possible issues and warn patients to act accordingly. The use of Internet-based systems also allows medical professionals to consult patients and monitor their health. For instance, psychologists can provide online consultations and assess individuals well-being. All in all, the current state of technology that helps people treat diabetes is very advanced.

Home Therapy

Monitoring devices are closely connected with equipment that helps patients to apply self-treatment. The insulin pumps described above, for example, can replace insulin injections. According to Liberman et al. (2016), the use of these devices often leads to patients experiencing less stress about their condition as they feel in control of their health. Moreover, diabetic patients that use technology for home therapy feel less pressured about their well-being. Liberman et al. (2016) state that many individuals with diabetes can be distressed by and tired of continuous monitoring of their BG levels. However, the use of automated programs and devices helps them not only to relieve stress but also to adhere to the treatment with success. Existing insulin-delivering devices do not require patients to do multiple injections a day, freeing them from the continuous strain of responsibility. Self-management of diabetes is becoming more dependent on technology than before as the development of new programs and devices gives patients an ability to monitor and treat themselves without regular check-ups at the hospital.

Billing and Insurance

Diabetic patients have to spend a substantial amount of money on their treatment. According to the Centers for Disease Control and Prevention (2017), lifetime medical costs for individuals with diabetes often put them in a challenging position as patients need to pay for the treatment of their condition and some possible complications that may follow it. Moreover, the financial burden of diabetes impacts the national health care system, as well.

Insurance can cover a part of the expenditures. For instance, Medicare.gov (2017) states that such equipment as BG test strips, BG testing monitors, insulin, and lancet devices and lancets can be obtained with insurance. However, only a number of providers work with insurance companies. Furthermore, more expensive equipment that would allow patients to automatize their processes is not covered. Thus, patients that want to have better technology to maintain their health have to spend significant amounts of money. Insurance also partially covers various treatment opportunities and exams, including a foot exam, a yearly eye exam, training for diabetes self-management, and nutrition therapy. These services are covered by some programs and are full of various rules and limitations.

References

Centers for Disease Control and Prevention. (2017). Modeling and economics. Web.

Gonder-Frederick, L. A., Shepard, J. A., Grabman, J. H., & Ritterband, L. M. (2016). Psychology, technology, and diabetes management. American Psychologist, 71(7), 577-589.

Kennedy, L., Runge, A., & Brown, A. (2016). New diabetes tech on the horizon: Whats coming by mid-2017 in the US? Web.

Liberman, A., Buckingham, B., Barnard, K. D., Venkat, M. V., Close, K., Heinemann, L.,& Laffel, L. (2016). Diabetes technology and the human factor. Diabetes Technology & Therapeutics, 18(S1), S-101-S-111.

Medicare.gov. (2017). Diabetes supplies & services. Web.

Diabetes is a disease that affects a persons sugar levels, keeping it higher or lower than usual. Type 1 Diabetes does so by attacking the insulin production of an organism (Diabetes Type 1, 2016). Insulin is a hormone that enables the cells of the body to absorb the sugar. Unlike other types of diabetes, Type 1 is the most understudied. It is relatively rare, too  only two to five percent of the afflicted population is diagnosed with this kind of disease (Maahs, West, Lawrence, & Mayer-Davis, 2011).

The scientists do not know the exact reason why it is happening, but popular theories suggest that a predisposition towards it tends to be hereditary. It means that genetics are largely involved. This paper is dedicated to researching the subject of Type 1 Diabetes, as it is important to raise awareness of such a disease in order to help mitigate their effects on the afflicted populace. Right now, due to the relative rarity of the disease, the populace is largely uninformed about this kind of illness.

Although Type 1 Diabetes can appear at any age, it seems to afflict young people more often. Groups under 20 years of age are most commonly at risk (Diabetes Type 1, 2016). It is the reason Type 1 is known as juvenile diabetes, and it can affect the life of a growing child quite a bit and in many ways. The importance of knowledge about the disease cannot be understated  while currently, there is no way to prevent the disease from happening; it is required to know how to mitigate the effects.

The target audience would be the children and young adults, who are more likely to be affected. Parents must also be made aware of the conditions, symptoms, and ways of dealing with them. After all, they are the ones who are going to be administering the treatment to their children and make sure it is followed.

Being diagnosed with Type 1 would affect a persons lifestyle in both physical and psychological ways. It reduces stamina, causes eye blur, induces limb numbness and stomach aches, weight loss, urination, headaches, and all sorts of other symptoms that could cause a lot of problems to a young organism (Type 1 Diabetes, 2015). If not properly managed, it could keep a child away from many social activities, such as sports and active games. Neglecting the bodys inability to control its sugar levels could also be dangerous to ones life. The psychological aspect of children having to live with the disease for the entire life must also be addressed  it could affect them greatly and cause serious self-esteem issues (Naranjo & Hood, 2013).

Being diagnosed with a case of diabetes is not a death sentence  many can live long and healthy lives with it if they are informed of the disease and know how to manage their sugar. For the most part, it is controllable with a healthy low-carbon diet, physical activities, and insulin injections (Type 1 Diabetes. How is it Treated? 2016).

The latter is necessary since Type 1 affects the bodys ability to produce insulin (Insulin Basics, 2015). It is something that could not be countered with exercises or a healthy diet. Scientists around the world are actively working to find the cause of Type 1 diabetes and come up with a cure. Until then, the only thing we could do is raise general awareness of the population to the problem, and promote healthy solutions to minimize their effects on peoples lives.

References

Diabetes Type 1. (2016). Web.

Insulin Basics. (2015). Web.

Maahs, D.M., West, N.A., Lawrence, J.M., & Mayer-Davis, E.J. (2011). Epidemiology of Type 1 Diabetes. Endocrinology and Metabolism Clinics of North America, 39(3), 481-497.

Naranjo, D., & Hood, K. (2013). Psychological Challenges for Children Living with Diabetes. Web.

Type 1 Diabetes. (2015). Web.

Type 1 Diabetes, How is it Treated? (2016). Web.

Fay is a man of age 34 who works for a construction company. He is a smoker. Being an unskilled laborer, he has been deployed in the housebuilding sector where he assists the masons in such activities as ferrying building stones and bricks to the site. It was noted that Fay becomes extremely worn out while executing the tasks. During the task, Fay makes a countless number of short calls and often takes water irrespective of the time of the day or the prevailing weather conditions.

Fay has impairments as his body functions are distorted. Once the human body develops diabetes, it follows that a person will regularly experience increased hunger, increased urination as well as an increased desire to take water (Beckles, 2008; White et al., 2010). Notably, Fays participation is quite inappropriate as he experiences activity limitations and participation restrictions.

According to site managers, his participation is not adequate. His workmates are not aware of his condition and they often make fun of him whenever he makes short calls and demandingly seeks water. While sometimes he develops a violent nature against his workmates for making fun of him, he complains of being side-lined and therefore becomes depressed.

Intervention

The future of a diabetic person who has ignored medication is usually hit by serious complications (Egede et al., 2002; DAntonio & Lewenson, 2010). If the condition is ignored, it follows that a person can also experience non-ending complications such as ketaocidiosis, hypoglycaemia and hyperosmolar coma among other complications.

Fay is suffering from diabetes mellitus and as such, an intervention is required. According to medics, the best intervention for diabetes is Nursing Intervention. Nursing intervention can be described as actions that a nurse undertakes in an effort towards furthering treatment for a patient. The targeted ICF aspects include the development of the patients participation (i.e. participation in activities to help in blood circulation and controlling the mood through engaging the patient in exciting events). In other words, nursing intervention helps improve environmental factors.

However, while nursing intervention is regarded as the most effective intervention for diabetes mellitus, there are risks that are associated with it. Thus, a diabetic person is known to be short-tempered and can get aggrieved by petty things (Wendy & Votroubek, 2010).

Since the risk of violence for the diabetic patient cannot be completely eliminated, it is necessary that mitigation strategies be identified (Wagner, 2001). One of the main violence mitigation strategies is as follows: the caregiver can make attempts of decoding communication patterns that are seemingly incomprehensible. In addition to this, the health care professional can seek both clarifications as well as validation from the patient.

Apart from this, the health care practitioner can orient the patient to reality as it is required with regard to all medical cases. In this strategy, the medical practitioner is required to call the patient by his name. Further, the caregiver is required to validate the communication aspects that are said to assist in differentiating the real from the unreal (Chalmers, 2007).

These strategies give a revelation on how other people perceive the patient, while the mandate of not comprehending their behaviour is readily accepted by the nurse. Also, the strategies, in some cases, help in restoring the patients functional communication patterns (Juall & Moyet, 2008).

The Inter-Professional Team

Physical health care providers also play a big role in giving care to diabetic patients. They work hand in hand with nurses in an effort towards trying to maintain or even restore the normal conditions of a person with diabetes. They are essential in the care process as they usually take the vital responsibility of engaging the patient in activities, both psychological and real time activities. The physical health providers, by involving the patients, help improve their body systems through blood circulation. Light activities are ideal as they help in proper circulation of blood in the body (Smith, 2000).

In addition to this, the Physical health care providers engage people with diabetic activities in light as well as exciting activities and as such, apart from improving the blood circulation, the diabetic people are able to overcome their short tempers (Peters, 2006). Through such an activity, the patient is usually immersed in the captivating nature of the activity and therefore, there will be no situation where the patient will develop temper.

Eventually, the patient can become more responsive and more active. Indeed, the patient will be craving for another day to become engaged in such activities and in the long run, the physical health care provider will have achieved his/her goal. Therefore, the patients participation can improve in a great way with regard to his body functions through these activities (Hall, 2008). Admittedly, physical health care provider can help the patient improve contextual factors (environmental as well as personal factors).

Characteristics of Professionalism

Professionalism is a term describing conduct and qualities that a profession should show. Medical care requires a high level of professionalism. Irrespective of whether faced with a difficult situation or not, a professional needs to maintain his poise. When conducting any kind of intervention on a diabetic case, a care giver should remember that it is a patient he/she is dealing with.

The professional ought to keep in mind that the patient is at times violent and as such, the care giver should not react violently to any violent sign or attack on him/her. Instead, the professional should maintain his/her calm and engage the patient in activities that will not offend the latter (Matt, 2002).

Adherence to a stricter code of ethics is a must for health care professionals. Regardless of whether a company has written codes or not, it is recommended that ethical behaviour should be exhibited. In nursing intervention, a medical practitioner should not at any time disclose unfolding information regarding the patient to a third party. However, he/she can disclose to the family members upon confirmation of the information (Beardsley, 2006).

Finally, reliability can also be regarded as one of professionalism characteristics. The society usually looks upon a professional to execute a job. As such, he/she is supposed to act in a prompt manner while ensuring that he/she keeps the promises timely. In nursing intervention, it is necessary that the nurse executes his/her duties well and ensure that the desired results are achieved (Matt, 2004).

In addition to this, a medical professional, during intervention, must be able to timely be getting the care process done and as such, he/she should not hold the patient in the care facility for a long time unless the patients condition has deteriorated and further care is necessary (Campbell & Bennett, 2002).

Person Centred Practice Strategies

Person centred practice is a term commonly used to describe a combination of approaches that are established in order to assist an individual (Nichols, 2007). One of the most effective strategies in terms of person entered practice is listening. In this strategy, the focus is usually on the patient and as such, the focus is on what the patient perceives to be important to him/her. In addition to this, the strategy makes an enquiry on how the patient lives (Solberg, 2007).

The health care professional should be able to listen to the patient, asking proper questions about physical conditions as well as life, emotions, relationships with others, etc.

One more strategy is team collaboration. Thus, the team of several health care professionals (nurse, physical health care provider, etc.), the care giver(s) and the patient should collaborate to work out a specific plan (Wilensky, 2004). This plan will include all meaningful details. Admittedly, the plan will be effective as all important details will be taken into account. This strategy is ideal as it ensures development of plans where the diabetic person as well as the caregiver can think together. Thus, the caregiver is able to introduce the necessary changes that will help restore the normal condition.

Professional Development

On-going education is a vital aspect for professional development. Educational activities usually come after formal training. Educational activities assist a person to maintain and develop knowledge, develop problem solving skills. It also expands a persons technical skills. Health care professionals also learn progressive professional standards of performance (Norris et al., 2006).

Notably, training courses are not the only way to develop. Health care professionals should attend various workshops and conferences. Sharing experiences is an important part of any learning. Besides, it is necessary to acquire knowledge in diverse spheres. Thus, nurses should not attend courses for nurses only. It is important to be able to collaborate in inter-professional teams. Therefore, it can be effective to learn more about different health care services provided.

Mental discipline strategy is also essential as it helps a professional focus on the goals irrespective of whether he/she is experiencing hardships or uncontrollable events or not. By focusing on the goals, a person is able to develop since when he/she encounters hurdles, he/she is able to find ways to overcome them and therefore, he becomes familiar with ways to handle diverse problems. Thus, mental discipline development is a very effective strategy (Bagchi & Sreejayan, 2012).

References

Bagchi, D., & Sreejayan, N. (2012). Nutrition and therapeutic interventions for diabetes and metabolic syndrome. Waltham, MA: Academic Press.

Beardsley, R. S. (2006). Chairs report of the APhA-ASP/AACP-COD task force on professionalization: Enhancing professionalism in pharmacy education and practice. Am. J. Pharm. Educ, 60(3), 26-28.

Beckles, G. L. (2008). Population-based assessment of the level of care among adults with diabetes in the U.S. Diabetes Care, 21, 1432-8.

Campbell, R. K., & Bennett, J. A. (2002). Assessing diabetes patients health care needs. Diabetes Education, 28(4), 49-50.

Chalmers, R. K. (2007). Contemporary issues: Professionalism in pharmacy. Tomorrows Pharmacist, 5(4), 10-12.

DAntonio, P., & Lewenson, S. (2010). Nursing interventions through time. London, UK: Springer Publishing Company.

Egede, L. E., Zheng, D. & Simpson, K. (2002). Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care, 25(8), 464-70.

Hall, R. H. (2008). Professionalization and bureaucratization. Am. Soc. Rev, 33(2), 104.

Juall, L., & Moyet, C. (2008). Nursing diagnosis: Application to clinical practice. New York, NY: Lippincott Williams & Wilkins.

Matt, D. (2002). Clinical practice guidelines for treatment of diabetes mellitus, expert committee of the Canadian diabetes advisory board. Canadian Medical Association Journal, 147(5), 19-92.

Matt, D. (2004). Nutrition recommendations and principles for people with diabetes mellitus. American Diabetes Association, Diabetes Care, 17(5), 14.

Nichols, K. K, (2007). Diabetic eye examination report. Optometry, 78(11), 588-95.

Norris, S. L., Chowdhury, F. M, & Van Le K. (2006). Effectiveness of community health workers in the care of persons with diabetes. Diabetes MED, 23(5), 44-56.

Peters, A. L. (2006). Quality of outpatient care provided to diabetic patients: A health maintenance organization experience. Diabetes Care, 19, 601-6.

Smith, M. C. (2000). Implications of professionalization for pharmacy education. Am. J. Pharm. Educ., 34(5), 16-32.

Solberg, L. I. (2007). Crossing the quality chasm for diabetes care: The power of one physician, his team, and systems thinking. J Am Board Fam MED, 20(3), 299-306.

Wagner, E. H. (2001). Effect of improved glycemic control on health care costs and utilization. JAMA, 285(9), 182-9.

Wendy, L., & Votroubek, A. T. (2010). Paediatric home care for nurses: A family-centred approach. Burlington, MA: Jones & Bartlett Publishers.

White, L., Duncan, G., & Wendy, B. (2010). Foundations of adult health nursing. Belmont, CA: Cengage Learning.

Wilensky, H. L. (2004). The professionalization of everyone? Am. J. Soc, 70(4), 137-146.

Introduction

Diabetes mellitus (DM) is one of the most common chronic diseases in the world. The rapid spread of the incidence of diabetes mellitus (DM) has become a non-infectious epidemic. Recently, this disease has begun to be studied as a social problem that is becoming increasingly more urgent. Moreover, six of the ten countries with the highest prevalence of diabetes are located in the Middle East (Icon Group International, 2017). This determines the exceptional relevance of research on the current situation and prospects for treating diabetes in the Gulf countries. One such study is the systematic review on the quality of type 2 diabetes management in the countries of the cooperation council for the Arab states of the Gulf, prepared by Alhyas, McKay, Balasanthiran, and Majeed back in 2011, published in PlosOne.

The Philosophical Underpinnings of the Paper

Medicine, like no other discipline, needs an understanding of processes and phenomena in their integrity. This most important task can be solved only on the basis of the interpretation of medical science data from the standpoint of a systems approach. A medical specialist needs, first of all, to see the connection between various processes and phenomena during the development of the disease, that is, the true essence of the pathological process, as well as to understand the principles of choosing therapy and indicators for assessing its effectiveness. The systematic review is a well-established and widely accepted tool in the medical community for applying a systemic approach to health problems.

The Theory Used to Support the Research

Systematic reviews synthesize the results of original studies using approaches that reduce the possibility of bias and random errors. The authors of systematic reviews use the theory of evidence-based medicine and prevention, which is a policy and practice of applying the best external evidence acceptable to healthcare professionals and related industries, patients, and society as a whole. In particular, the aim of the review under consideration was to examine the current quality of management of type 2 diabetes in the member states of the GCC (Alhyas et al., 2011, p. 2). It is an important technology for maintaining and improving health.

The evidence-based approach as a technology for achieving high-quality medical care and management in health care is recognized and has been introduced over the past decades. The prerequisites for this were primarily economic: against the background of limited sectoral resources in the world, the costs of medical services and research increased significantly, which, among other reasons, was due to the predominance of chronic noncommunicable diseases in the morbidity and mortality patterns. A significant problem was also the quality of information support for management decisions in medicine and its transparency for patients and society as a whole. Accordingly, information support of medicine regarding such chronic non-communicable diseases as diabetes, especially in the regional context, is an important theoretical implication of research.

At the same time, the methodological basis of the evidence-based approach in health care  clinical epidemiology  provided it with the methods of medical statistics, reliability criteria, and methods of data generalization. The authors suggest clear criteria for inclusion and exclusion of publications for reviews and identified 27 published studies to include in the review. The selection of the main parameters of SD type 2 management provided the formation of a data array for further use by medical professionals and public health regulators. This data is used in medicine as a source of information for clinical decision making, planning of future research, and health policy development, thereby strengthening the link between the best research results and optimal care.

The Appropriateness of the Methodology Used

The evident proof of the appropriateness of the methodology applied by the authors is their conclusion that the quality of type 2 diabetes management in the GCC region can be characterized as poor. Based on the available data sets, the authors modeled heterogeneous groupings in accordance with the requirements of systems analysis, within the framework of the systems approach. At the same time, it should be noted that the authors do not pay enough attention to the quality of the general sample of studies for analysis  they claim that there are no limitations on publication type, publication status, study design (Alhyas et al., 2011, p. 1). Dividing the sample into subsections according to research design criteria, patient samples potentially could significantly improve the quality of the results obtained.

Alternative Theory and Alternative Research Methodology That Could Have Been Used

It is known that the most general and unifying theory of the origin of diseases is the theory of diseases of civilization and social adaptation. The term adaptation as a process of overcoming inadequate conditions by the body that does not correspond to the properties of the body is no less popular than stress (Topol, 2019). Disadaptation is considered as the basis of the disease; in this regard, a determination theory of medicine was developed, the main goal of which is to unite all the basic modern knowledge accumulated in the field of biomedical research into a single system (Topol, 2019). The doctrine of adaptive response is that the determination factor is always specifically refracted through internal systems. Investigating the regional features of the incidence of type 2 diabetes, the authors should consider, in particular, some social and cultural determinants of the current situation. The determinative theory of medicine is an attempt at an integrative methodological concept that generalizes the patterns of the emergence and development of pathological conditions, processes, and patterns of the formation and maintenance of health. Its functions are the following (Topol, 2019):

• Informative (obtaining information about the adaptive nature of reactions);
• Systematizing (generalization of the facts of clinical and experimental medicine into a single system of adaptive response);
• Predictive (anticipation of new facts, phenomena, and patterns of adaptive response);
• Explaining (phenomena, facts, adaptive response).

In view of the approach to the formation of the sample presented in the considered systematic review, as well as the tasks of publication of the study set by the authors, the application of the determinative theory seems to be the most appropriate. In addition, when speaking of alternative research methodology, the application of grounded theory should be proposed. It enables in-depth analyses of empirical facts and allows the emergence of new themes, issues, and opportunities in the process of research, as well as revealing of latent interrelationships and dependencies, not evident in a standard systematic review.

Ethical Issues

In accordance with the concept of evidence-based medicine, the results of only those clinical studies that are conducted on the basis of the principles of clinical epidemiology are recognized as scientifically grounded. It makes possible minimization of both systematic and random errors (using the correct statistical analysis of the data obtained in the study). Thus, this fact determines the need for a high level of the ethical responsibility of the researcher. The authors themselves claim about the heterogeneity of studies included in the sample as a major limitation on the strength of conclusions formulated (Alhyas et al., 2011). No proper statistical analysis has been performed, but the authors argue that the level of treatment for type 2 diabetes in the Gulf countries is not satisfactory. The validity of the systematic review under consideration cannot be verified, which is somewhat of a violation of research ethics.

Conclusion

The critical analysis of the article under consideration allows concluding that systematic review represents a kind of first step in outlining the problem of type 2 diabetes management in the countries of the cooperation council for the Arab states of the Gulf. Although the overall philosophy and methodology of systematic reviews is observed, the sample is not representative, and the quality of the publications included in the review is ambiguous. However, the review has scientific and practical value in terms of evidence-based medicine in treatment of type 2 diabetes in the Gulf countries and other regions, especially for developing countries.

Reference List

Alhyas, L. et al. (2011) Quality of type 2 diabetes management in the states of the cooperation council for the Arab states of the Gulf, PlosOne, 6(8), pp. 16. Web.

Icon Group International (2017) The 2018-2023 world outlook for type 2 diabetes mellitus treatments. Author.

Topol, E. (2019) Deep medicine: How artificial intelligence can make healthcare human again. New York: Basic Books.

The healthcare system often faces problems related to patients, their families, or medical workers that the hospitals leaders must address. It is the duty of the doctor or unit manager to resolve conflicts or crises that appear. The given case study describes the case of a Hispanic teenage girl who was recently diagnosed with insulin-dependent diabetes. This paper will discuss what problems persist in the case and suggest a plan to resolve the issue.

The primary problems in the case study are ethical issues and violation of hospital rules. It has been written in the case study that the patients family violates the laws of the hospital by visiting as a group of more than two people, bringing excessive amounts of sweets, and staying at the hospital during non-visiting hours. These violations can become a significant issue if other patients follow this example and similarly begin breaking the rules. Another problem is that medical workers cannot adequately address the case because patient is from ethnic minority. This ethical issue, whether the patient should be treated equally to others or slightly better or worse because of her background can result in more severe problems. The possible outcomes of the issues that can be achieved are discussing the violations with the patients family and convincing them to follow the medical regulations; convincing the girls family to leave her at the hospital due to therapeutic reasons; discussing the issue with unit personnel and find methods of safe interactions with the patients family.

Resolving these problems requires a detailed plan involving steps to creating a safe environment in the hospital unit for the patient and her family members, and the team. The first step would be to provide training for the medical team. It was emphasized in the case study that the group did not know how to react to conflicting situations of violations and, at the same time, were aware of the sensitive care plan for the patient. Moreover, the possibility of patient discharge appeared on the day nurses started responding to familys violations of rules. Therefore, educating the nursing team about working with patients from ethnic minorities and how to implement a sensitive care plan (Citizens Advice, 2020). The next step would be discussing the case with the patients parents. Correctly delivering the message about the importance of hospital rules is a critical action the unit leader should take to complete solving the problem.

The expectations from the unit team would be to find compromise in interacting with the patient and her family and learn from this experience for future cases. Theres a possibility that awareness of the Hispanic minority is not enabling the team to fulfill their responsibilities. Thus, it is essential for the team to learn to treat patients equally by eliminating biases. This case might be an excellent example for the team to learn how to work with patients from ethnic minorities; thus, it is essential for the team to scrutinize the case.

This case requires the unit leader to employ transformational leadership theory. This theory is the most suitable for the nursing team because its core is an effective performance for the sense of mission and purpose. According to Collins et al. (2020), this type of leadership aligns with nurses because of its emphasis on morals and instant changes. The patient with insulin-dependent diabetes requires quick changes in the system to incorporate the sensitive care plan more accurately and educate the nurses about working with ethnic minorities. Therefore, the transformational leadership theory is the most appropriate for the case.

The effectiveness of the described plan can be evaluated after implementing it, but there are some risks. Theres a risk of failure in implementing the sensitive care plan for the patient because the research has supported that Hispanic and non-Hispanic patients perceive the treatment differently (Serna, Arevalo & Tomar, 2017). Therefore, there is a risk that the designed care type will not be effective for the patient with insulin-dependent diabetes. In addition, there is a risk that the chosen leadership approach will not be effective in this case.

References

Serna, C. A., Arevalo, O., & Tomar, S. L. (2017). Dental-related use of hospital emergency departments by Hispanics and non-Hispanics in Florida. American journal of public health, 107(S1), S88-S93. DOI: 10.2105/AJPH.2017.303746

Collins, E., Owen, P., Digan, J., Dunn, F. (2020). Applying transformational leadership in nursing practice. Nurse Stand, 35(5), 59-66. DOI: 10.7748/ns.2019.e11408

Citizens Advice. (2020). Taking action about discrimination in health and Care Services. Citizens Advice.

Nowadays, the spread of diabetes across the globe is on the march. Sitting lifestyle, obesity, and the aging of the population contribute to this health problem. While there is no cure for diabetes, methods to improve patients quality of life have been elaborated and implemented. However, in cases when a patient has diabetes and dementia simultaneously, it may be difficult for them to do all the necessary procedures. Healthcare services should provide additional care to such patients. This paper hypothesizes that a patient-centered strategy should be implemented to promote health in patients with diabetes and dementia.

First of all, it is necessary to determine the significance of health problems to health status. To do this, the implications of age, gender, and ethnicity should be thoroughly considered. Research shows that Afro-Americans and Latinos are most at risk of developing diabetes of the second type (Marseglia et al., 2019). The risk indicators are slightly lower for American Indians and Alaska natives though both these groups have a higher predisposition to diabetes than white people. Gender does not play a significant role in disease development: both men and women have an equal chance of getting the disease. With age, the predisposition to diabetes grows, and older people are more likely to suffer from diabetes.

It has been established that diabetes may provoke the development of dementia in older age groups. The incidence of dementia in diabetes-related groups is 50% higher than in people who do not suffer from the disease. Dementia is an age-related disease that is predominant in the women population. Studies show that ethnic factors do not play any role in dementia development. The mortality rate of patients with dementia and diabetes varies depending on their care. The cost of care is relatively high since these patients need day-to daycare provided by nurses and other health specialists. The population of focus for this study will be Afro-American women aged between sixty and ninety who have diabetes of the second type and dementia or are likely to develop dementia in the future. The geographical area where prevention strategies will be implemented will be Georgia since this state has a high percent of the Afro-American population.

Health teaching principles lie at the core of the successful implementation of any strategy. First of all, the readiness to learn should be measured. By asking questions about the patients view on the health problem and possible ways that they may take to improve their quality of life, one can assess the patients readiness to learn. There are several stages through which a patient changes his behavior, from ignorance of the problem to establishing healthy habits and changing their lifestyle (Marseglia et al., 2019). In adults, readiness to learn is closely associated with the developmental task of ones social role.

Subject prevalence is an essential factor in promoting adult learners motivation. Adults do not usually learn for the knowledges sake but want to see the practical results of their activity. It is especially true for patients with dementia whose ultimate goal is to take as much control of their life as they can. Initial simple tasks with practical application that allow patients to feel that they succeed can motivate further learning activity.

Reading level of patients with dementia is crucial in the learning process since it is essential to provide learning materials that people can understand. Dementia often leads to dissociation and memory gaps, so reading materials should be adapted to the understanding level of the patients. To access the reading level, healthcare workers may ask patients to read some article or brochure and then ask questions on the articles content. Learner engagement is another factor that influences the success of the teaching process. Patients with dementia get better learning results when they are interested and motivated. Irresponsive and passive learners are unlikely to significantly improve their quality of life.

The most effective approach to teaching patients with diabetes and dementia is a person-centered approach to care planning. Bunn et al. (2017) state that patient priorities [must be] at the forefront of therapy, while medical considerations should serve as a background. Indeed, independence and patient and carer priorities come to the fore, as they allow the patients to see the learning process results and improve their quality of life. Nevertheless, the minimum requirements of good diabetic control must be implemented (Bunn, 2017). The education content would be centered around life skills, such as taking care of ones needs or interests. For example, washing the dishes or watering the plants may be beneficial for dementia patients. In the cognitive sphere, doing simple arithmetic could be a good example.

The timeframe for such activities would necessitate several weekly visits by healthcare workers. Later, when the learning process transforms into habits, the number of visits could be reduced. The education will take place either at patients homes if they have difficulty getting to social centers or at social centers. The teaching would go in the form of practical skills education combined with mental training.

Learning success would largely depend on cultural variables such as culture, socio-economic circumstances, and family surroundings. Cultural variables should be taken into consideration when planning education processes as cultural implications may prevent people from doing certain things. Thus, women may refuse to wash the dishes or floor if they had a housekeeper who did it for them all their life. Poor socio-economic circumstances may prevent people from getting necessary medication. Healthcare workers must see to it that the insurance covers all medicines for this group of patients. Family support means a lot for patients with dementia and would broadly impact learning results.

References

Bunn, F., Goodman, C., Reece Jones, P., Russell, B., Trivedi, D., Sinclair, A., Bayer, A., Rait, G., Rycroft-Malone, J., & Burton, C. (2017). What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Medicine, 15(1).

Marseglia, A., Wang, H. X., Rizzuto, D., Fratiglioni, L., & Xu, W. (2019). Participating in mental, social, and physical leisure activities and having a rich social network reduce the incidence of diabetes-related dementia in a cohort of Swedish older adults. Diabetes Care, 42(2), 232-239.