Category: Diabetes

Health Care Informatics

Type 1 diabetes (T1D) refers to a chronic condition when the pancreas fails to produce insulin, thus hindering the transfer of glucose from the blood to cells. The treatment involves the administration of insulin several times a day or by using an insulin pump continuously injecting the hormone into the body (Vettoretti & Facchinetti, 2019). Although T1D is supposed to be treated by endocrinologists, patients having this disease often turn to primary care for medical help.

To treat patients with T1D effectively, primary care specialists may need information about patients’ blood glucose levels throughout the day. These data are necessary to determine correct doses, which is crucial for preventing severe complications (Vettoretti & Facchinetti, 2019).

As a solution to this problem in primary care settings, continuous glucose monitoring (CGM) may be proposed. CGM is a technology allowing patients to monitor their blood glucose levels in real-time and notice patterns of changes depending on performed activities (Alcántara-Aragón, 2019). This paper aims at proving that the use of CGM in primary care would allow physicians to choose better treatment options and help patients decrease negative disease outcomes due to facilitated self-care.

Literature Review

Researchers exploring promising medical technologies for diabetes pay attention to CGM. Alcántara-Aragón (2019), in her review of emerging diabetes technologies, identified the characteristics that patients and clinicians expect from innovative devices and described such options as different types of CGM, telemedicine, and smartphone applications. According to Alcántara-Aragón (2019), patients want diabetes technologies to be adaptive so that they could easily use them in their everyday lives, while clinicians are concerned about costs and the ease of adherence and learning.

Prahalad et al. (2018) explored potential complications of T1D and technologies designed to prevent these complications. Researchers noted that CGM could replace traditional self-monitoring of blood glucose (SMBG) using finger sticks (Prahalad et al., 2018). Prahalad et al. (2018) also noted the possibility of using the internet for educating patients about T1D, telemedicine for providing healthcare in distant areas, and big data for personalized care delivery. Vettoretti and Facchinetti (2019) focused on the opportunity of the combined use of CGM and insulin pumps and reviewed algorithms used to automatically tune the dosage of injected insulin based on the CGM measurements. Thus, CGM is one of the major developments in diabetes technologies.

CGM has already been tested in multiple clinical trials that proved its potential in decreasing negative outcomes of diabetes. For example, Beck et al. (2017) aimed at investigating whether CGM improved the level of hemoglobin A1c (HbA1c) compared to SMBG. This randomized clinical trial involved 158 participants with T1D who used multiple daily injections, 105 of whom were provided with CGM, and 53 were assigned to usual care (Beck et al., 2017). The results of the trial that lasted 24 weeks showed that the use of CGM led to a more considerable decrease in HbA1c levels compared to usual care (Beck et al., 2017).

These findings concur with the results of various studies reviewed by Slattery and Choudhary (2017). Researchers also concluded that the combined use of CGM and systems that automatically suspended insulin delivery when hypoglycemia was expected resulted in the reduction of the frequency of hypoglycemia (Slattery & Choudhary, 2017). Bando et al. (2018) conducted a study in which they identified glucose profiles of a 57-year-old woman with T1D. The findings indicated that CGM lets patients notice the relationship between glucose levels and their lifestyles and adjust their treatment.

Description of the Patient Condition

T1D is a chronic illness resulting from the inability of the pancreas to produce insulin. The number of individuals with diabetes is rising around the globe (Bando et al., 2018). The treatment of the disease is directed toward maintaining adequate levels of blood glucose, which is about 70–180 mg/dl (Vettoretti & Facchinetti, 2019). To reach this target range, proper doses of insulin should be administered. Otherwise, there is a high risk of various complications of diabetes.

If the doses of insulin are too low, it leads to hyperglycemia, which may result in diabetes ketoacidosis, cardiovascular diseases, diabetic foot, kidney disease, neurological damage, or retinopathy (Vettoretti & Facchinetti, 2019). In the case of insulin overdose, hypoglycemia occurs, and it may lead to unconsciousness, seizures, or death if it remains untreated (Vettoretti & Facchinetti, 2019). Therefore, patients with T1D should always be aware of their blood glucose levels to estimate the necessary dosage of insulin.

Individuals with T1D encounter several barriers to care, most of which are related to the necessity of continuous adherence to self-care. For example, young people with T1D are more subject to depression than those without diabetes, and this psychiatric disorder prevents them from the regular self-monitoring of blood glucose (Prahalad et al., 2018). People with T1D undergoing intensive insulin therapy often suffer from obesity (Prahalad et al., 2018).

As a result, girls with T1D sometimes refuse to inject insulin and develop eating disorders to lose weight, which leads them to have microvascular complications (Prahalad et al., 2018). Furthermore, individuals, especially adolescents, have difficulties in adhering to self-care because it requires multiple actions regularly (Alcántara-Aragón, 2019). Thus, patients with T1D feel the need for technology that would facilitate their self-care and lighten their burden of life-long adherence to insulin therapy.

Description of the Technology

CGM is a technology intended to help individuals to monitor their levels of blood glucose. Generally, CGM is a small sensor that is implanted right under the skin of the arm or the abdomen (Vettoretti & Facchinetti, 2019). This sensor measures the concentration of glucose in the subcutaneous tissue at short intervals, for example, five minutes (Vettoretti & Facchinetti, 2019). The sensor is attached to a transmitter, which sends the measurements to a portable receiver that displays the glucose levels and trends (Vettoretti & Facchinetti, 2019). There are two types of CGM: blinded retrospective CGM and real-time CGM.

The first category shows retrospective data and is helpful for physicians adjusting treatment plans (Slattery & Choudhary, 2017). The second type measures interstitial glucose in real-time and activates alarms if hypo- or hyperglycemia is expected so that a patient could quickly respond with appropriate actions (Slattery & Choudhary, 2017). Since real-time CGM measures interstitial glucose, it needs several calibration tests with finger sticks to ensure precision (Slattery & Choudhary, 2017). Recently introduced flash glucose monitoring systems also show real-time data but do not need to be calibrated by patients.

Monitoring blood glucose levels is essential for patients with T1D, and CGM provides several advantages of this process compared to finger sticks. First of all, CGM allows for frequent testing, which helps to prevent hypoglycemia (Slattery & Choudhary, 2017). Although traditional blood glucose monitoring also can be conducted frequently, people often avoid it because of pain, inconvenience, and social uneasiness (Slattery & Choudhary, 2017).

Alarms are also a useful feature because they urge patients to take the necessary measures before their condition worsens. Yet, although alarms are effective, users sometimes feel uncomfortable when their devices make noise in such environments as school or workplace (Alcántara-Aragón, 2019). Finally, CGM is useful for treatment adjustments and the diagnosis of glucose fluctuations due to its capability of identifying trends (Slattery & Choudhary, 2017). The efficiency of CGM has been proved by many clinical trials. For example, the study conducted by Beck et al. (2017) demonstrated that the application of CGM resulted in a larger decrease in HbA1c level in contrast with the control group. The technology is still being improved in terms of accuracy, safety, and ease of use.

One of the most promising benefits of CGM is the possibility of its integration with insulin pumps. Scientists have developed algorithms that allow for attenuating or suspending basal insulin delivery based on the CGM readings (Vettoretti & Facchinetti, 2019).

If an attenuation or suspension method is based on the detection of hypoglycemia, insulin infusion is decreased when current CGM measurements reach a certain threshold (Vettoretti & Facchinetti, 2019). In the prediction-based method, basal insulin delivery depends on the measurements predicted by CGM rather than current ones (Vettoretti & Facchinetti, 2019). The second method is considered more reliable because it prevents a hypoglycemic event, while the detection-based method only reduces its duration (Vettoretti & Facchinetti, 2019).

Such algorithms have already been employed in medical devices, such as MiniMed 640G, and proved to be effective in reducing hypoglycemia events in clinical trials (Vettoretti & Facchinetti, 2019). Scholars are still working on improving the performance of these devices and developing algorithms that would allow for increasing automatic basal insulin infusion in response to hyperglycemia.

The Integration of the Technology

CGM may become a proper solution for patients with T1D turning to primary care for medical help. For such patients, it is crucial to be aware of their blood glucose levels to prevent the incidence of hypo- or hyperglycemia. Therefore, primary care specialists may suggest that these individuals should implant a CGM sensor to monitor their glucose levels and watch the trends. The use of CGM in primary care is likely to facilitate the provision of care. Once physicians get precise information about the patient’s blood glucose dynamics, they will be able to adjust insulin dosages as required by the patient’s condition.

CGM has great potential to integrate treatment and monitoring from the primary care setting to the patient’s home. Healthcare professionals should explain to patients with T1D what advantages CGM has as a tool for monitoring glucose levels. If patients are educated about how to check CGM measurements, how to interpret them, and how to respond to those readings, they will be able to improve their well-being and prevent complications.

CGM seems to be especially suitable for children because they are usually less likely to adhere to routine tasks, and their parents cannot always keep their eyes on them. Furthermore, primary care specialists may recommend the use of flash glucose monitoring systems for children with T1D. Since these systems do not need to be calibrated with finger sticks, they will allow for frequent and painless testing of glucose levels in children.

Finally, CGM is a useful tool for integrating communication between a healthcare professional and a patient from primary care to the home and then to ongoing care. Since CGM registers the patient’s data and notices trends, this information is of great value for primary care specialists because it demonstrates the patient’s situation more accurately than the patient would report orally.

For example, in the study by Bando et al. (2018), CGM allowed researchers to identify how different activities, such as moving, eating, and omitting insulin injections, influenced the patient’s glucose fluctuations. Moreover, recent developments, such as the Dexcom G4 and G5 systems, enable transmitters to send data to the cloud so that information can be accessed via web resources and shared with the patient’s physician (Slattery & Choudhary, 2017). These technologies facilitate the communication between patients and healthcare professionals and allow for providing care at a distance.

Conclusion

To sum up, primary care specialists should be aware of diabetes technologies to treat patients with T1D. One of the existing options is CGM, a system that automatically measures glucose levels at short intervals. CGM ensures frequent measurements of glucose levels, which is often unattainable using traditional testing with finger sticks. The use of CGM in primary care would allow physicians to supply patients with a powerful monitoring tool and choose better treatment options to reduce hypo- and hyperglycemia and avoid complications. CGM facilitates the communication between patients and healthcare professionals by providing specific data about glucose levels and allowing for sharing patients’ information remotely.

References

Alcántara-Aragón, V. (2019). Improving patient self-care using diabetes technologies. Therapeutic Advances in Endocrinology and Metabolism, 10, 1-11. Web.

Bando, H., Ebe, K., Kato, Y., Bando, M., & Yonei, Y. (2018) Investigation of blood glucose profile by continuous glucose monitoring (CGM). Endocrinology Research and Metabolism, 2(1), 1-4.

Beck, R. W., Riddlesworth, T., Ruedy, K., Ahmann, A., Bergenstal, R., Haller, S., Kollman, C., Kruger, D., McGill, J. B., Polonsky, W., Toschi, E., Wolpert, H., & Price, D. (2017). Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections. JAMA, 317(4), 371-378. Web.

Prahalad, P., Tanenbaum, M., Hood, K., & Maahs, D. M. (2018). Diabetes technology: Improving care, improving patient‐reported outcomes and preventing complications in young people with type 1 diabetes. Diabetic Medicine, 35(4), 419-429. Web.

Slattery, D., & Choudhary, P. (2017). Clinical use of continuous glucose monitoring in adults with type 1 diabetes. Diabetes Technology & Therapeutics, 19(S2), 55-61. Web.

Vettoretti, M., & Facchinetti, A. (2019). Combining continuous glucose monitoring and insulin pumps to automatically tune the basal insulin infusion in diabetes therapy: A review. BioMedical Engineering OnLine, 18(37), 1-17. Web.

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.

Researcher’s 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.

Introduction

As healthcare becomes increasingly complicated and technologically sophisticated, its efficacy and application need to be re-evaluated. Modern medicine’s reach is not infinite, and medical workers are not infallible. Sometimes the healthcare system may not be effective, especially when dealing with remote, socially disadvantaged, or otherwise notable groups of people. It has long been the case that Indigenous Australian and Torres Strait population is more likely to suffer and die from Type 2 diabetes. While the medical diagnostic measures and treatments may have advanced, their application may have remained lacking. The situation of the Indigenous and Torres Strait population can potentially be improved by implementing integrated healthcare. Before any conclusions regarding its efficacy can be made, this paper will present a discussion on Type 2 diabetes, the socioeconomic factors that influence the Indigenous population, the Social Determinants of Health, the Chronic Care Model, the Principles of Primary Health Care, and the integrated healthcare.

Indigenous Health and Social Determinants

Health problems do not appear out of the blue and strike at people indiscriminately. The social nature of humans, with all the complexities and inequalities inherent to it, has a profound influence on how people live their lives and what adversity they may face throughout. In practice, that means that health is dependent on social factors as well as biological ones. Examining these dependencies leads to the Social Determinants of Health, which are broad overlapping aspects of human life that can influence the person’s health and overall wellbeing (Clendon and Munns 7). These Social Determinants feature such things as child development, emotional support networks, education, and employment. Social inequalities experienced by the Indigenous and Torres Strait population create a divide in Social Determinants of Health in the Australian public.

A survey conducted in 2012-13 has found that 13% of Indigenous and Torres Strait adults had diabetes. Female respondents were slightly more likely to have diabetes than male respondents. Overall, the Indigenous population was 3.5 times more likely to have diabetes than non-Indigenous Australian adults (Burns 35). Of the Indigenous people, those living in the remote areas were twice as likely to have the condition than those who lived in non-remote areas, driving the disparity between Indigenous and non-Indigenous populations even higher. Curiously, the incidence of Type 1 diabetes is slightly lower in Indigenous Australians than in non-Indigenous Australians. Type 2 diabetes is the most prevalent type among the Indigenous and Torres Strait people and comprised 92% of all diabetes cases. Diabetes is the second leading cause of death for that group; on average, they were twice as likely to die from diabetes than non-Indigenous Australians.

There is evidence of ethnic differences in Type 2 diabetes incidence in other countries too. Minority youths in the United States of America have shown an increase in Type 2 diabetes incidence. Approximately 80% of all young people with that diagnosis belonged to ethnic minority groups (Butler 2). There are notable negative trends in the Social Determinants of Health of these groups. These youths belonged to households that had relatively low income and socioeconomic status, with their parents having attained low education. Suffering from Type 2 diabetes often coincided with experiencing major life stressors regularly.

These negative Social Determinants of Health are also experienced by the Indigenous Australian population, which may explain why they suffer from diabetes to such a disproportionate degree. According to Colagiuri, there are such socioeconomic disparities as lower educational attainment rates, lower employment, lower household income, and higher homelessness (156). Apart from the Social Determinants of Health, the Indigenous populations face a number of unique challenges when it comes to engaging with the healthcare system. Particularly, Indigenous women cited lack of transport, lack of comprehensive information, negative emotions brought by medical information, lack of control, and culturally unfriendly healthcare services (Campbell 559). Some of these barriers stem from living in remote areas and having relatively low income, consistent with the Social Determinants. In contrast, some stem from the healthcare system being unable to adapt to the particular needs of that ethnic group.

Unfortunately, diabetes is not a disorder that can be cured by a single procedure once and forever, it requires follow-ups and lifestyle changes. The negative Social Determinants of Health in the Indigenous and Torres Strait population indisputably play a role in the lifestyles available to them, which may not always facilitate wellness and regular medical evaluations. Profound structural changes should be made to improve the outcomes of the group and the way the healthcare system treats that population.

Principles of Primary Healthcare, Chronic Care, and Integrated Care

The Principles of Primary Healthcare underpin the practice of facilitating care from a social standpoint. These principles are oriented at providing accessible, scientifically sound care, which treats communities and cultures with respect, and, at the same time, promotes long-term wellness in individual patients (Clendon and Munns 13). Accessible care, appropriate technology, and health promotion are a given for any effective healthcare system. However, several of the principles are especially important for dealing with Indigenous communities.

The first crucial principle is intersectoral collaboration, which dictates that various communal sectors should cooperate and communicate to ensure that community members live healthy lives. This collaboration reduces structural inefficiencies, improves the quality of activities, and, ideally, tailors them to particular communities through decentralized management (Clendon and Munns 15). That would ensure small-scale action that is mindful of the local structures, which would engage the limited resources and people who know the most about the Indigenous Australians. Another essential principle, which stems from that local action, is cultural sensitivity and safety. Indigenous people responded much better to treatments that were designed specifically for them, involving members of their group (Gwynne 318). Similarly, a lack of cultural awareness alienated the Indigenous patients and decreased their follow-up rates (Campbell 559). Being intimately familiar with the Indigenous culture appears to be a necessity for an effective healthcare system.

As diabetes is a disorder that requires long-time management, Chronic Care Model could prove especially useful. The model features several core components and many building blocks, which serve to facilitate productive change in how healthcare systems deal with chronic patients. An especially important component of the model is community resources and policies, which include building up local infrastructure and health-oriented programs and events to promote wellness. Another crucial component is self-management support, which entails teaching the patient to live with the diagnosis and make beneficial lifestyle changes using the resources they have (Bodenheimer and Willard-Grace 90). Other components feature significant institutional changes that can reorganize facility personnel, introduce digital solutions, and improve access to disadvantaged groups. Reynolds et al. have found that including even a small number of these components can create tangible change (11). Introducing digital solutions was found to improve outcomes even in the research not concerned with the Chronic Care Model (Li 5). Creating a healthier environment and educating the Indigenous population about their health will serve to improve their outcomes and may even positively influence their Social Determinants of Health by creating a stronger community.

Integrated care is coordination of multiple healthcare systems, levels of care, stakeholders, and methods in order to create a holistic and comprehensive uninterrupted process of healthcare that promotes lifelong wellness and provides support to the patient throughout their lifespan. Integrated care incorporates disease prevention, treatment, rehabilitation, and palliative care, where information about the patient is managed and shared, and their health and wellness are considered from multiple angles (Goodwin). Integration can happen across several axes and areas of healthcare, with various intensity, complexity, or breadth. Effective integration creates a patient-centered approach that engages local resources that are mindful of the local culture, which is particularly important for the Indigenous and Torres Strait population. As integrated care is oriented to delivering lifelong holistic help, it could help manage a chronic condition like Type 2 diabetes for a long time. Moreover, that approach could develop the local infrastructure and create healthcare facilities in remote regions that are more convenient for the locals. Optimistically, that could improve the Social Determinants of Indigenous Health, helping prevent diabetes rather than treat and manage it.

Conclusion

While difficult and, most likely, very costly to introduce, integrated care delivery can help provide better service to the Indigenous and Torres Strait population and manage their various needs. A high-quality local-level healthcare system, which also engages community resources, can directly improve the Social Determinants of Health in the population. That approach combines the Chronic Care Model and integrated care delivery in accordance with the Principles of Primary Care to improve the health and wellbeing of the most vulnerable part of the Australian population.

References

Bodenheimer, Thomas, and Rachel Willard-Grace. “The Chronic Care Model and the Transformation of Primary Care.” Lifestyle Medicine, edited by Jeffrey I. Mechanick and Robert E. Kushner, Springer, 2016, pp. 89–96.

Burns, Jane, et al. Overview of Aboriginal and Torres Strait Islander health status 2018. 2019. Web.

Butler, Ashley M. “Social Determinants of Health and Racial/Ethnic Disparities in Type 2 Diabetes in Youth.” Current Diabetes Reports, vol. 17, no. 8, 2017. Web.

Campbell, Sandra, et al. “Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes.” Primary Health Care Research & Development, vol. 18, no. 6, 2017, pp. 549–562.

Clendon, Jill, and Ailsa Munns. Community Health and Wellness: Principles of primary health care. Elsevier Health Sciences, 2018.

Colagiuri, Stephen. “Diabetes in Indigenous Australians and Other Underserved Communities in Australia.” Diabetes Mellitus in Developing Countries and Underserved Communities, edited by Sam Dagogo-Jack, Springer, 2017, pp. 151–163.

Goodwin, Nick. “Understanding Integrated Care.” International Journal of Integrated Care, vol. 16, no. 4, 2016. Web.

Gwynne, Kylie, et al. “Improving the efficacy of healthcare services for Aboriginal Australians.” Australian Health Review, vol. 43, no. 3, 2018, pp. 314-322.

Li, Shu Qin, et al. “Does delay in planned diabetes care influence outcomes for aboriginal Australians? A study of quality in health care.”BMC Health Services Research, Vol. 19, 2019. Web.

Reynolds, Rebecca, et al. “A systematic review of chronic disease management interventions in primary care.”BMC Family Practice, vol. 19, 2018. Web.

Diabetes type 2 is a disease that occurs when the body does not respond to insulin normally, leading to the rise of a sugar level. The pancreas responds by producing more insulin. This excessive insulin production leads to the wearing out of the pancreas. Eventually, it is no longer able to produce enough insulin to keep the blood sugar levels within the normal range.

There are a couple of reasons why Type 2 Diabetes is most common in children. This includes being overweight, brought about by children eating high-fat and low-fiber diets which lead to weight gain. Excess fat makes it harder for the cells to respond to insulin and this makes it inactive thereby reducing the body’s ability to respond to insulin.

It can also occur when there is little or no physical activity. Regular exercise helps control the amount of glucose in the blood. It also helps burn excess calories and fat which helps in weight management.

Children may also get diabetes through hereditary means, where close family members pass on the disease to the children. It may also occur due to race as certain ethnic groups tend to be more prone to developing type 2 diabetes. African-American, Hispanic, Native American, Asian-American, and Pacific Islander children are at greater risk for developing type 2 diabetes than white American children. Children may also get diabetes if the mother developed diabetes during pregnancy.

The symptoms of diabetes type 2 include;

• Frequent urination. The kidneys respond to high levels of glucose in the blood by flushing out the extra glucose in urine.
• Drinking a lot of liquids. Because the child is urinating so frequently and losing so much fluid, he or she can become very thirsty. He or she drinks a lot in an attempt to keep the levels of body water normal.
• Getting tired often because the body can’t use glucose for energy production properly.
• Nausea.
• Blurred vision.
• Frequent infections and slow-healing wounds or sores.
• Weight loss.
• Increased appetite.

Diabetes type 2 affects children in various ways: A child becomes less active as he/she can not participate actively in sports and other important physical activities due to increased tiredness since the body can not use body glucose properly for energy production. Besides, there is slow healing of wounds and sores that may occur when a child gets hurt when playing.

Type 2 Diabetes affects the child’s ability to concentrate in learning as there is an increased frequency of urination. Blurred vision also affects a child’s performance in school and special arrangements have to be made for the child to be able to read what is being taught.

Due to excessive drinking of liquids, families must ensure they make regular provisions of drinks to keep up with the body’s demands. They are also put at a task to ensure they provide the child with a well-balanced diet which should include the right portions of proteins, carbohydrates, and fat that are needed in the meal.

When diet and exercise do not help maintain normal or near-normal blood glucose levels, doctors prescribe medications that include injection of artificial insulin. The treatment and monitoring of diabetes are expensive, this leads to financial constraints especially for those people who do not have health insurance.

Reference

Barbara Toohey, Diabetes Spectrum journal, 2007 issue.

John K. Davidson (2000) Clinical Diabetes Mellitus; a Problem-Oriented Approach, Davidson publisher, United States.

Louis Steven Levene (2003) Managing Type 2 Diabetes Mellitus in Primary Care: A Practical Guide, Elsevier Publishers, United States Type 2 Diabetes. Web.

Virginia Valentine, June Biermann, (1998) Diabetes Type 2 & What to Do, McGraw-Hill Professional publishers.

Introduction

As a chronic disease, diabetes has a marked influence on the physical, psychological, and social aspects of individuals. Type 1 is a form of diabetes mellitus that occurs due to diminished levels of insulin, loss of energy, and increased levels of glucose in the blood (Markowitz et al., 2019). Since type 1 diabetes is common among young people, it creates a lot of challenges in management. Limited experience and insufficient knowledge are the problems that complicate and hinder the successful implementation of self-management strategies. Patients need to understand the physiological mechanism, treatment and management interventions, long-term effects, educational materials, social reactions, and misconceptions regarding diabetes. Smith and Harris (2018) recommend the early diagnosis, consistent use of insulin, and stringent control of blood glucose as effective strategies to reduce the impact of diabetes on the health status of individuals. Hence, the assessment of patients’ knowledge and experiences would highlight their ability to manage diabetes using appropriate strategies and improve health status.

Statement of Purpose

The purpose of the study is to examine the perceptions that a patient with type 1 diabetes holds about this condition and its impacts on people. The study employed the qualitative approach in the collection, analysis, and interpretation of data collected through interviews of a patient with type 1 diabetes. The qualitative approach is appropriate in this study because it allows the interpretation of knowledge, experiences, and attitudes that patients with diabetes possess. As self-management is an integral aspect of the treatment of diabetes, individuals need to understand their conditions and make appropriate adjustments in their lifestyles. Management strategies such as regulating the intake of carbohydrates, physical activity, and monitoring of blood glucose levels would alleviate the effects of diabetes on the body (Smith, & Harris, 2018). The knowledge that people with diabetes possess determines their ability to manage and improve their health conditions. Health education is usually a critical strategy that healthcare providers employ in promoting the understanding of diabetes and its respective management interventions. Therefore, the analysis and interpretation of the interview transcript of a patient with type 1 diabetes would highlight their perceptions and the capacity to undertake self-management strategies.

Literature Review

Diabetes is an enduring condition that stems from the inability of the body to control the levels of blood sugar within the normal limits for utilization in the production of energy. Depending on the course, diabetes can either be type 1 or type 2. While type emanates from the deficiency of insulin, type 2 occurs due to the resistance of cells to insulin (Markowitz et al., 2019). Moreover, type 1 diabetes is common among children and young adults, whereas type 2 is prevalent among adults. Treatment interventions used in the treatment of type 1 and type 2 varies. In the management of this condition, doctors use insulin injections to supplement the deficiency in the body in type 1 diabetes and utilize glycemic agents in reducing resistance in cells. Hence, understanding the causes would enable doctors and patients to employ appropriate interventions in the management of diabetes.

Although type 1 diabetes is a rare form of this condition, it requires a set of interventions for effective management. The common interventions for type 1 diabetes are insulin injection, regulation of carbohydrates, healthy diet, and physical activity (Smith, & Harris, 2018; Turton et al., 2018). Insulin promotes the intake of glucose into the cells and utilization in the production of energy. Regulation of carbohydrates hinders a rapid increase in blood sugar levels and deteriorates outcomes of diabetes. A healthy diet and physical activity stimulate cells to increase metabolic rates and boost the utilization of blood glucose. These treatment and management interventions are effective because they have long-term therapeutic effects on diabetic patients.

As a chronic condition, diabetes requires consistent treatment and management interventions focused on controlling the level of blood glucose levels in the body. Diabetic complications, such as retinopathy and neuropathy, result in a poor quality of life among patients (Karam et al., 2018). Self-management skills are critical in the management of diabetes because they empower patients to change their lifestyles and adopt healthy behaviors. Rasoul et al. (2019) hold that health education is the best treatment intervention since it promotes healthy lifestyles and alleviates the short-term and long-term effects of diabetes. Therefore, knowledge about diabetes and self-management skills are integral in the treatment of diabetes.

Conceptual Framework

The epistemological premise of the study is that knowledgeable individuals determine their perceptions of diabetes and related impacts. According to Saldana and Omasta (2018), the epistemological basis of a research framework entails the construction of knowledge using diverse perceptions and experiences of people. As the conceptual framework, the qualitative study elucidates that knowledge of diabetes, feelings, treatment interventions, health education, long-term effects, social reactions, and misconceptions are vital factors that shape perceptions of diabetes and its impacts on patients. Markowitz et al. (2019) support the use of qualitative study in examining the experiences of patients with type 1 diabetes by analyzing and interpreting words and expressions in interviews. The analysis of different aspects of the conceptual framework would enhance understanding of the perceptions of diabetes and its impacts on diabetic patients.

Data Collection

The data was collected by interviewing a female patient with diabetes type 1 aged 33 years old. The patient has ample knowledge and experience with the management of diabetes because she was diagnosed six years ago and has successfully adhered to necessary treatment interventions. The interviewer allowed the patient to offer informed consent, seek clarification, and permit audio-recording of her responses for research purposes. The interview process entailed the administration of open-ended questions to direct dialogue and provide freedom to the patient. Markowitz et al. (2019) explain that the use of open-ended questions is effective in qualitative studies because it enables respondents to express their perceptions, experiences, and attitudes, as well as allows researchers to probe emerging themes. Thus, through the interview, the study managed to examine the patient and gather information related to knowledge of diabetes, feelings, treatment interventions, health education, long-term effects, social reactions, and misconceptions.

Data Analysis

Thematic analysis was used in the evaluation of interview transcripts of the patient with type 1 diabetes. Saldana and Omasta (2018) explain that qualitative analysis entails the condensation of large data, identification of patterns, unification of concepts, formulation of themes, understanding of social processes, and interpretation of themes. Multiple readings and the analysis of the interview transcript revealed the existence of major themes related to the perception of diabetes and its impacts on the patient.

The sequential steps employed in the thematic analysis are familiarizing with interview transcript, generating initial codes, identifying major themes, review of themes, defining these themes, and tabulation of results for interpretation (Maguire & Delahunt, 2017). Multiple readings in the first step enabled familiarization with the interview transcript, while the generation of initial codes in the second step permitted condensation and organization of data. The third step is the identification of major themes that relate to diabetes and its impacts on the patient. In the fourth and fifth steps, significant themes were reviewed and defined to meet the purpose of the study. Ultimately, the analysis of the relationships between interview transcripts, initial codes, and major themes was tabulated to provide a clear focus of thematic analysis.

Interpretation of Findings

The thematic analysis of the interview transcript generated codes that were summarized into seven major themes, namely knowledge of diabetes, feelings, treatment interventions, long-term effects, health education, misconceptions, and social reactions, as perceptions of diabetes and its impacts. The thematic analysis exposes that the patient has an excellent knowledge of diabetes. Since the patient has type 1 diabetes, she understands that her pancreas does not produce the required insulin to stimulate the intake of blood sugar into the cells and generate energy. Paschou et al. (2018) report that type 1 diabetes stems from the deficiency of insulin due to the degradation of beta cells of the pancreas by auto-antibodies. As insulin stimulates the intake of glucose by cells, its deficiency leads to lethargy and reduced activity of the brain. From the transcript, the patient is aware that type 1 diabetes does affect not only the production of insulin but also energy production in the body and subsequent effects on the physiology of the brain.

Regarding feelings, the patient demonstrates that she is sensitive to changes that occur in her body and ready to make appropriate adjustments to her lifestyle. When she was diagnosed with type 1 diabetes, the patient was relieved because she got an explanation of her feelings in her body, which represented vital signs and symptoms of her new condition. The patient started to understand that weight loss, frequent urination, and tiredness are some of the major symptoms of type 1 diabetes. The absence of insulin in the body creates a physiological hunger, deprives the body of energy production in cells, and causes persistent tiredness or fatigue.

Treatment interventions comprise a significant theme that is evident in the interview transcript. The patient understands treatment interventions for type 1 diabetes because she states that injecting insulin, rationing carbohydrates, eating a healthy diet, and performing physical activities augment the effectiveness of managing diabetes. According to Turton et al. (2018), the administration of insulin and the consumption of the low-carbohydrate diet ensure long-term management of diabetes because they avert a rapid increase in blood glucose levels. Moreover, Colberg et al. (2016) add that physical activity increases the use of energy, strengthens muscles, improves the activity of oxidizing enzymes, and enhances the sensitivity of body cells to low levels of insulin. Given that the patient applies these interventions in the management of type 1 diabetes, it implies her condition is stable.

The patient is aware of the long-term effects of diabetes since she notes blindness and neuropathy as two extreme conditions. Karam et al. (2018) hold that a chronic increase in blood sugar levels among patients with diabetes degrades nerves, resulting in retinopathy and neuropathy. While retinopathy causes blindness, neuropathy results in diabetic foot and vascular complications. In this aspect, it is apparent that the patient comprehends the long-term effects of diabetes, and she is ready to prevent or cope with them.

The comprehension, treatment, and long-term effects of diabetes originate from the appropriate health education that the patient receives. Following diagnosis, the patient states that she received health education from her doctor and reading materials from the hospital. Moreover, she got critical information from books, websites, and food labels, which enabled her to eat healthy diets and manage diabetes effectively. Rasoul et al. (2019) recommend the use of health education as an intervention to improve the self-management skills of patients with diabetes. However, one needs to be wary of sources of information because some websites or reading materials are not credible. The accessibility of reading materials and the dedication of the patient have empowered the development of self-management skills.

In the interview, the patient highlighted the existence of misconceptions about diabetes. The first misconception is that people confuse type 1 and type 2 diabetes because they present similar signs and symptoms. While an autoimmune degradation of the pancreas causes type 1 diabetes, the physiological deficiency of insulin due to the resistance of cells leads to type 2 diabetes (Smith & Harris, 2018). Another misconception is that diabetic patients should not take sugar because they have excess amounts in their blood. In times of strenuous activity or fasting, diabetic patients require sugar to boost their sugar levels and prevent the occurrence of hypoglycemia. When the patient interacts with people, she encounters varied social reactions. For instance, friends are concerned about health conditions as they fear violating dietary restrictions for people with diabetes. In this view, it is evident that people understand sugar or carbohydrates as having detrimental effects on diabetic patients.

Reflexivity

I have gained important skills in the qualitative analysis of the interview transcript and came up with major themes. Berger (2015) argues that reflexivity sanctions researchers to share the experience of respondents and limit the influence of personal bias. Specifically, I have learned how to code data by reading the transcript numerous times, noticing patterns and unifying sub-themes, and generating major themes, which explain social processes in the management of diabetes. The challenges encountered entailed the identification of sub-themes in the interview transcript and subsequent condensation to generate major themes that match with the literature.

Limitations

The qualitative data has two major limitations regarding the sample size and thematic analysis. One limitation is that since the interview script is of one patient, it has a low external validity to allow the generalization of findings to the population of patients with diabetes (Shanmuganandapala & Khanlou, 2019). Another limitation is that thematic analysis is a subjective process as it tends to introduce researchers’ biases into the interpretation of data and generation of findings.

Conclusion

The qualitative study was performed to determine perceptions of the patient with type 1 regarding knowledge and the capacity to undertake self-management strategies. Thematic analysis and interpretation of the interview transcript revealed seven major themes, which are knowledge, feelings, treatment interventions, health education, long-term effects, social reactions, and misconceptions of diabetes. Comparative analysis reveals that the patient understands diabetes and can undertake effective self-management to alleviate chronic effects, as well as improve quality of life.

References

Berger, R. (2015). Now I see it, now I don’t: Researcher’s position and reflexivity in qualitative research.Qualitative research, 15(2), 219-234. Web.

Colberg, S. R., Sigal, J. R., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association.Diabetes Care, 39(11), 2065-2079. Web.

Karam, T., Kamath, Y. S., Rao, L. G., Rao, K. A., Shenoy, S. B., & Bhandary, S. V. (2018). Diabetic retinopathy in patients with diabetic foot syndrome in South India.Indian Journal of Ophthalmology, 66(4), 547–550. Web.

Maguire, M., & Delahunt, B. (2017). Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Teaching and Learning in Higher Education, 8(3), 3351-3367. Web.

Markowitz, B., Pritlove, C., Mukerji, G., Lavery, J. V., Parsons, J. A., & Advani, A. (2019). The 3i conceptual framework for recognizing patient perspectives of type 1 diabetes during emerging adulthood.JAMA Network Open, 2(7), Article e196944. Web.

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis.Endocrine Connections, 7(1), 38-46. Web.

Rasoul, A.M., Jalali, R., Abdi, A., Salari, N., Rahimi, M., & Mohammadi, M. (2019). The effect of self-management education through weblogs on the quality of life of diabetic patients.BMC Medical Informatics Decision Making, 19(1), Article 205. Web.

Saldana, J., & Omasta, M. (2018). Qualitative research: Analyzing life. Sage.

Shanmuganandapala, B., & Khanlou, N. (2019). An interview between a professor and a nursing graduate student on the current state of post-secondary student mental health in Ontario, Canada. International Journal of Mental Health and Health Addiction 17, 418-424. Web.

Smith, A., & Harris, C. (2018). Type 1 diabetes: Management strategies.American Family Physician, 98(3), 154-162. Web.

Turton, J. L., Raab, R., & Rooney, K. B. (2018). Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review.PLoS ONE, 13(3), Article e0194987. Web.

Introduction

The number of Americans diagnosed with diabetes is approximately 20 million ( Eberhart et al, 2004). The number continues to rise as the population ages and the prevalence of obesity increases. Consequently there is great urgency in the need for diabetes education and self care among patients. The article by Seley and Weinger, improving diabetes self management attempts to address the possible barriers to patient education and the role of the nurse in assisting the patient to manage diabetes. This article includes the input of various nurses who participate in a symposium on how to promote diabetes self management.

Main Text

Diabetes mellitus is a condition in which the body’s production or use of insulin is impaired. It is characterized by deranged metabolism and hyperglycaemia – characteristic symptoms include polyyuria, polydipsia, blurred vision and high blood sugars. There are generally two main forms of diabetes mellitus. Type 1 diabetes and type 2 diabetes. Type 1 diabetes occurs as a result of inadequate insulin and may be caused by autoimmune destruction of the beta cells of the pancreas.

Type 2 diabetes has its aetiology in insulin resistance on target tissues. Due to this, an abnormally high amount of insulin is required by the cells and when the beta cells cannot meet this demand, diabetes develops. Type 1 insulin is treated using insulin (injected). Dietary and lifestyle modifications re also part of the management. Type two usually does not require insulin injections and is managed by a combination of dietary treatment, oral hypoglycaemic agents and lifestyle adjustment (WHO, 1999).

Self management of diabetes is very important since diabetes can lead to various complications. Among these are acute complications for example diabetic ketoacidosis and hypoglycaemia. Long term complications are increase risk of cardiovascular disease, retinopathies, nephropathies, neuropathies, micro vascular damage which may lead to importance and poor healing of wounds. Diabetic foot is a common and serious complication among diabetic patients who get wound of the feet. Poor healing of the wound leads to gangrene which more often than not makes amputation a requirement.

In the developed countries, diabetes is a significant cause of blindness among non-elderly adults, it is the major cause of non-traumatic amputation and nephropathy secondary to diabetes is the most prevalent illness requiring renal dialysis in the United States (Mailloux, 2007). To prevent these complications, patients are asked to follow a meal plan, exercise on a regular basis and to take medication. While new treatments may help to avoid complications, self care is made more complex, and it becomes even more complicated when the patient has comorbidities.

The article provides patient teaching instructions by authoring how attitudes and approaches to patient education as far as diabetes self management can be improved. The article begins by pointing out that most health care system stakeholders do not value patient education enough. The article then goes on to suggest that research proves the need for patient education should be collected. Routine reimbursement to nurses and diabetic educators is an outcome that could be measured to indicate that has been recognition of the value of patient education (Seley and Weinger, 2007). The article emphasizes the need for clearly defined desired outcomes of self management education. This will serve as evaluation measures for the quality and effectiveness of the patient teaching.

The article also points out that a nurse teacher ought to have adequate flexibility to accommodate patient’s differences, such as literacy and cultural background. The teach back method is endorsed as an effective and useful tool which would require evaluation as well as the use of support groups during the patient education process. The diabetes education workforce as presented by the article needs expansion. The article presents a number of strategies that can be used to achieve this (Seley and Weinger, 2007). Among these are competencies, credentialing and the continued education for nurses and diabetic educators working with nurses. A method suggested in the article to teach nurses how to be self management educators is postgraduate mentoring programs (Seley and Weinger, 2007)..

Benefits that can be gained from reading this article include an increased awareness of the barriers that keep patients from successfully managing their diabetes. The article also provides some insight into the working relationship between the nurses and community health workers with reference to diabetic patients and management of their conditions. Being aware of the challenges that patients face in adhering to their treatment regimens is important since from that premises, the nurse can assist the patient to comply as much as possible with the regime.

Further, the article identifies several strategies to help patients overcome these barriers. Among these are helping the patient to navigate the healthcare system. The article suggested use of the chronic care model as a means of being successful at self managing diabetes. The article has also contributed to my appreciation of importance of research in the nursing curriculum and in the providing evidence-based nursing. Consequently, I have identified gaps in research as a result of reading the article and realizing that is limited research on the relationship between great clinical education and better outcome for patients as well as the role of no cure healthcare professionals in giving patient education.

The information obtained from the article can be incorporated in various ways in my nursing practice. To begin with, I will have a more proactive and educative role when managing diabetic patients, when teaching I will employ the teach back method to find out how effective it is in helping the patient to understand management of their condition.

The information learnt from the article can also be incorporated into nursing practice by linking patients who have been recently diagnosed with diabetes to self management education programs. This will make it easier for the patients to go through the health systems.

Eliciting patients’ fears, concern, worries and needs is also practical approaches that could be incorporated into patient teaching. This is an especially good approach when the patient has comorbidities and doing so helps to prioritize the needs of the patient leading to optimum use of time and effectively addressing the patient’s problems.

Utilization of computers to track patients and as a tool of patient education are also strategies that can be easily incorporated into nursing practice especially in hospitals whose the policy altars. Support groups can also be adequately used to give a sense of comfort and solidarity for patients. I would employ this strategy with an aim of addressing the psychosocial issues associated with diabetes and especially when working in a situation where the clients are from similar backgrounds.

Conclusion

The information generated on research by the article can be incorporated into nursing practice when I join a journal club that would provide the opportunity to be involved in research work and to practice skills of evaluation to enhance evidence based care nursing. Another benefit of reading this article is the fact that it has opened my eyes to possible ways in which my professionalism can be enhanced. This is because the article mentions postgraduate mentoring programs that I would benefit not only the nurse but also patient. In addition, by mentioning some of the research gaps in diabetes patient care management, the article has helped to provide several research problems that could be pursued in my final year of study.

References

Eberhart, MS; Ogden C, Engelgau M, Cadwell B, Hedley AA, Saydah SH (2004). Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes — United States, 1988–1994 and 1999–2002 Morbidity and Mortality Weekly Report 53 (45): 1066-1068.

Seley J and Weinger K 2007 American Journal of Nursing.

– Supplement: State of the Science on Diabetes Self Management: Strategies for Nursing. Pages 6 – 11 Volume 107 Number 6.

Mailloux L, 2007 Up-To-Date Dialysis in diabetic nephropathy. Web.

World Health Organisation, 1999 Department of Noncommunicable Disease Surveillance Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Web.

Introduction

Mrs. G is a 55-year-old Hispanic female who had visited the office for her annual wellness exam. She complained of fatigue and lethargy for the last three months. The patient had also gained weight since menopause in the previous year. She exercised for 30 minutes twice a week expecting to lose weight but instead, she gained 3 pounds. Mrs. G also complained of extreme hunger, thirst, and increased urination. She wanted to know why she had these symptoms and how to lose weight. This paper evaluates the subjective and objective findings of Mrs. G and develops appropriate diagnoses. The paper also formulates an evidence-based treatment guideline.

Assessment

Primary Diagnosis

Type 2 diabetes mellitus without complications (E11.9)

Pathophysiology. Type 2 diabetes occurs following a reduction in the efficiency of beta cells of the pancreas, which results in low production of insulin, insulin resistance, and high blood glucose levels. The classic indications of the disorder include polydipsia (increased thirst), polyuria (increased urination), and polyphagia (elevated hunger), and weight loss (American Diabetes Association [ADA], 2019).

Pertinent positive findings. The patient complained of fatigue, lethargy, increased hunger, and thirst. Mrs. G also admitted that she passed more urine than usual at night. These symptoms had persisted for the last 3 months (subjective findings). The objective findings included hemoglobin A1C of 6.9% and urinalysis of 1+ glucose. The patient had a major risk factor for type 2 diabetes (obesity) as indicated by a BMI of 33.8 (ADA, 2019).

Pertinent negative findings. The patient did not have a family history of type 2 diabetes. Her urine was negative for ketones, whereas her fasting blood glucose level was 95 mg/dL (within the normal range of 71 to 99 mg/dL) (ADA, 2019).

Rationale for the diagnosis. The patient exhibited the classic indications of type 2 diabetes, namely, polyphagia, polydipsia, and polyuria that have been occurring for the last 3 months. The patient had risk factors for the disorder such as being obese, Hispanic ethnicity, and age. The hemoglobin A1C was increased at 6.9% instead of 6.5% or lower, whereas urinalysis indicated glucosuria. ADA (2019) recommends that a diagnosis of type 2 diabetes should be made when a patient meets the above criteria in the absence of the hallmarks of hyperglycemia devoid of repeat testing.

Secondary Diagnosis

Hyperlipidemia, unspecified (E78. 5)

Pathophysiology. Hyperlipidemia is a metabolic disorder characterized by the presence of high levels of lipids and lipoproteins (such as total cholesterol, very-low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and triglycerides) that elevate the risk of atherosclerosis and low amounts of beneficial lipoproteins such as high-density lipoproteins (HDL). The disorder is a common complication of other health problems such as type 2 diabetes mellitus, hypertension, and coronary artery disease and presents with symptoms such as corneal arcus, carotid bruit, and yellowish deposits of cholesterol beneath the skin (xanthomas) or around the eyelids (xanthelasma) (Li et al., 2019).

Pertinent positive findings. The patient had a diagnosis of type 2 diabetes, obesity, a positive family history of hypercholesterolemia (father), and high blood pressure (129/80 mmHg). She also had an abnormal lipid profile as follows: total cholesterol 230 mg/dL (<200 mg/dL), LDL 144 mg/dL (optimal range < 100 mg/dL or 70 mg/dL in people with diabetes or cardiovascular disease), VLDL 36 mg/dL (2-30 mg/dL), HDL 38 mg/dL (40-50 mg/dL), and TG 232 mg/dL (<150 mg/dL) (Karr, 2017).

Pertinent negative findings. The patient had no history of smoking or atherosclerosis. She had been exercising regularly (for at least 30 minutes twice a week) (Karr, 2017).

Rationale for the diagnosis. The lipid profile confirmed high levels of bad cholesterol (TC, VLDL, LDL, and TGs) and low levels of good cholesterol (HDL). The patient also possessed risk factors for hyperlipidemia such as her Hispanic ethnicity, a diagnosis of diabetes, obesity, and hypertension (Karr, 2017).

Secondary Diagnosis

Obesity, unspecified (E66.9)

Pathophysiology. Obesity is the accumulation of excess body fat in the adipose tissues, which results from an imbalanced caloric intake and expenditure, as well as impaired balance between lipid and glucose metabolism. The excess stored triglycerides hamper lipogenesis whose role is to facilitate serum clearance of triacylglycerols, contributing to hyperlipidemia, excess free fatty acids, and insulin resistance alongside symptoms such as fatigue and joint pains (Heymsfield & Wadden, 2017).

Pertinent positive findings. Objective findings included the patient’s obese appearance, a BMI of 33.8 kg/m² that signified obesity class I (normal BMI is 18.5-25), left knee arthritis, and high blood pressure (129/80). Subjective findings indicative of obesity included fatigue, weight gain of 3 pounds, as well as increased appetite and eating (polyphagia) (Heymsfield & Wadden, 2017).

Pertinent negative findings. The patient exercised for 30 minutes twice a week (subjective). The thyroid function tests were normal: TSH 2.35 (normal range 0.5-4.5 mU/L) and Free T4 0.7 (normal range 0.7-1.9 ng/dL) (Heymsfield & Wadden, 2017).

Rationale for the diagnosis. The subjective and objective findings indicate obesity. An unsuccessful weight loss attempt was an indication of impaired lipid and glucose metabolism due to insulin resistance that is associated with obesity. The patient had other health complications such as hypertension, hyperlipidemia, and type 2 diabetes where obesity plays a significant role as a risk factor (Heymsfield & Wadden, 2017).

Plan

Diagnostics

Hemoglobin A1C. Blood samples should be drawn and retested for hemoglobin A1C levels after 3 months.

Rationale. ADA (2019) recommends that HbA1C levels should be tested every 3 months to assess the patient’s glycemic control and management of diabetes. This test determines the efficiency of the treatment plan and directs the clinician’s decision to modify the regimen. The patient’s condition at the time of testing determines the future frequency of testing.

Complete metabolic panel (CMP). This test should be repeated after 6 weeks (ADA, 2019).

Rationale. CMP determines blood sugar levels, fluid-electrolyte balance, and assesses liver and renal function. ADA (2019) requires diabetic patients on metformin to undergo a CMP annually to monitor the possibility of megaloblastic anemia following vitamin B12 deficiency in protracted metformin use. However, for patients taking statins for the treatment of hyperlipidemia, this test should be performed sooner to assess liver function. An initial test was performed during the annual visit. Nonetheless, given that the patient had hyperlipidemia and was to be treated with statins, a CMP would be required after 6 weeks (ADA, 2019).

Urinary albumin to creatinine ratio. ADA (2019) requires all patients diagnosed with type 2 diabetes to undergo annual testing of urinary albumin to creatine ratio. This test should be scheduled during the patient’s next annual visit.

Rationale. Type 2 diabetes is associated with kidney failure (diabetic nephropathy). The presence of albumin in the urine (albuminuria) is a sign of renal complications and should be evaluated regularly. The patient’s urinalysis showed traces of proteins, which could be indicative of renal failure. A normal test should give an albumin-to-creatinine ratio of 30 mcg/L or less. Levels ranging from 30 to 300 mcg/L indicate microalbuminuria while values exceeding 300 mcg/L are considered macroalbuminuria. However, given the possibility of false-positive results, the test should be repeated every three to six months. Microalbuminuria is confirmed if two positive tests are obtained in a span of 3 to 6 months (ADA, 2019).

Medications

Medication. Rx: Metformin 500 mg tablets

Sig: Take one (1) tablet by mouth twice daily

Disp: #60 (Sixty). RF: 2 (ADA, 2019).

Rationale. Metformin is the first-line treatment for type 2 diabetes. All patients diagnosed with type 2 diabetes should receive this drug unless there are any contraindications (ADA, 2019).

Medication. Rx: Simvastatin 20 mg tablets

Sig: Take one (1) tablet by mouth once daily

Disp: #30 (Thirty). RF: 2 (Rhee et al. 2018).

Rationale. A moderate statin such as simvastatin should be selected for patients with a 10% risk of atherosclerotic cardiovascular disease. This risk was computed for Mrs. G and found to be 6.3%. The US Preventive Service Taskforce (USPSTF) recommends that adults aged between 45 and 75 years who have no indications of stroke or coronary artery disease but have risk factors for heart disease such as diabetes, an abnormal lipid profile, and elevated blood pressure should be treated with statins (Fay et al., 2019).

Education

Diagnoses

Your lab results for hemoglobin A1C indicate that you have type 2 diabetes. This test measures the mean blood sugar levels for the last 3 months and is at 6.9%, which is higher than the recommended level of 6.5% in healthy people (ADA, 2019). These outcomes mean that your body is unable to use up glucose efficiently, which is why you have been experiencing symptoms such as increased thirst, hunger, and urination. The amount of fats in your blood is also high, meaning you have a condition known as hyperlipidemia. Specifically, your blood contains high volumes of bad cholesterol and low quantities of good cholesterol. Another health problem is obesity, which means that the proportion of fat in your body is higher than normal (ADA, 2019).

Medication. To manage diabetes effectively, you are expected to take metformin orally, twice daily after breakfast and dinner. This drug will help you to control your blood sugar levels and weight. You are also expected to take simvastatin to lower the levels of bad cholesterol and boost the good cholesterol in your blood. This drug should be taken once a day with your evening meal (Rhee et al., 2018).

Diet. The effective management of diabetes requires you to choose your meals carefully. It will also help you to lose weight, reduce harmful cholesterol, and increase the good cholesterol. You should make healthy food choices and cut down your portions of carbohydrates and fats. ADA (2019) recommends that you should take between 1,200 and 1,500 calories per day. Important guidelines for your meals include cutting down your intake of sugar, salt, and trans-fats (animal fats) and increasing the consumption of fruits and vegetables, whole grains, nuts, and legumes. About half of your plate should comprise vegetables, whereas the remaining half should be split between proteins and carbohydrates. You should also reduce the intake of wine or try to avoid it altogether (ADA, 2019).

Exercise. Exercising regularly helps your body to use up glucose and will improve your diabetic symptoms as well as help with weight and cholesterol issues. You should try aerobic exercises and strength training, which may entail specific exercises like hinges, squats, pulls, pushups, and core work. You should do these exercises for at least 30 minutes for 5 days a week. If possible, you can prolong the time to 45 minutes or an hour (ADA, 2019).

Warning signs for diagnosis and medication. The two major problems that you should watch out for are hyperglycemia (very high blood sugar levels) and hypoglycemia (very low blood sugar levels). The indications of hyperglycemia include fatigue, restlessness, queasiness, and dizziness, whereas the signs of hypoglycemia encompass hunger, shaking, dizziness, confusion, and anxiety. To avoid these issues, you should take your medications as prescribed and adhere to a specific eating pattern (ADA, 2019). Diabetes can result in other health problems such as eye issues, foot sores, and damage to the nerves and kidneys. Hyperlipidemia increases your risk of heart attack or stroke. Therefore, you should watch out for any chest pains and shortness of breath and seek medical attention. Obesity increases your risk of coronary heart disease and worsens other conditions that you already have such as diabetes, hypertension, and hyperlipidemia (ADA, 2019).

Metformin may cause side-effects such as queasiness, vomiting, stomach upset, and diarrhea (ADA, 2019). Conversely, simvastatin may cause side effects such as muscle pain, headache, flatulence, constipation, and vertigo (RxList, 2020). However, these effects will resolve with time as your body gets used to the drug.

Referral

Registered Dietitian. Mrs. G was referred to a competent dietitian for help with customizing her meals. Personalized nutritional therapy promotes the attainment of glycemic goals in diabetes (ADA, 2019).

Assessment of Comorbidities

ADA (2019) recommends that patients with type 2 diabetes be assessed for hip fractures because diabetes increases the risk of this condition. The relative risk is 1.7 and persists in diabetic patients despite having a high bone mineral density (BMD). Diabetes causes hyperglycemia that is accompanied by increased generation of advanced glycation end-products, development of reactive oxygen species, and inflammation. These factors elevate the numbers of osteoclasts and reduce the populations of osteoblasts, thereby interfering with bone formation (Jiao et al., 2015). Studies show that the risk of osteoporosis and hip fractures increases in females after menopause (Boschitsch et al., 2017; Peng et al., 2020). Mrs. G is post-menopausal and diabetic, implying that her fracture risk is compounded. Her history of arthritis and obesity further aggravate the risk. Therefore, the patient’s BMD should be measured.

Follow-Up

Mrs. G will be required to return to the hospital for follow-up after 4 weeks to be evaluated for the remission of symptoms and adherence to treatment. The side effects and tolerability of the drugs will also be evaluated (ADA, 2019). Any other concerns of the patient will be addressed at this time.

Medication Cost

The cost of 30 tablets of simvastatin 20 mg with a Costco free coupon is $5.16 (GoodRx, 2020a), whereas the price of 60 tablets of metformin 500 mg at Walmart pharmacy is $4 (GoodRx, 2020b). The approximate monthly cost of the new prescription drugs for Mrs. G is $9.16. Managing diabetes is a costly affair, and most patients become non-adherent to treatment due to cost implications. Therefore, generic formulations of drugs were chosen to minimize costs (ADA, 2019).

Conclusion

Type 2 diabetes is a longstanding health disorder that is characterized by impaired blood glucose metabolism. The risk factors for the development of the disorder include age, ethnicity (Hispanics are at higher risk), body weight (obesity), high blood pressure, physical inactivity, aberrant triglyceride and cholesterol levels, and positive family history, whereas its complications include cardiovascular disease, neuropathy, nephropathy, skin conditions, retinopathy, depression, foot disorders, and hearing impairment. The effective management of type 2 diabetes requires the concerted effort of a primary care provider, the patient, and specialists such as dieticians, ophthalmologists, or podiatrists as the patient’s needs dictate.

References

1. American Diabetes Association. (2019). Standards of medical care in diabetes-2019. Diabetes Care, 42(Supplement 1), S1-S193. Web.
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Identification of the Problem

Type 2 diabetes is a form of diabetes characterized by high levels of blood sugar, resistance to insulin, and its relative lack. The chances of developing the condition depend on a combination of risk factors that include both the genetic background and the lifestyle. While the risk factors associated with one’s age, gender, ethnicity, or family history cannot be changed, the lifestyle choices linked to weight, physical activity, and dietary habits are possible to modify (National Institute of Diabetes and Digestive and Kidney Disease, 2016). If an individual is not physically active, does not make healthy nutritional choices, and continues such behaviors over prolonged time periods, the risk of developing diabetes increases. At this time, the individual at risk of type II diabetes regularly consumes fast food due to its convenience because she is heavily occupied by work.

Cooking healthy meals every day takes up too much time, and she has indicated that she would rather spend that time resting after a long workday. The job that the family member does is low in physical activity, she is at her computer most of the time, working with documentation. She has indicated that she tries to walk home from work sometimes because it takes around 30 minutes; however, it does not happen often. Consistent but straightforward changes in lifestyle can be hypothesized to help in decreasing the risk for the condition’s development. There is a high need to invest more time into cooking healthier meals and inserting more movement into daily life.

Proposed Solution for the Problem

Consistent and positive lifestyle changes represent the leading solution recommended for the family member. Researchers have widely explored lifestyle changes as being a continuous challenge that many women find complicated to maintain. According to Ahlin and Billhult (2012), women have shown to exhibit ambiguous feelings of others’ involvement in their lifestyle, experiencing deficits in knowledge, as well as finding reasons to justify not making any changes. It is imperative for the patient to overcome these challenges despite the inner struggles that make the experience of making modifications in one’s lifestyle.

To facilitate a change in lifestyle to include more exercises and change dietary habits, it is recommended for the patient to participate in a structured diabetes patient education program that would be evidence-based, culturally-sensitive, and delivered by trained educators that would provide support in both group and individual settings. Such a structured program for enhancing diabetes prevention education is necessary for the patient to understand her current condition and facilitate a positive change in her daily habits (Chong et al., 2017). Since the patient has indicated that she does not have enough time and moral power to facilitate a change in her physical activity and dietary choices, an educational program can be a good option for the patient.

Long-term lifestyle management and preservation of healthy choices are key behaviors that would facilitate physical activity, healthy eating, weight management, and other positive changes. Physical activity is essential for helping prevent the onset of the condition, reduce the risk of complications, and improve the control of blood pressure. Weight management and dietary modifications, such as the implementation of the Mediterranean or low-glycemic index eating patterns, have shown to be effective in improving the markers of cardiovascular disease risk, which are associated with type 2 diabetes.

With the help of an educational program, the patient is expected to develop a better understanding of how she can self-manage her health to prevent the occurrence of the condition. Effective-self management that relies on physical activity and exercises can facilitate the improvement of clinical outcomes, the health status of the patient, and the quality of life overall. These improvements are necessary to instil a positive attitude toward one’s health and can support the well-established routine that will be measured and monitored consistently. Self-management is the primary outcome of patient education and is expected to facilitate improved diabetes knowledge and self-care behaviors, which would further facilitate lower self-reported weight, health coping, and reduced costs of healthcare.

The current solution targets the lifestyle choices area because it has the most impact on changing the patient’s health trajectory. The proposed changes are universally applicable because they can be tailored to individual needs, preferences, and capabilities while also addressing psychosocial issues and related behavioral strategies (American Diabetes Association, 2017). Ultimately, the recommended solution will promote and support healthy eating patterns and physical activity to achieve and maintain body weight goals and delay the onset of type 2 diabetes. The educational aspect of the solution will promote self-management behaviors intended for creating balance in the patient’s life. While limiting caloric intake and replacing harmful fast food for healthier options may be challenging, self-management will slowly maintain the pleasure of eating and provide non-judgmental messages about appropriate food choices. Self-management will also ensure that individuals with diabetes have the practical tools for developing healthy patterns that will be pleasurable to them.

Description of the Solution

The solution pertaining to improving lifestyle choices that include dietary improvements and enhanced physical exercises may provide an individual with a high risk of type 2 diabetes with a set of defined tools, which can be used for creating an environment within which such choices will be celebrated. The lifestyle changes may not come at once, which means that small but consistent adjustments are necessary to integrate the new practices and behaviors. For the patient’s health and well-being, establishing a set of practices that would facilitate an overall improvement. With the help of an educational course that would inform the patient about the evidence-based best practices of preventing diabetes development, it is possible to facilitate changes that would enhance the quality of life.

The patient has indicated that her current lifestyle, including her work and dietary choices, is confined to a heavy workload, which prevents her from developing a more active and healthy routine to prevent the occurrence of type 2 diabetes. For the individual who has not been making particularly healthy lifestyle choices, the challenges of a new plan is determining what behaviors should be embedded into a new routine and how the plan can be followed (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). Since there is no one-size-fits-all approach, the self-management approach will facilitate the engagement of the individual into the development of a personalized plan that will benefit her health

In terms of the specific behaviors and the ways in which they should be modified, the self-management practices are expected to give the patient strength to be more active in changing her practices. When there is a transition associated with healthcare, it is essential to identify the current behaviors and practices that either limit or facilitate lifestyle change. In the specific case of the patient, the lack of time that the person has to spend on preparing healthy food or exercising is the main barrier. With the help of self-management, the patient will have to allocate free time in her schedule to implement new behaviors. To overcome the obstacle, she may have to negotiate a more flexible work schedule at work. Moreover, a time management application can be a useful tool for managing the patient’s timetable and allow her to plan ahead for physical exercises and food preparation. Moreover, there are new services that specialize in the delivery of healthy pre-prepared meals or ingredients to make them in a short amount of time.

For maintaining the healthy lifestyle choices for long-term wellness, the patient is recommended to use the full availability of tools and resources designed to make lifestyle planning more manageable and less stressful. It is imperative to have a positive attitude toward the changes that she will be making to approach the problem through preparation and a pre-prepared list of goals to achieve. The support from the educational program is necessary because it will offer a roadmap to success, while the patient will adjust the proposed plan to her needs and capabilities. Long-term behavior changes cannot come at once to ensure the prevention of type 2 diabetes; rather, they imply small steps in the direction of establishing a healthy and fulfilling routine that will be manageable and effective.

Reflection on the Assignment

When completing the assignment, it was necessary to cope with some challenges associated with the proposal of a solution and its integration into the daily life of a patient. The positive aspect of the assignment pertained to making recommendations on the positive lifestyle choices that the individual can implement to reduce the risk of type 2 diabetes development. It was important to communicate the message of introducing the changes that will be positively approached by the patient and those that would enhance the quality of her life. There is really no universal approach to preventing type 2 diabetes because people’s lives, needs, capabilities, and situations are often different. Therefore, the proposal of lifestyle improvement changes, which is an integral component of the strategy, is the strong aspect of the current project.

When formulating the proposed solution to address the identified health challenge, coming up with the idea that would support the solution was challenging. Since the patient does not have much free time and support that would help her overcome the challenge associated with the lifestyle change, many methods seemed unreasonable and ineffective. The solution related to attending educational courses that would train the patient on how to make the decisions that would benefit her overall well-being and prevent type 2 diabetes from developing. However, it seems that additional considerations are necessary because it is unclear whether the patient will have enough free time to attend the courses. Therefore, if the patient finds the courses to take up too much of her time, it is necessary to adjust the recommendation based on her daily schedule and time capacity. Overall, the solution can be adapted, and it is essential to remember that the patients’ needs should be set as a priority of the plan.

References

1. Ahlin, K., & Billhult, A. (2012). Lifestyle changes – a continuous, inner struggle for women with type 2 diabetes: A qualitative study. Scandinavian Journal of Primary Health Care, 30(1), 41-47. Web.
2. American Diabetes Association. (2017). Lifestyle management. Web.
3. Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2017). Primary care – e-book: A collaborative practice. Elsevier.
4. Chong, S., Ding, D., Byun, R., Comino, E., Bauman, A., & Jalaludin, B. (2017). Lifestyle changes after a diagnosis of type 2 diabetes. Diabetes Spectrum, 30(1), 43-50.
5. National Institute of Diabetes and Digestive and Kidney Disease. (2016). Risk factors for type 2 diabetes. Web.

Type 2 diabetes is one of the most dangerous diseases in the modern world. In 2016, “the International Diabetes Federation reported around 425 million people living with diabetes worldwide” (1, p. 442). According to Berbudi, Rahmadika, Tjahjadi, and Ruslami (1), type 2 diabetes is responsible for approximately 90% of all the cases above. This information means that many people suffer from this health condition. That is why this assignment will comment on type 2 diabetes’ effect on morbidities, life expectancy, health care cost, and how it is necessary to address this disease.

Firstly, it is necessary to discuss type 2 diabetes morbidities and mortality. According to Yakaryilmaz and Öztürk (2), this disease results in many morbidities, including sarcopenia, cognitive impairment, urinary incontinence, numerous kinds of physical disability, and others. Mortality rates are also high because approximately five million people died because of diabetes in 2017, meaning that individuals with this health condition experience a shorter life expectancy (1). Secondly, the disease under consideration is a severe economic burden for every country. Some researchers (2) admit that the United States spends approximately $245 million on diabetes patients every year. Simultaneously, other scientists (1) show that worldwide spending accounted for $850 million in 2017. This information denotes that this issue should be addressed from a public health point of view.

There exist multiple strategies of how to meet the public health demand regarding type 2 diabetes. On the one hand, Yakaryilmaz and Öztürk (2) argue that medical nutrition therapy is a suitable strategy to prevent individuals from consuming ingredients that are dangerous for them. On the other hand, researchers (2) stipulate that patients with type 2 diabetes should be involved in regular physical activity according to their abilities. These two options are effective in improving public health response to type 2 diabetes, meaning that they help minimise the impact of the disease on society.

In conclusion, statistical evidence demonstrates that type 2 diabetes is a significant health issue in the modern world. Millions of people suffer from this condition, which exposes them to multiple morbidities and decreased life expectancy. This information inevitably leads to the case that the health care industry faces an economic burden to treat the given disease. Thus, medical nutrition therapy and regular physical activity are useful options to improve public health resistance to type 2 diabetes adverse impact.

References

Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev. 2020; 16(5): 442-449.

Yakaryilmaz FD, Öztürk ZA. Treatment of type 2 diabetes mellitus in the elderly. World J Diabetes. 2017; 8(6): 278-285.

Randi Streisand and Maureen Monaghan, PhDs, researchers in the Center for Translational Science Children’s National Medical Center, describe the qualitative study of type 1 diabetes (T1D) in children. The study is presented in the context of T1D current treatment procedures, and behavioral aspects of care for these children. The authors emphasize that, despite the diversity of management needs, specific education is not provided properly, and clinical services for managing diabetes in young children are rarely offered. Moreover, available behavioral research involving this age group is limited in scope and quantity. In the article, the psychological difficulty of controlling type 1 diabetes, as well as potential parental stress, are given attention. Moreover, young T1D patients need to integrate their condition into a new lifestyle and get used to the transition to an adult outpatient health care network. Previous research findings concerning the population of young children with T1D are reviewed in the article, and potential clinical implications are discussed; moreover, potential directions for future research in this field are formulated.

The authors present detailed characteristics of T1D management in young children, trying to include all the necessary elements. In particular, goals of therapy include maintaining appropriate BG levels, as well as the problems of the increased insulin sensitivity potential development, unpredictable nature of patterns in diet or physical activity, and glycemic variability. Specifically, based on the literature analysis, challenges to glycemic control and physiologic challenges are considered, in particular, as neurocognitive consequences of early T1D onset. Much attention is paid to physiological challenges and issues of initial adjustment following T1D diagnosis, including physical activity and nutrition. Moreover, the high value of the research is determined by the fact of analyzing the impact of T1D on quality of life and emotional functioning in children, and anxiety and depression symptoms in parents, including parents, sleep disturbances. Potential interventions are considered, based on the presentation of a brief review of existing evidence-based practice. Thus, the research presented in this article has the potential to enable an in-depth understanding of the impact of early-onset type 1 diabetes on children.

References

Streisand, R., & Monaghan, M. (2014). Young children with type 1 diabetes: Challenges, research, and future directions. Current Diabetes Reports, 14(9), 1-14.