Category: Diabetes

Identification of Focus for Community Teaching

Secondary Prevention/Screening for Vulnerable Populations: Rural Adult Citizens with Prediabetes Conditions at a High Risk of Developing Type 1 and Type 2 Diabetes Mellitus.

Epidemiological Rationale for Topic

Diabetes Mellitus is a highly dangerous disease, the epidemic of which has been affecting various populations worldwide. The number of people with this condition grows at a high rate. The statistical data show that “more than 29 million people in the United States and 420 million globally have diabetes, with a projected global prevalence of 642 million by 2040” (Reusch & Manson, 2017, p. 1). The need for providing teaching sessions for patients with prediabetes is vital due to the necessity of disseminating knowledge and self-management skills to prevent Type 1 and Type 2 Diabetes Mellitus, as well as the multiple complications that might accompany the disease. Indeed, according to Rutledge et al. (2017), patients suffering from diabetes are at risk of developing “microvascular and macrovascular complications (e.g., heart disease, stroke, kidney disease, and retinopathy) that lead to a decrease in quality of life” (p. 1). The scope of complications has psychological, social, and economic implications for individuals and communities.

Moreover, rural citizens demonstrate an elevated level of a tendency to have diabetes. At the same time, patients living in rural areas “face barriers and challenges to accessing diabetes care” and less frequently participate in preventative4 care practices (Rutledge et al., 2017, p. 2). Therefore, the high level of comorbidity risks, diabetes prevalence in rural citizens, and their low rate of access to preventative care include the essential elements of the rationale for community teaching. The rationale justifies the application of teaching methods that would help the target population adhere to self-management behaviors, including healthy dieting, physical activity, blood glucose monitoring, and eHealth application use.

Nursing Diagnosis

The risk for changing blood glucose level, the risk for insufficient self-management, insufficient treatment and management knowledge.

Readiness for Learning

The level of community readiness for learning is an important indicator of the overall success of the planned teaching sessions. The preventative educational efforts provided for a prepared and acknowledged community is expected to be effective. The readiness of the target population might be assessed with the help of interviews or questionnaires. As for the factors that would indicate the readiness to learn, they might include emotional preparedness, currently used community practices to prevent Diabetes Mellitus, the knowledge of the community members about the disease, awareness about the prevalence and complications, and the overall community climate. In essence, the willingness of the population to obtain the knowledge would be a driving force for the teaching process.

Learning Theory to Be Utilized

For the proposed community teaching project, the behavioral learning theory will be used. The primary goal of the teaching is the changes in participants’ behavioral patterns and lifestyle to reduce the risks for comorbidities and complications that might follow from the mismanagement of diabetes mellitus. Behaviorism-oriented learning theory will stimulate the practical skills of the students in changing and maintaining their daily health routine.

Goal

Healthy People 2020 objectives address diabetes from various angles to combat the disease and its multiple complications in all populations. The current community teaching plan targets the goals under the D-16 category, which necessitates to “increase prevention behaviors in persons at high risk for diabetes with prediabetes” (Healthy People 2020, n. d., para. 20). In particular, the teaching plan’s objectives for behavioral change deal with the subcategories of the D-16 objective. D-16.1 objective requires an increase in “the proportion of persons at high risk for diabetes with prediabetes who report increasing their levels of physical activity” (Healthy People 2020, n. d., para. 21). D-16.2 targets prevention for persons trying to lose weight, and D-16.3 – for persons trying to reduce “the amount of fat or calories in their diet” (Healthy People 2020, n. d., para. 22-23). These objectives are prioritized in the teaching plan and are addressed in the interventions for the students.

How Does This HP2020 Objective Relate to Alma Ata’s Health for All Global Initiatives

The presented Healthy People 2020 objectives concerning the prevention of diabetes relate to the Alma-Ata Declaration’s initiatives. When taken to the dimension of rural communities, Alma-Ata’s initiative identifies the disparities and inequalities in access to healthcare, which requires substantial improvement of preventative and educational efforts on the community level (Kalra et al., 2018). Within the context of the contemporary high rates of diabetes morbidity, diabetes care and prevention must be addressed by multiple stakeholders.

Develop Behavioral Objectives (Including Domains), Content, and Strategies/Methods.

Creativity

The techniques and methods used for the teaching plan are creative due to the utilization of various approaches of participants’ engagement in the learning process. Teamwork, visualization, and role-playing all contribute to the creativity of the project and are aimed at facilitating the most effective outcomes.

Planned Evaluation of Objectives

1. For the healthy diet knowledge objective, the ability of the participants to choose healthy products from the list of foods and beverages will be measured. Multiple-choice tests will be created to evaluate the students’ knowledge.
2. Students’ ability to name an anticipated number of hours necessary to spend for exercising and the vital signs to maintain effective and safe training will be measured via questions and answers.
3. Students’ ability to use the tests according to instructions and interpret the results will be measured in the mode of observation.

Students’ independent usage of the main features of the app will be evaluated by tasking them to find specific data in their application.

Planned Evaluation of Goal

The achievement of the goal of increased prevention behaviors in the target population will be evaluated in three months after the sessions’ ending. The questionnaires and interviews with the participants will be conducted to retrieve their perception of their preventative behavior. The results will be compared with the pre-teaching indicators.

Planned Evaluation of Lesson and Teacher

The teacher will be evaluated by anonymous student feedback. The lesson effectiveness will be evaluated by the participants by allocating a particular score on a scale from 1 to ten.

Barriers

The barriers that might obstruct the learning process might include participants’ lack of attention, distractions, insufficient attendance rate, and misunderstanding. To address these barriers, the teacher will engage all the participants in the learning process by initiating dialogues. Distractors, such as phones or other devices, will be prohibited. Attendance will be tracked and encouraged; any misunderstanding will be resolved with the help of question and answer sections within each class.

Therapeutic Communication

The presentation will start with the teacher’s introductory encouragement that people with diabetes can live a qualitative life if the disease is properly managed. At the stage of the new content presentation, the audience will be asked follow-up questions and will be encouraged to give feedback on the pieces of information obtained from the lecture to monitor their active listening. Active listening will be encouraged by the continuous establishment of a dialogue with the participants and between them in small discussion groups. The teaching sessions will be concluded with the summation of the learning information and the encouragement of using it in daily life. Facial expressions of smiling, brow movements, and head nods will be used to encourage the students to speak and act.

References

Explore mySugr app features. (n. d.). Web.

Healthy People 2020. (n. d.). Diabetes [Data set]. Web.

Kalra, S., Akanov, Z. A., & Pleshkova, A. Y. (2018). Thoughts, words, action: the Alma-Ata declaration to diabetes care transformation. Diabetes Therapy, 9(3), 873–876.

Reusch, J. E., & Manson, J. E. (2017). Management of type 2 diabetes in 2017: Getting to goal. Journal of the American Medical Association, 317(10), 1015-1016.

Rutledge, S. A., Masalovich, S., Blacher, R. J., & Saunders, M. M. (2017). Diabetes self-management education programs in nonmetropolitan counties – United States, 2016. MMWR Surveillance Summaries, 66(10), 1-6.

Exercise and physical activity are one of the first and primary strategies advised for patients either at risk or newly diagnosed with type 2 diabetes. In combination with diet and behavior modification, exercise is a critical component of virtually every treatment or program aimed at diabetes, obesity prevention, and lifestyle intervention (Kirwan, Sacks and Nieuwoudt, 2017). Education and intervention programs attempt to focus on lifestyle changes, particularly physical activity because it is a powerful tool at prevention, managing, and sometimes reversing type-2 diabetes. In 53-study meta-analysis, Coppola et al. (2015) found that physical activity promotion program reduces the incidence of type-2 diabetes by 41%.

The modern medical approach to type-2 diabetes or pre-diabetes patients is to concentrate on symptom control and targeting glycosylated hemoglobin (HbA1C) levels. Lifestyle change and weight loss through interventions such as physical activity is important for managing glycaemia, dyslipidemia and hypertension after the diabetes diagnosis. Taheri et al. (2018) found improvement in glycemia associated with weight loss and a diabetes remission occurring in 11.5% of participants. This was further supported by Pan et al. (2018) which saw that supervised aerobic, combined, and resistance exercises showed up to 0.30% lower reductions in HbA1c compared to no exercise with also benefits to total cholesterol, triacylglycerol, and improvements in systolic blood pressure alongside weight loss due to physical activity. Targeted interventions which encompass dietary guidance alongside physical activity such as resistance training and increase to overall physical activity over a one year maintentance period demonstrate effective results at decreasing multiple risk factors for diabetes such as body weight, dietary and saturated fat, and dietary fiber (Lindstrom et al., 2003). There is also the added benefit of saving costs for medication for treatment of diabetes, as Kikuti‐Koyama et al. (2019) found that increased physical activity improves the status of diabetes mellitus through lower body weight and HbA1c levels, thus reducing medication expenses.

Al-Thani et al. (2018) suggests that regular physical activity has a protective effect on the risk of non-communicable diseases such as diabetes which is the major cause of morbidity and mortality in the Gulf region. Unfortunately, his studies found that for majority of youth, one of the least at-risk populations but represents the future of Qatar, do not receive the minimum requirement of 60 minutes of physical activity per day. More than 85% of females and 75% of males do not engage in sufficient amount of daily activity.

As mentioned earlier, physical activity is universally one of the primary lifestyle changes recommended by medical professionals for prevention of type-2 diabetes as well as a range of other health conditions. Physical inactivity can inherently increase the risk of stroke, heart disease, cancers, and remains one of the leading risk factors for mortality around the globe and in the Gulf region especially (Chrismas, Majed and Kneffel, 2019). Outside of highly unique or specific cases, there is no evidence to suggest that there are detrimental effects to physical activity in the management of diabetes. There was no research found which found negative or even neutral effects. Universally, all studies found some sort of positive effect of both short-term and long-term exercise for management of type-2 diabetes, either through weight loss or decreasing HbA1c levels. These studies, medical professionals, and health organizations worldwide include physical activity as a primary recommendation for the prevention and management of type-2 diabetes.

Policy

This paper will seek to examine policy approaches at the national level in Qatar regarding management of type-2 diabetes using physical activity and other related measures. The Gulf region is seeing increasingly high levels of obesity, cardiovascular disease, and type-2 diabetes. In 2017, a WHO study found that 72% of Qatari adults are overweight, 34% are obese. As known, obesity is directly linked with prevalence and risk factors for type-2 diabetes. 90% of diabetes diagnosed cases in Qatar are type-2 diabetes. Currently the prevalence rate for type-2 diabetes in Qatar is at approximately 17%, expected to increase to 24% by 2050 and accounting for 32% of national health expenditure if drastic measures are not taken (Awad et al., 2018). The WHO recommends a global action plan for prevention and control of noncommunicable diseases, diabetes being one of the primary targets. It is recommended that by 2025, national health targets seek to achieve a 25% reduction in premature mortality and reduce the prevalence of the primary behavioral risk factors which for diabetes are unhealthy diet (by 30%) and physical inactivity (by 10%) (Awad et al., 2019).

In 2016, Qatar launched its National Diabetes Strategy which is a comprehensive national plan targeted at prevention and treatment of diabetes. The focus is on providing access to correct information and tools to make healthy lifestyle choices alongside the proper services, research, and infrastructure which is aimed improving quality of life and diabetes service provision for citizens of Qatar (Ministry of Public Health, 2020). While a comprehensive and structured plan with long-term objectives is both beneficial and necessary, it is necessary to address critical preventive measures through education and stimulation of physical activity among the population. A 2012 survey found that 44% of young adults in Qatar had insufficient levels of physical activity, statistics that have likely increased by current year due to prevalence of technologies and stay-at home culture. For majority of these young adults, family health values as well as Islam played a role. Unfortunately, religion, culture, and family give priority to work and academic achievement as well as largely promote male physical activity rather than for females (Alijayyousi et al., 2019). This is indicative that a large sociocultural shift needs to occur over time which promotes equitable influence for physical activity through families as well as various institutions such as government, education, and places of work.

A proposed policy will take on a dual approach of educating the population and introducing government-run and funded initiatives that will popularize and motivate physical activity at the mass level, particularly in younger populations where diabetes prevention is both critical but also easier. In order to be successful at the national level, the initiative has to be universally implemented at all levels of population (urban and rural), governance, and levels of care including primary and secondary care. The centralized nature of Qatar’s government, the outreach of the ministries, and culture benefits a comprehensive national approach.

The first part of the initiative is a large public awareness campaign regarding obesity and type-2 diabetes. The key is to associate the two factors together alongside other health-related issues. The population should be aware of the origins and basic risks of type-2 diabetes development. However, the key is to create an informational but optimistic messaging which promotes solutions for addressing the health issue and incorporate citizens into the physical activity programs discussed below. Large scale studies demonstrate that professionally developed campaign advertisements for health can increase search for additional information regarding the health topic by as much as 50% in those exposed to the campaign (Yom-Tov). Educational and psychosocial interventions can improve diabetes management. With culturally appropriate and targeted interventions on diabetes health education, both knowledge regarding the disease as well as glycemic control via lifestyle changes and public attitudes improve (Nazar et al., 2016).

The public education program can be rolled out with the Ministry of Health at the leadership, creating all the necessary materials ranging from advertisements to billboards, posters, and brochures. There can be cooperation with the Government Communications Office as well as the Ministry of Education to roll out the program massively. The roll-out should focus on cooperation with government, health and education institutions which will promote the information campaign amongst its staff and students. A specific focus on targeting education institutions should be made with a promotion of healthier lifestyles and physical activity.

The second part of policy should aim at increasing physical activity through 1) infrastructure and 2) initiatives. Qatar is a unique position of hosting the FIFA World Cup in 2020, so there is a rapid construction boom of large sports facilities ongoing around the country. The government should take advantage of this to promote athleticism and physical activity. These facilities are world-class and consist of not only large stadiums but multiple training infrastructure. This can be utilized to the advantage of Qatar leading up to and after the World Cup, to adapt the infrastructure towards use by citizens. This should be done in combination of investment in localized sports infrastructure as well, including community gyms, outdoor parks, and other active recreational areas, all of which should be promoted and created with appeal to the female population as well. It includes investment into athletic facilities for local community centers and schools, ensuring that schools and universities offer comprehensive physical education. A number of public health research studies indicate that communities should offer a healthy physical and social environment for physical activity to thrive. This includes providing transportation networks for greater activity such as sidewalks, parks, and bicycle lanes as well as modifying residential and commercial facilities which offer appropriate resources to facilitate physical activity (MacKenzie et al., 2015).

Targeted government-sponsored initiatives can be undertaken to boost physical activity. National campaigns such as the Move Your Way launched in the U.S. a decade ago targets all populations and offers both resources and guidelines to increase physical activity. In the prominence of digital culture of the modern world, a smartphone app can be developed that promotes activity, offers tutorials and guided workouts, and perhaps creates competition both locally and nationally for prizes. Another initiative which can be adopted in Qatar in urban areas and had significant success in Singapore, is users of the Apple Watch product could get paid up to $380 dollars during the two year participation for consistently using the health application and conducting health activities such as walks, yoga, and swimming (Elegant, 2020). Financial incentive to maximize long-term participation in activity can be highly effective. Overall, policy should aim at publicly promoting and popularizing physical activity amongst all layers of the population while providing the necessary information, infrastructure, and potential rewards for citizens to utilize when they make the necessary adjustments to lifestyle.

Reference List

Aljayyousi, G.F., Munshar, M.A., Al-Salim, F. and Osman, E.R. (2019). Addressing context to understand physical activity among Muslim university students: the role of gender, family, and culture. BMC Public Health, 19(1).

Al-Thani, M., Al-Thani, A., Alyafei, S., Al-Kuwari, M.G., Al-Chetachi, W., Khalifa, S.E., Ibrahim, I., Sayegh, S., Vinodson, B. and Akram, H. (2018). Prevalence of physical activity and sedentary-related behaviors among adolescents: data from the Qatar National School Survey. Public Health, 160, pp.150–155.

Awad, S.F., O’Flaherty, M., Critchley, J. and Abu-Raddad, L.J. (2018). Forecasting the burden of type 2 diabetes mellitus in Qatar to 2050: A novel modeling approach. Diabetes Research and Clinical Practice, 137, pp.100–108.

Awad, S.F., O’Flaherty, M., El-Nahas, K.G., Al-Hamaq, A.O., Critchley, J.A. and Abu-Raddad, L.J. (2019). Preventing type 2 diabetes mellitus in Qatar by reducing obesity, smoking, and physical inactivity: mathematical modeling analyses. Population Health Metrics, 17(1).

Chrismas, B.C.R., Majed, L. and Kneffel, Z. (2019). Physical fitness and physical self-concept of male and female young adults in Qatar. PLOS ONE, 14(10).

Coppola, A., Sasso, L., Bagnasco, A., Giustina, A. and Gazzaruso, C. (2015). The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine, 53(1), pp.18–27.

Elegant, N. X. (2020) ‘One country is now paying citizens to exercise with their Apple Watch’, Fortune, Web.

Kikuti‐Koyama, K.A., Monteiro, H.L., Ribeiro Lemes, Í., Morais, L.C., Fernandes, R., Turi‐Lynch, B. and Codogno, J. (2019). Impact of type 2 diabetes mellitus and physical activity on medication costs in older adults. The International Journal of Health Planning and Management, 34(4).

Kirwan, J.P., Sacks, J. and Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic Journal of Medicine, [online] 84(7 suppl 1), pp.S15–S21. Web.

Lindstrom, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., Uusitupa, M. and Tuomilehto, J. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12), pp.3230–3236.

MacKenzie, J., Brunet, J., Boudreau, J., Iancu, H.-D. and Bélanger, M. (2015). Does proximity to physical activity infrastructures predict maintenance of organized and unorganized physical activities in youth? Preventive Medicine Reports, 2, pp.777–782

Ministry of Public Health. (2020) ​​​​​​National Strategy to Prevent Diabetes in Qatar​. Web.

Nazar, C.M.J., Bojerenu, M.M., Safdar, M. and Marwat, J. (2016). Effectiveness of diabetes education and awareness of diabetes mellitus in combating diabetes in the United Kigdom; a literature review. Journal of Nephropharmacology, 5(2), pp.110–115.

Pan, B., Ge, L., Xun, Y., Chen, Y., Gao, C., Han, X., Zuo, L., Shan, H., Yang, K., Ding, G. and Tian, J. (2018). Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, [online] 15(1).

Taheri, S., Chagoury, O., Zaghloul, H., Elhadad, S., Ahmed, S.H., Omar, O., Payra, S., Ahmed, S., El Khatib, N., Amona, R.A., El Nahas, K., Bolton, M., Chaar, H., Suleiman, N., Jayyousi, A., Zirie, M., Janahi, I., Elhag, W., Alnaama, A., Zainel, A., Hassan, D., Cable, T., Charlson, M., Wells, M., Al-Hamaq, A., Al-Abdulla, S. and Abou-Samra, A.B. (2018). Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I): a randomised controlled trial to examine the impact of an intensive lifestyle intervention consisting of a low-energy diet and physical activity on body weight and metabolism in early type 2 diabetes mellitus: study protocol for a randomized controlled trial. Trials, 19(1), 1-14.

Yom-Tov, E., Shembekar, J., Barclay, S. and Muennig, P. (2018). The effectiveness of public health advertisements to promote health: a randomized-controlled trial on 794,000 participants. npj Digital Medicine, 1(24).

Introduction

The following is an evaluation of the advantages and disadvantages of point of care testing with reference to diabetes. The additional tests required for long term control of the disease are also discussed. It is important to first define the meaning of diabetes and point of care testing before determining the advantages and limitations of point of care testing. Diabetes is a relatively familiar condition in the world today. It is a collection of metabolic illnesses whereby the blood sugar is higher than normal.

High blood sugar has the effect of producing the classical symptoms making one to urinate frequently. In addition, one feels thirsty and hungry most of the times. Diabetes occurs in two types, 1 and 2. When the body fails to produce insulin, it results to type 1 diabetes. According to This type of diabetes therefore calls for an insulin injection (American Medical Association & College of American Pathlogists.2007, 71). Type 2 results from the failure of insulin to function well in the body and therefore causing insulin resistance complications. An insulin resistance complication arises once the cells fail to utilize the insulin well.

Other modes of mellitus diabetes are gestational diabetes, which is associated with pregnant women, congenial diabetes, and steroid diabetes among others. All the above types of mellitus diabetes can be easily dealt with through improving the insulin functionality. However, type2 diabetes may be managed through prescriptions. Mellitus diabetes has long-term effects, which includes; damaging the retinal, cardiovascular illnesses, hypoglycemia among other effects. Diabetes Mellitus is very costly to manage and therefore, frequent treatment is essential since it ensures that the blood pressure is controlled. Frequent treatment is also ideal as it helps to check the body weight (Ozcan, 2003, 86).

Approximately, more than 120 million of the world’s population have diabetes.For instance, Type 2 diabetes is the most prevalence in the United States affecting more than 85% of the adults (Lewandrowski, 2001, 58).

Point of Care Testing

Point of care testing commonly referred to as POCT is an analytical testing whereby, the patient’s samples are tested outside the laboratory in the vicinity of the patients medical staff.The medical staff are usually untrained and the devices used may be situated in portable carts. Point of care testing thus brings the laboratory tests to the patients instead of sending the patients to the laboratories. Point of care testing has been enhanced through the development of transportable analyzers that ensures rapid test outcomes (Estridge et al., 2000, 17). Point of care testing was because of development of the blood glucose monitors for home usage by the diabetics.

Point of care testing is implemented to reduce the overall time involved for analytical tests and thereby enhancing the patients’ treatment.However, the reduction of overall time involved in analytical tests does not enhance the patient’s conditions most of the times. The technological innovation has played an important role of instrument design and this has led to the development of smaller and sophisticated instruments that are easy to use for the analytical tests (Williams, 2002, 89). The following are the advantages and disadvantages of Point of Care Testing;

Advantages of Point of Care Testing

Point of Care testing is associated with the reduction of turn-around time i.e. the laboratory tests are obtained rapidly implying that there are minimal or no quality controls that are required during screening. For instance, the POL which is a point of care testing program allows blood glucose tests,haemoglobin tests and other tests to be performed rapidly by the medical assistants before the diabetes patients sees the medical doctors.

This implies that the medical results are readily available for the doctors in order to make decisions regarding the patient’s follow-ups or further treatment. This is thus an efficient mode rather than sending the patients to a hospital laboratory to get tested wait for results and then come back at a later period in order to get to know about their conditions (American Diabetes Associatioin, 1991, 23-24). The laboratory time for care testing is 14 days, which is far much higher than the turn-around.

The reduced turn around time is ideal as it motivates the medical staff. The point of care testing also allows the patients to share information with the staff. Therefore, patients are able to discuss about their diabetes conditions and receive immediate answers. This helps to save time and the anxiety associated with waiting for the results (Price et.al, 2004, 142).

Point of care testing helps to improve the patient’s outcome due to the reason that the analytical tests are conducted while being close to the patients. By conducting the analytical tests in close proximity, the outcomes are obtained immediately and therefore, the staff can immediately detect areas that require to be improved so as to enhance the patient’s conditions. The reduced turn around times, helps to improve the outcome of the patients by increasing efficiency i.e. the delays and follow-ups that are costly with regards to the patient’s outcomes are avoided. The patients are able to discuss their diabetes condition face-to-face with the staff as opposed to telephone conversations and this promotes joint decision-making.

There are complex behavioral changes that are required for the diabetes’ patients and therefore, point of care testing plays an important role of helping the patients monitor their blood glucose. This blood glucose’ self monitoring process is essential for diabetes patients especially those that are suffering from type 2. POCT ensures that the meals compositons, mealtimes and physical activities are controlled. It also helps to detect and avert the hypoglycemia and also to assess and maintain metabolic controls especially during the acute illnesses (Ford, 2006, 65).

The home testing application of point of care testing has played an important role with regards to self-monitoring by the patients. The diabetes patients for instance have found the glucose meters to be very important as far as their self monitoring is concerned. Capillary testing has also enhanced the patients’ ability to maintain their glycemic controls as opposed to obsolete methods like urine glucose tests.

Capillary testing plays an important role of diagnosing gestational diabetes. Point of care testing ensures that parental care is conducted on routine basis. Gestational diabetes is usually screened for pregnant women in order to test the acceptable level of venous plasma. The reflectance meter is used to measure the venous samples and is an effective tool as it ensures that accuracy is attained (Garcia, 1999, 69).

Point of care testing helps to reduce the prevalence of chronic complications in diabetes. Chronic complications refers to the main outcomes of diabetes mellitus particularly type 2 and these complications has the effect of reducing the patients’ life quality, incurring huge financial burdens and also increasing the death rates among the patients. The Chlamydia screening plays an important role of reducing the occurrence of complications especially in women who suffers from gestational diabetes (Bernoville, 1999, 76).

Point of care testing involves the cross-trained medical staffs who maximize the productivity. In point of care testing, the health care expert’s works as a team. Teamwork is important as it enhances job satisfaction and this in turn helps to increase the patient’s welfare. Teamwork also contributes to improved health care quality and more productivity. Highly performance teams also play an important role as they offer huge support to medical staff that has low experience (Bishop, & Fody, 1978, 24).

Teamwork also helps to reduce the stress levels due to the fact that the members monitor their performance and therefore giving feedback among themselves. This thus helps to reduce the error rates. In point of care testing, the cross training of medical staffs enhances teamwork (Northwestern University, 2005, 42).

Point of care testing is associated with better laboratory –nursing units which facilitate effective communication. The fact that results are immediately established helps to improve communication between the health care givers and the patients. Communication is essential because it is through the communication that the patients are educated on how they can manage their conditions. Communication also accelerates the decisions that are made concerning the patients’ health condition and therefore, the patients become the center of attraction whereby, the decisions that are made are directed towards improving the health condition of the patient (Guthrie, & Guthrie, 2008, 46).

Point of care testing helps to reduce the workload required for the central laboratories. The point of care testing has developed a strategy that enables better management of the program. For instance, an interdisciplinary point of care testing which comprises of the nurses and physicians has been set so as to determine the analytical tests menu, establish procedures and policies, and select the technologies and also to ensure that there is compliance with regards to training.

Point of care testing helps to reduce the healthcare care resources that are needed for each diabetic patient. In many occasions, the cost concerning diagnostic tests does not appear. This makes the point of care testing to be highly preferred among the diabetic patients (Jacobs, 2008, 45).

Point of care testing has adopted the use of information technology in the recent years so as to enhance its effectiveness. The increased use of computers and microchips has made it possible for the patients to monitor themselves. This has also made it possible for the lesser trained staff to perform the analytical analysis. The information technology has thus made the point of care testing to be more flexible as compared with the laboratory testing (Lee, 2009, 201).

Point of care testing is often cheaper than laboratory testing as a result of reduction in the turnaround time. Point of care testing enables the diabetes patients to receive treatment quickly as well as shortening the patient’s wait. This means that the transport expenses are reduced making it to be cheaper than laboratory testing. The methods that are used in point of care testing are usually simple implying that any person who has some basic health care training can be able to perform the analytical tests.

The sampling types that are required in point of care testing are usually not invasive as opposed to the ones that are required in central laboratory tests and this thus makes POCT to be more acceptable by the patients.Aslo, there are no logistics that are required in transporting specimen to central laboratory and therefore errors that are associated with assigning incorrect patient details are greatly reduced (Brubaker, & Simpson, 1995, 53).

Disadvantages of point of care testing

The following are the advantages of point of care testing with reference to diabetes. The equipment for point of care testing is usually expensive as opposed to the equipment used in central laboratory testing. There are complicated technologies that are used in point of care testing and so, much expertise and time have been invested by the manufacturers making the equipment to be costly.

The reagents on the other hand have limited life implying that they require to be replaced if the analytical tests are not conducted more often. A single test is thus very expensive in point of care testing as compared to the central laboratory tests. With the sophistication of technology, the point of care testing has been less sensitive as compared to the laboratory testing. Usually, the training of point of care testing kit users is often neglected implying that it is easy for systematic errors to creep in.

Errors are therefore not easily noticed and there is a possibility of ignoring random errors. Also, the point of care testing poses uncertainty in that, the systems used for recording the results may fail to capture all the patients’ records as opposed to the central laboratory. The nurse may thus record patient’s information in patient’s notes and fails to do so in the central record (Slee, & Joachim, 2001, 56-59).

Point of care testing demands regular audits so as to be certain that the patients are provided with the necessary information and this is also costly. On the other hand, the costs of analytical tests for diabetic patients in point of care testing are higher as compared to that of laboratory. Point of care testing direct charges for diabetic patients is higher as opposed to that of central laboratory. The central laboratory has the advantage in that, it can duplicate the tests.

The central laboratory also enjoys economies of scale as opposed to point of care testing and this makes the central laboratory to be deemed as cheaper. In point of care testing, such costs as machine costs, maintenance, storage e.t.c.requires to be considered and this makes point of care testing to be expensive compared to central laboratory testing. The glucose costs in point of care testing is usually costly i.e. about five times higher than that of the central lab implying that point of care testing program requires many resources than the central laboratory testing.

Also, the point of care devices is not accurate as compared to the instruments that are used in the main laboratory (British Medical Associatiion, 2005, 75). The glucose meters used in point of care testing for instance has 20% accuracy level as compared to laboratory instruments that have more than 94 % accuracy level. On the other hand, the reference ranges of point of care testing are usually different. Point of care testing devices usually depends on operators for performance.

This implies that the visual results are likely to change with regards to specimen loading differences. Therefore, slight variations can affect the point of care testing results.Aso, the point of care devices are usually limited in that, they cannot store huge amounts of data. They thus require periodic downloading which is a bit cumbersome. It is also very expensive to connect the point of care devices. This is due to the fact that various manufacturers have developed their user interfaces independently and uniquely. In other words, the points of care testing devices are not standard and they therefore provide varied information to the users (Gibbons et.al, 2009, 92).

Point of care testing is usually a complex method and poses various chances of committing an error i.e. in order to deliver quality, point of care testing, there are several multidisciplinary coordination’s that are required. Poor communication in point of care testing provides opportunities for error. The progress of point of care testing entails a clear understanding of the patient care and in most occasions, the staff fails to do so and this makes system to be less effective (Williams, et al., 24, 2003).

Additional tests required for long term control of the disease

Diabetes is usually a serious disease and it estimated that more than 20 % of adults particularly in developed nations have diabetes. The additional tests will play an important role of diagnosing and monitoring diabetes. The following are the additional tests that are required for long term control of the disease i.e. plasma tests, urine glucose and ketone bodies tests and glycated protein tests. The purpose of these additional tests is to screen people in order to know as to whether or not they have diabetes. Earlier detections are vital since they help people to be aware of their condition and seek for treatment in advance (Wilkinns & Williams, 2006, 68)

Plasma/blood tests

Plasma tests are aimed at measuring the glucose levels. The three Plasma glucose tests are fasting, oral tolerance and causal plasma which are explained in the following paragraphs. For Fasting plasma test, it usually takes 8 hours fasting period which helps in testing the level of glucose in the body (AMACAP, 2007). Fasting has the effect of stimulating the hormone glucagons’ release and this helps to raise the level of plasma glucose (Bishop et al., 2000, 52).

The level of glucose for the persons suffering from diabetes is always higher than the acceptable level. Oral tolerance test takes one hour intervals within which the blood glucose is tested. The diabetic patients are given a glucose solution which causes a rise in the glucose levels during the opening one hour. The glucose levels falls to normal level within a period of three hours for the reason that the body releases insulin which helps to normalize the level of glucose. Random tests also referred to as causal plasma test and can be administrated at any given time. These tests are performed even if the patient has not eaten (Feinglos, & Bethel, 2008, 29).

Urine glucose test and ketones test

These are self monitoring tests aimed at detecting the main hyperglycemic episodes with reference to patients who may be unwilling to undergo through the blood glucose screening. These tests are carried out two to three times a week. The target of these tests is to separate the urine from glucose (Olefsky, 2004, 30).

The Glycated protein tests for diabetic

These are those tests that are performed in order to enable one to determine the glucose content of his or her body. Glycated protein tests therefore indicate the levels of fructosamines or the plasma. It determines the average level of glucose in a patient within a period of three weeks (Nicholas, 2003, 64).

Conclusion

Point of care testing is among the most controversial issues relating to laboratory medicine. The controversy is a result of the testing cost, the staff competency and the relationship between POCT and the similar testing that are conducted elsewhere. The main objective of point of care testing is to produce the results more quickly as opposed to most of the equivalent tests that are performed in the central laboratory.There are various reasons as to why the reduction in turn around time is necessary with regards to clinical considerations. The technological innovation today has enhanced the reliability of point of care testing devices (AMACAP, 2007).

Point of care testing encompasses various medical staff e.g. nurses, physicians, therapists e.t.c. It is usually performed in the homes and examination rooms of physicians and emergency department. POCT approach is very crucial clinically and also convenient to both the patients and the care givers.However, the cost involved in point of care testing may be a bit higher as opposed to that of the laboratory and therefore it should be applied as and when necessary.

Point of care thus has such benefits as maximizing the productivity of staffs, reducing the workload for central labs among others (Bernoville, 1999). Point of care testing has some disadvantages such as higher analytical costs, lack of efficiency among the care givers, different reference ranges and poor data management. There is need to consider additional tests for the long term control of the disease. Some of the additional tests include the plasma tests, urine glucose and ketone bodies tests and glycated protein tests.

Reference List

American Diabetes Associatioin., 1991. Diabetes care. Illinois: Northwestern University.

American Medical Association & College of American Pathologists (AMACAP). 2007.

Archives of Pathology & laboratory medicine, Volume 131, Issue 7. New York: College of American Pathologists.

Bernoville, F. 1999. Diabetes Mellitus. New Delhi: B. Jain Publishers.

Bishop, M. L. & Fody, E. P., 1978. Diabetes mellitus: theory and Management. London: Urban & Schwarzenberg.

Bishop, M. L. et al., 2000. Clinical chemistry: principles, procedures. Philadelphia: Lippincott Williams & Wilkins.

British Medical Association. 2005. Diabetes mellitus. British medical journal, Volumes 7524-7531. New York: the University of California.

Brubaker, D. B. & Simpson, M. B., 1995. Dynamics of homeostasis and thrombosis. New Yok: American Association of Blood Banks.

Estridge, B. E. et al., 2000. Basic medical laboratory techniques. Stamford: Cengage Learning.

Feinglos, M. N. & Bethel, M. A., 2008.Type 2 diabetes mellitus: an evidence-based Approach to practical management. New York: Humana Press.

Ford, A.M., 2006. Focus on diabetes mellitus. New York: Nova Publishers.

Garcia, L., 1999. Practical guide to diagnostic parasitology. US: ASM Press.

Gibbons, M.C. et al., 2009. Handbook of Digital Homecare. Berlin: Springer.

Guthrie, D.W. & Guthrie, R.A., 2008. Management of diabetes mellitus: a guide to the Pattern approach. Berlin: Springer Publishing Company.

Jacobs, D. S., 2008. Laboratory test handbook. Hudson: Lexi-Comp.

Lee, M., 2009. Basic Skills in Interpreting Laboratory Data. Bethesda: ASHP.

Lewandrowski, K., 2001. Point-of-care testing. London: W.B. Saunders Co.

Nicholas, J. H., 2003. Point-of-care testing: performance improvement and evidence-Based outcomes. New York: Marcel Dekker.

Northwestern University., 2005. Archives of pathology & laboratory medicine. Illinois: Northwestern University.

Olefsky, J. M., 2004. Diabetes mellitus: a fundamental and clinical text. Philadelphia: Lippincott Williams & Wilkins.

Ozcan, S., 2003. Diabetes mellitus: methods and protocols. New York: Humana Press.

Price, C. P. et al., 2004. Point-of-care testing. New Yok: American Assoc for Clinical Chemistry.

Slee, V. S & Joachim, H., 2001. Slee’s Health care terms. Sudbury: Jones & Bartlett Learning.

Wilkinns, G. & Williams, L., 2006. Diabetes mellitus: a guide to patient care. Philadelphia: Lippincott Williams & Wilkins.

Williams, D. R., 2002.The evidence base for diabetes care. Hoboken: John Wiley and Sons.

Williams, R. H. et al., 2003. Clinical Diagnostic Technology: The Total Testing Process. New Yok: American Assoc for Clinical Chemistry.

First of all, Alex’s age indicates that he is at risk of getting type 2 diabetes. Based on the information presented, it is possible to conclude that his feelings of uncertainty and powerlessness derive from a 5-year disease history. Two years before the diagnosis, he had symptoms of hyperglycemia, when blood glucose records indicated values of 6.5-7.0 mmol/l. However, these indicators were described only as ones indicative of ‘borderline diabetes’. This vague description and the lack of a coherent disease prevention plan contributed to the feeling of uncertainty.

Furthermore, Alex does not understand the connection between family factors and type 2 diabetes. Most likely, his parents did not receive appropriate treatment and, therefore, Alex was not aware of this risk factor. He also believes that only eating sweets influences the condition, whereas a well-balanced, healthy diet does not imply complete sugar avoidance. Hence, he assumes there is no need to check glucose levels because doctors already know that his sugar levels are high. In addition, Alex’s wife attempts to treat suspected diabetes with natural components, and weight-loss supplements amplified his doubts.

The feeling of powerlessness comes from an inability to lose weight despite doing physical exercises. Alex has gained 10kg and has been unable to lose more than 2kgs after retiring. As a result, his Body Mass Index accounts for 35, which puts him in the obese category. Even though he is taking prescribed medication to keep cholesterol levels under control, he does not know exactly how it helps him avoid complications. Consequently, Alex feels powerless to find out the reasons behind type 2 diabetes and opportunities to adjust to the lifestyle.

Older Adults with Diabetes

Diabetes is a serious health condition that can significantly reduce the quality of life, especially for older adults. First of all, adults, especially women with diabetes, are more likely to suffer from disability (Koye, Shaw, and Magliano, 2017). Secondly, older people diagnosed with diabetes are at risk of acquiring cognitive impairments, such as dementia or memory loss (Bruce et al., 2009). Finally, there are social aspects, including the absence of caregivers among family members that can provide support.

That is why it is crucial to connect patients at risk of becoming handicapped with diabetes educators to take prevention measures. Early detection screenings are necessary to determine whether an individual is prone to developing cognitive disabilities. Staff at care facilities has to be trained to meet the needs of older adults with diabetes (Tran et al., 2016). Australian national strategy has set a goal to reduce the occurrence of diabetes-related complications (Department of Health, 2015). It includes improving local prevention programs, using social marketing campaigns, and advancing workforce capabilities.

Adolescents with Type 1 Diabetes

The Healthcare and emotional needs of young adults are different from those of older adults and children. Young people with type 1 diabetes experience anxiety and have depressive symptoms that relate to the fear of hypoglycemia and inconsistent blood glycose monitoring (Rechenberg, Whittemore, and Grey, 2017). The transitional puberty stage changes the social environment and affects youth behavior, thus, leading to disease stigmatization. Youngsters face rejection and negative judgment coming through various sources, such as individuals, groups, and media (Brazeau et al., 2018). Therefore, it is vital to implement programs that address the needs of youth with type 1 diabetes.

The primary objective of care providers is to assist in transitioning to adult care treatment plants to ensure positive outcomes. It has been proved that Australian adolescents can achieve resilient outcomes through self-management behaviors (Hilliard et al., 2017). However, Youngsters need help from medical professionals to underscore priorities and identify small and achievable goals. Australian national strategy focuses on expanding self-management programs for adolescents. It also proposes steps to encourage primary healthcare services by incorporating digital tools.

Reference List

Brazeau, A.S. et al. (2018) ‘Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes: cross-sectional study’, Journal of Medical Internet Research, 20(4). p. 151. Web.

Bruce, D.G. et al. (2009) ‘Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study’, Diabetologia, 52(9), p.1808-1815.

Department of Health (2015) Australian national diabetes strategy. Web.

Hilliard, M.E. et al. (2017) ‘Strengths, risk factors, and resilient outcomes in adolescents with type 1 diabetes: results from Diabetes MILES Youth–Australia’, Diabetes Care, 40(7), pp. 849-855.

Koye, D.N., Shaw, J. E., and Magliano, D. J. (2017) ‘Diabetes and disability in older Australians: the Australian diabetes, obesity and lifestyle (AusDiab) study’, Diabetes Research and Clinical Practice, 126, pp. 60-67.

Rechenberg, K., Whittemore, R. and Grey, M. (2017) ‘Anxiety in youth with type 1 diabetes’, Journal of Pediatric Nursing, 32, pp. 64-71.

Tran, D.T., et al. (2016) ‘Variation in the use of primary care services for diabetes management according to country of birth and geography among older Australians’, Primary Care Diabetes, 10(1), pp.66-74.

Depression is common in human beings in case of any distress or disease. Whether Diabetes II and its pathophysiological sequel has any role in enhancing the depressive state in sufferers’ has been investigated in this study with an attempt to eliminate other contributory factors of depression such as demographic traits or ethnicity (Lee et al, 2009). The title of the paper is succinct enough and illustrative of the content of this study as it mentions all the dependent variables under investigation. In addition, the authors have explored the role of diabetic complications, resultant quality of life, and depression on a readily measurable parameter, the A1C (Hb A1c) or glycohemoglobin level, which is an indicator of diabetes pathology.

The abstract clearly states the purpose of the study as elaborated above and explains the study method used in the form of a cross-sectional survey of 55 identified and shortlisted diabetes patients. The mode of measuring depression has also been stated in the abstract which rounds off by highlighting the main findings of the research followed by the recommendations based on this study.

The introduction is comprehensive in content and begins by explaining the basis of the study due to the significant levels of depression (28%) encountered in the diabetic population of the United States. Adequate sources have been cited for an appropriate level of conviction to justify the study. The common pathophysiological mechanisms associated with both diabetes and depression have been explained as the basis for establishing a correlation between the two and their close interdependence.

The complex interplay between social, psychological, and biological processes has been cited as a reason leading to the need for investigating the involvement of demographic characteristics in the complex interplay between the concurrence of diabetes, depression, and quality of life. The introduction has a good flow leading to the final investigational aims of the study. The problem being investigated has certain implications for nursing as the results can serve as pointers towards nursing interventions that can help in alleviating depression in susceptible individuals. The study design seems to be appropriate as distinctive parameters have been shortlisted and appropriate quantitative tools used to measure the endpoints with a good degree of confidence.

The study design involved a combination of qualitative and quantitative approaches. It was conducted as a cross-sectional survey in the form of questionnaire’s submitted to willing volunteers shortlisted after satisfying definite criteria of age, sex, knowledge of the English language, educational background, and history of the disease, after prior sanction from appropriate authorities at a University of Maryland affiliated diabetes clinic. The level of depression was assessed with Beck Depression Inventory-II (BDI-II) which incorporates the use of the Lickert scale and the quality of life evaluated with Medical Outcomes Study 36 Item Short-Form Health Survey (SF-36).

IDS-SR was used to assess the major domains of depression satisfying the criteria of DSM-IV. The degree of Diabetes control was measured by A1c levels and both macro and micro comorbidities were evaluated for obtaining coherence of results. The hypothesis and research questions have a strong correlation and have been adequately addressed by citing numerous studies which indicate an investigation in this direction.

The literature review is comprehensive and prominent workers in this area have been cited which establishes a strong basis for the study itself as well as the design used to evaluate specific parameters. The conceptual and theoretical frameworks for the study are pertinent as there is a strong degree of association between the parameters studied which are capable of yielding significant points for statistical analysis. Both demographic, as well as clinical data, were analyzed using appropriate modes of statistical analysis which needed transformation due to the skewness of the data obtained. Correlations between endpoints were measured using multiple regression and hierarchical analysis and chi-square and t-tests were used, which offered some degree of confidence in interpretation.

Both measures of depression, BDI-II and IDS-SR correlated well in the indication of the prevalence of depression among the participants and gave figures between 41% and 46% respectively. 49% of the participants elicited mental component scores which were poor when compared to the normative data for the general US population. So was the case with physical component scores which were worse in 71% of the participants when compared to the national normative sample’s median value.

As indicated by BDI-II scores there was no significant difference between the prevalence of depression between males and females, however, females showed a significant tendency to suffer from moderate to severe levels of depression. Black patients (53%) were found to be more likely to suffer from depression than white patients (33%). It was also inferred that depressed patients significantly fell into the younger age group and they had a tendency to suffer from moderate to severe levels of depression. After evaluation of depression levels, the authors have focused their attention on the frequency of diabetes-related comorbidities in such participants and no correlation based on varying degrees of depressive states and comorbidities like hypertension, hyperlipidemia, obesity, nephropathy, etc., micro comorbidities as well as the A1c values were observed.

Transformed variables were used to determine the correlation between measures of depression and quality of life and average MCS (mental subscale) and PCS (Physical subscale) scores were found significantly worse for the depressed patients. The regression analysis has been performed to predict the depression scores based on gender, race, and age. The data is well tabulated and explanations coherent enough to show the confidence level of the analysis.

However, in this study, too many correlative approaches and normalization of values have been employed which can lead to some degree of misinterpretation due to bias of comprehension and understanding of qualitative aspects based on purely speculative statistical analysis. Individual variations and medication history, compliance habits in participants have not been considered and too much emphasis has been placed on confining the study to a small group of participants within a specific clinical location. Other factors like climate, living conditions, lifestyles, and socio-cultural backgrounds may elicit different responses.

The study has merely substantiated previous reports of the correlation between depression and diabetes and found some level of significant correlation and higher occurrence based on sex (females) and race (blacks). No direct relationship of depression to the measurable biological parameter A1c was obtained which is therefore not a good indicator of the correlation between diabetes and depression. Despite the comprehensive study design and deep statistical analysis, the study has only pointed towards the need for addressing the issue of depression in diabetics and not come up with any definite pointer towards establishing a correlation as variable factors are too many and too much reliance on statistical tools, however appropriate cannot serve to predict events in a diabetic.

The only constructive argument put forward by the authors is the need for identifying and addressing the problem of depression in patients suffering from type II diabetes at an early stage which suggests a need for alertness by the attending healthcare professionals and nursing staff. Treatment initiated at an early stage can assist in enhancing the quality of life as well as compliance with medication in the patients which can prevent further deterioration and occurrence of comorbidities. The study indicates a more comprehensive future research in a broader population and a larger sample size to substantiate and confirm the analysis obtained.

Reference

Lee H., Chapa D., Kao C., et al, (2009) Depression, quality of life, and glycemic control in individuals with type 2 diabetes, Journal of the American Academy of Nurse Practitioners 21, 214–224.

Introduction

The global prevalence of diabetes mellitus continues to rise at alarming rate. Accordingly, Eckel et al. (2004, p. 2971) underscore that this trend is instilling fear among governments due to its implications on healthcare budgets. Additionally, this chronic condition has equally been blamed for high levels of morbidity and mortality (Eckel et al., 2004, p. 2972). As a matter of fact, diabetes has been termed as a lifestyle disease and its rapid spread has triggered the need for public awareness campaigns aimed at educating vulnerable populations on the risk factors associated with the condition (Australian Institute of Health and Welfare, 2006, p. 12). Moreover, the situation has also triggered intense and extensive research as experts seek knowledge about anti-diabetes solutions owing to the fact that recognition of preventive measures will go a long way towards containing the disease (Alqurashi, Aljabri & Bokhari, 2011, p. 20). As epitomized above, diabetes epidemic is widespread around the world. However, this essay is limited in scope and will only analyze its prevalence in Australia and Middle East with an aim of exposing both similarities and differences. Furthermore, this essay also aims at an analyzing the condition from a sociological point of view whereby the views of sociologists like Karl max, Goffman, Foucauldian ,Durkheim as well as Feminism concept will be integrated in this analysis. Most importantly, the essay begins with a background analysis of diabetes prevalence in Australia and Middle East as well as the Pathophysiology of the disease.

Background information

According to Eckel et al. (2004, p. 2968), the year 2000 world statistics stood at heartbreaking figure of 171 million patients. Experts warn that this figure might reach 366 million patients by 2030. Statistics in Australia from a research conducted between 2004 and 2005 estimated that around 700,000 Australians had diabetes mellitus type 2 (Australian Institute of Health and Welfare, 2006, p. 12). In addition, it has been regarded as a leading chronic condition and during the same period it was the cause of most hospital admissions in South West region of Australia (AIHW, 2006, p. 12). Prevalence cuts across all segments of the population ranging from old to young people regardless of gender or social class owing to the increasing habits of unhealthy consumption of foods as well as reduced physical activity among (Alqurashi, Aljabri & Bokhari, 2011, 20).On the other hand, owing to rapid industrialization in Saudi Arabia, people’s lifestyles have changed. This has exposed individuals to numerous lifestyles diseases like diabetes (Eckel et al., 2004, p. 2971). Since late 1980s, intensive studies have been carried out among populations to expose diabetes prevalence statistics. Conclusive results indicate an increasing trend (Eckel et al., 2004, p. 2972). The major risk factor that has been blamed for rising diabetes prevalence in Saudi Arabia is obesity. The latter has also increased cases of hypertension and coronary heart diseases (Alqurashi, Aljabri & Bokhari, 2011, 19).

Diabetes is an endocrine disorder characterized by chronic hyperglycemia syndrome, which is a consequence of inadequate production or action of insulin. This leads to a violation of all types of metabolism related to vascular lesions (angiopathy) and nervous system (neuropathy) (Eckel et al., 2004, p. 2968). Since the onset of the 21^st century, diabetes has acquired an epidemic character, being one of the most frequent causes of disability and mortality. It is within the first triad in the structure of the most common adult diseases: cancer, sclerosis, and diabetes. Among the chronic diseases in children, diabetes is also ranked third, behind the palm of bronchial asthma and infantile cerebral palsy (Eckel et al., 2004, p. 2971). The main causes of this increased morbidity are “urbanization, sedentary lifestyle, and defects in food, stress as well as the aging” population (Eckel et al., 2004, p. 2972).

Moreover, in order to understand the devastating effects of diabetes to the infected individuals as well as shed light on why the condition leads to high rate of mortality, it imperative to expose the pathophysology process of the disease as outlined below.

Pathophysiology of diabetes

The absolute lack of insulin decreases insulin levels due to violations of its synthesis or secretion of beta-cells of Langerhans cells (Ferri, 2009, p. 44). Relative insulin deficiency may result from decreased activity of insulin due to its high protein binding, enhanced destruction of liver enzymes and predominance of the effects of hormonal and non-hormonal antagonists of and changes in insulin sensitivity of tissues to insulin (Ferri, 2009, p. 55). This lack of insulin leads to disruption of carbohydrate, fat and protein metabolism and often accompanied by polyuria and polydipsia (Ferri, 2009, p. 54). Reduced formation and increased breakdown of fats increases ketone bodies in the blood such as acetoacetic, beta-hydroxybutyric and acetoacetic acid condensation product – acetone. Such occurrences may lead to shift in acid-base balance towards acidosis which contributes to increased excretion of potassium, sodium and magnesium in the urine. It also interferes with working of the kidney (Australian Institute of Health and Welfare, 2006).

These facts are vital in terms of setting objectives, identifying strategies and implementing those within the areas selected. Despite the extraordinary scientific and practical advances in medicine diabetes mellitus (DM) continue to be a widespread and serious illness, presenting severe health and social problem among affected individuals (Ferri, 2009, p. 52).

Epidemiology of diabetes in Australia and Saudi Arabia

The number of registered patients with diabetes in Australia is approaching 700 000 mark (12% of them are patients with type 1 diabetes). This represents approximately 3.5% of the total population (Australian Institute of Health and Welfare, 2006, p. 16). However, as evident from results of the epidemiological studies, the actual number of such patients is at least two times larger. Currently in Australia, diabetes affects about 1.5 million people (including those with latent and other forms of this disease), representing 5% of the total population (Australian Institute of Health and Welfare, 1999, p.12). As at 2003, one in four Australians over the age of 25 years were among groups of individual with diabetes or at risk of illness from this disease due to metabolic disorders. Diabetes is diagnosed in every 5^th Australian resident over the age of 65 years and approximately 70% of people aged over 50 are at risk (Australian Institute of Health and Welfare, 2006, p. 12). The number of patients with diabetes in Australia is increasing by 25-26 thousand annually. This high incidence is due not only to well-known risk factors but also demographic features of this multicultural country. In Australia, about 25% were born in other countries (Australian Institute of Health and Welfare, 2006, p. 26).

Approximately 30% of the population consists of immigrants and their children in the first generation. The Australian-born share of patients with diabetes is 3.0%, while among Australian residents born in the South, Central and South-East Asia, the figure ranges from 6.6 to 9.0% (Australian Institute of Health and Welfare, 2006, p. 46). Meanwhile, immigrants are becoming Australian permanent residents from these countries as well as other regions where the prevalence of diabetes reaches 7-8% or more (Australian Institute of Health and Welfare, 2006p. 22). For example, migrants from Southeast Asia, India, Bangladesh, Pakistan, Sri Lanka and others exceed 10-15% of the total Australian migrant population.

Other population groups at high-risk of diabetes are indigenous Australians. Among this group are adults (aged over 25). The Australian Aborigines who are more than 40% of the population suffer from diabetes.

There has been increasing cases of type 2 diabetes of late, not only among the elderly. Young adults and children are equally affected. The number of hospitalized patients with diabetes and its complications in 2004 was 1334per 100 000 sample of of vulnerable ppeople, which is three times higher than during the 1993-1994 period (Australian Institute of Health and Welfare, 2006p. 12). The major share of hospitalized patients with diabetes consists of individuals with heart and vascular diseases (40%), kidneys (30%), feet, etc. DM absorbs a significant portion of national spending on medicine, the average sum per patient ranged from $2500 to $4000, in general, reaching $ 3 billion per year (12% of health spending). The cost of servicing patients with diabetes in Australia on average is about 2 times higher than similar charges in the same populations of persons not suffering from this disease. There is evidence that the total cost per patient with complicated diabetes may reach 15 000 dollars a year or more. For the treatment of patients with DM with concomitant cardiovascular and other diseases the hospital spends 40-50% more than in the treatment of patients with similar diseases, but not suffering from diabetes (Australian Institute of Health and Welfare, 2006, p. 32).

One of the capacious expenses is procurement of insulin and other medicines. For example, 5 bottles of insulin with 10 ml each, depending on the brand manufacturer, was costing 50-90 dollars some five years ago (Australian Institute of Health and Welfare, 2006p. 23). Through the various subsidies of the Pharmaceutical Benefits Scheme (PBS), a prescription will cost no more than $33.30, and retired or concession card holder pays $5.40 with the PBS pays more than 80% of market value of the drug. It is predicted that this ratio will remain by 2025(Australian Institute of Health and Welfare, 2006, p. 23). In 1996, Australia has developed multi-faceted federal program for the National Diabetes Strategy (NDS), one of five national priority programs in the health care field. Particular attention in this program is devoted to the quality and availability of treatment of patients with DM. As in most other countries, such treatment is comprehensive and is based on generally accepted principles of modern treatment: a balanced diet, adequate physical activity, personal hygiene and healthy lifestyles, use of hypoglycemic medications, regular medical and self-control, early diagnosis and treatment of opportunistic diseases and complications (Ferri, 2009, p. 55).

For drug therapy in patients with type 2 diabetes (more than 85% of all diabetic patients) sulfa drugs are used of the second and (most) of the third generation, biguanides (metformin, etc.), derivatives of benzoic acid, etc (Ferri, 2009, p. 58). However in recent years a new class of drugs thiazolidinediones (glitazones, etc.) is used increasingly. The main advantage is their ability in a relatively small daily doses (6-10 mg) effectively increases the sensitivity of tissue receptors to endogenous insulin enhance its production by β-cells, to optimize the lipid metabolism. If necessary, thiazolidinediones may be combined with taking sulfonamides and insulin (Ferri, 2009, p. 52).

Nearly 24% of the population of Saudi Arabia suffers from diabetes, according to Saudi newspaper Al-Riyadh, citing data from the Ministry of Health of the Kingdom. The main reasons for this high level of morbidity are, according to experts, poor diet and sedentary lifestyle. As a result, approximately half of Saudi women and about a quarter of men suffer from obesity, frequent companions of which are diabetes and cardiovascular disease (Alqurashi, Aljabri & Bokhari, 2011, 19). The fight against diabetes in Saudi Arabia is placed on a nationwide scale. Only during the 2007 the country opened nine specialized medical centers eleven more were commissioned in 2008 (Eckel et al., 2004, p. 2968). Simultaneously, a national program to combat chronic illnesses government of the kingdom has been a widespread awareness among the population aimed at prevention and prevention of diabetes, cardiovascular diseases and cancer (Alqurashi, Aljabri & Bokhari, 2011, 19).

As outlined above, diabetes is to a greater percentage a lifestyle disease and statistics indicate that high levels of new infections are attributable to social factors than biological predisposition. Against this consideration, the disparities as well as similarities in epidemiology of diabetes in Australia and Saudi Arabia can be critically analyzed through the wider window of social theories which include; feminism,. Goffman view on stigmatization, Marxists and Foucauldian Social Theories and Durkheim’s view on religion.

The link between Social Theories and Diabetes

Feminism and diabetes

Generally, the concept of feminism was conceived amidst widespread outcry to liberate women from matriarchal perception that viewed women as lesser beings (Harkess, 2000, p. 153). Since its inception numerous feminists’ movements around the world have been established in an attempt to fight for equal treatments among men and women (Harkess, 2000, p. 153). Although, the rise of feminism has attracted much criticism especially in societies where patriarchal systems are deeply observed, its successful role cannot be overemphasized. Nonetheless, although the initial movements were rooted in political ideas, recent day movements encompass all aspects of women’s life and more importantly in health matters since healthy women would translate to a healthy world owing to the fact that women play a vital role in families and society as a whole (Harkess, 2000, p. 155). According to Harkess (2000, p. 160) women continue to be at risk of preventable diseases because of high level of illiteracy, poverty, unemployment and restrictive cultural practices. The above notion justifies the significant role of feminism movements to liberate women from practices that put a risk to their health. Harkess (2000, p. 162) further elucidate that though heath matters should be a concern of every member of the society, the feminist element of women health should not be overlooked because some biological elements of being a women puts them at a greatest risk to some disease prevalence as compared to men.

Apparently, diabetes prevalence has been associated with obesity. Moreover, more often than not obesity is a lifestyle condition that is linked to consumption of higher-fat diets and lack of physical exercises (Eckel et al., 2004, p. 2968). The lack of physical inactivity especially among women is more aggravated in Saudi Arabia owing to cultural and social practices that limit the opportunities for women to exercise (Eckel et al., 2004, p. 2970). However, it is imperative to mention that empirical researches indicate generally women are more inactive than women in terms of physical activity regardless of whether they reside in developing countries like Saudi Arabia or developed like Australia. According to Eckel et al. (2004, p. 2972) regular exercise has been attributed to myriad health benefits ranging from mental, emotional and physical well being. On the same note, regular exercise can go along way in preventing obesity and as a result eliminate or reduce risk factors of diabetes.

Contrastingly, the uptake of physical exercises to reduce diabetes prevalence among women in Australia may be facilitated with ease as compared to Saudi Arabia (Alqurashi, Aljabri & Bokhari, 2011, 19). In Australia, women are more liberated than in Saudi Arabia and all that is needed might be as simple as creating media campaign to promote physical exercise (Eckel et al., 2004, p. 2973).On the other hand, media campaign might do little in Saudi Arabia where women are still being oppressed by the patriarchal and religious perceptions of women. Walker (2009, p.6) underscores that in Saudi Arabia women shy away from physical exercises since it is forbidden in fatwa, though covertly. This controversial fatwa which is deeply embedded in Islamic religion forbids women from physical exercises since it requires women to stay at home and look after their children. Moreover, women are treated as a home jewel and unless it is very necessary their husbands run the households errands; thus even the least opportunity to engage in physical exercise such is walking is most of the times unavailable (Harkess, 2000, p. 152). The above situation calls for deliberate and aggressive measures to promote the uptake of physical exercises among women in Saudi Arabia. As epitomized above, feminism seeks to empower women so that they can be in charge of all aspects of their life. According to Harkess (2000, p. 155) empowerment of women through feminist movements in US to promote sports and subsequent self esteem have yielded positive results. Similarly, the same strategy can be adapted in Saudi Arabia owing to the fact in recent year’s diabetes prevalence among women in Saudi Arabia have exceeded that of men.

Walker (2009, pp.2-17) also supports this notion that physical exercise is the way to go if the epidemic of diabetes in the world is to be controlled from further incapacitating the population. He quotes a recent study that indicated that physical exercise and the resultant weight loss could reduce the incidence of diabetes by approximately 58 percent. To revisit the issue of feminism and women heath issues it is imperative to mention women generated and led campaigns are likely to succeed in promoting physical exercises among women both in Saudi Arabia and Australia.

On the same note, whereas there are established network like Australian Women’s Health Network in Australia to promote health issues among women, such incentives are lacking in Saudi Arabia (Eckel et al., 2004, p. 2970). This further exposes the need for introduction of feminist ideas in Saudi Arabia to liberate their women from patriarchal and religious oppression. As epitomized elsewhere in the paper, consistent care for diabetic patients is necessary to promote positive living. However, most women in Saudi Arabia are unable to access health care due to the fact that they have to obtain permission from the men in their lives of which it is not always granted (Walker, 2009, p.2). Furthermore, these men also have to give consent incase women are to be admitted in hospital as well as to medical procedures (Walker, 2009, p.2). It is obvious that some cases of diabetes sometimes require urgent medical attention and the above social and cultural puts a woman’s health at risk. Therefore, the few feminist movements in Saudi Arabia should incorporate health matters in their agenda to promote physical exercises and curb practices that hinder access to medical care (Harkess, 2000, p. 152).

Goffman view on stigmatization its implications to diabetes prevention

Empirical researches have indicated obesity predisposes an individual to diabetes mellitus and other types of lifestyles diseases. The prevalence of obesity is more prominent in developed than developing countries although the situation is changing as world economies improve (Eckel et al., 2004, p. 2968). Statistics indicate that obesity prevalence has been on the rise in Australia for the last 20years and this trend will continue if appropriate measures are not adopted. Currently the figure stands at 20.5 % with men leading at 67.4% and women at 52% (Australian Institute of Health and Welfare, 2006, p. 22). The above statistics is alarming and the government should be prepared to dig deeper in healthcare allocation if timely measures are not implemented to reverse the situation. According to Eckel et al. (2004, p. 2968) treatment of obesity in most worldwide healthcare settings is greatly hindered by lack of prioritization of obesity as a health risk condition. Physicians are sluggish in identification and treatment of obesity partly because of lack of adequate and efficient tool. The gravity of the matter is the stigma associated with obesity whereby such individuals are blamed for their situation owing to the fact that societies associate the condition with overeating (Rochon, 2008, p. 8).

On this note, stigmatization of obese patients can be linked to the social and cultural setting of the society. For instance, in ancient Greek society an individual was stigmatized by society if at all they exhibited any usual portray of health complication (Rochon, 2008, p. 8). Goffman a 19^th century sociologist expounded on the concept of stigmatization and highlighted that it arose depending on the social expectations embedded in a particular culture. This implies that the negative perception about obese individuals by some physicians arises due to the same perceptions within the society. Goffman further expounds that society tend to stigmatize individuals if their behavior and appearance falls short of the expected standards (Rochon, 2008, p. 10). On the same note, obese people tend to be isolated because the stereotypical view in the society that obesity is due to overeating exposes them to stigmatization. According to Eckel et al. (2004, p. 2971) prevention of obesity should begin at societal level whereby members are required to adjust their socio-cultural towards healthier lifestyles. However, the above strategy might prove to be impossible if obesity continue to be a concept of stigmatization (Rochon, 2008, p. 13). Besides, adequate campaigns to change the mindset that an individual is to blame for his or her illness are the way to go in creating acceptance that obesity is a disease that calls for effective preventive and curative measures (Rochon, 2008, p. 11).

Durkheim’s view on religion; implications to diabetes prevalence among women in Saudi Arabia

As highlighted elsewhere type 2 diabetes is the recent epidemic in the world and Saudi Arabia is not spared from this catastrophe and apparently it has been associated with high mortality rates (Alqurashi, Aljabri & Bokhari, 2011, 20) in this region. Diabetes prevalence in relation to age, social class and gender varies from country to country due to lifestyle differences that are informed by culture. However, it is imperative to mention that diabetes prevalence in relation to gender in Saudi Arabia indicates a different pattern in comparison to other countries like Australia (Alqurashi, Aljabri & Bokhari, 2011, 21). Whereas diabetes mellitus prevalence among men in Australia as well as in most countries surpasses that of women, the situation in Saudi Arabia is slowly changing whereby recent research statistics as shown below indicate that women more prevalent than men to diabetes mellitus epidemic (Alqurashi, Aljabri & Bokhari, 2011, 22). As indicated elsewhere, diabetes mellitus is more of a lifestyle disease whereby factors such as obesity and physical inactivity predispose individuals to the disease. However, society has a role to play in this new discovery since patriarchal and religious perceptions of women roles puts them at a risk (Walker, 2009, p.2).

According to Harkess (2000, p. 158).) women health orientation is shaped by societal perceptions and as explained above fatwa confines Saudi Arabian women to their homes without any leeway to get access to physical fitness programs or access to medical care for those who are already affected (Walker, 2009, p. 12). The fact that Islamic religion seems to yield oppressive results among Saudi Arabian women as compared to their fellow counterparts in Australia undermines Durkheim view that religion reinforces societal values (Walker, 2009, p. 12). Durkheim viewed religion as a unifying factor that directed society to observe sacred practices and beliefs. Moreover, he believed that religion provided significant guidelines for fruitful social life. Nonetheless, whereas this view was significant in creating and maintaining a harmonious society it has no place in modern society since numerous changes calls for diversified and flexible religious view ( Alqurashi, Aljabri & Bokhari, 2011,p. 20).Walker(2009, p. 8 ) underscores that although the role of religion in society should not be despised, oppressive religious practices have no place in modern society. As a matter of fact, Durkheim observation was based on Australian aborigines, but the practice by these society is not comparable to Islamic practices in Saudi Arabia that views women as lesser and voiceless beings. This negative view of religion is also accentuated by feminists who perceive religion as a foundation upon which oppressive patriarchal ideologies are executed (Harkess, 2000, p. 156). Therefore, measures that are aimed at reducing diabetes mellitus prevalence among women in Saudi Arabia should first address these religious shortcomings.

Marxists Social Theory

Social development, according to Marx (Paolucci, 2008, p.352), is in accordance with certain laws, by which he means the “internal and necessary connection” between events. Marx believed in the existence of universal and immutable historical laws that underlie the development of humankind. He believed that the contradictions, the struggle of opposites are the sources of the driving force for development. The ascent from the abstract to the concrete he is considered as a general scientific method of cognition (Paolucci, 2008, p.354).

Theory of classes and class struggle is central to the teachings of Marx. In his work, he does not define the class, although the definition of the reconstructed on the basis of his works there. Classes, according to Marx are social groups that are disadvantaged and struggling with each other, but in a narrower sense, it is social groups that differ in relation to property, especially to the means of production (Paolucci, 2008, p.355)

Marx saw class in terms of ownership of capital and means of production, dividing the population into property owners and the poor, the capitalist class and the proletariat. He acknowledged the existence of groups that do not fit into this framework (such as farmers or small proprietors), but argued that they represent the remnants of pre-capitalist economy, which will disappear as the maturation of the capitalist system (Owen & Powell, 2006, p.112). Category class for Marx means something more than a simple means of describing the economic positions of different social groups – classes, he considered as a real community and real social forces that can change society (Paolucci, 2008, p.379)

Marxist theory can be applied to the epidemiological data to explain the variations in presentation in the population who are diabetic because the concept of spheres of public life captures the social being as a one that characterizes all of the relevant phenomena of social life in its entirety, and in this meaning serves as an important independent category of historical materialism. Spheres of public life:

1. Economic is characterized by unity of productive forces and production relations and processes of production, distribution, exchange and consumption of material means of subsistence, etc. Serves primarily as the foundation of society and all other spheres, as the leading cause of the condition and background of the historical process, for people to “make history” should live, to have the material means of life. It represents the highest manifestation of the need and at the same freedom in society, becoming a kind of vector for all other spheres of public life, the matrix, the benchmark, on the model which they construct (Paolucci, 2008, p.365).
2. Social Network. Human society is a complex collection of different groups, their relationships and interactions, i.e, it is socially structured. Stable social ties between certain people are reflected in the features of lifestyle of this social group, in the unity of the needs, interests and value orientations, behavioral and other characteristics of public individuals. Certain aspects of basic and superstructural phenomena are “synthesized” into a single entity – a real community of people who have, along with economic and depending on them and other features of their social image (Paolucci, 2008, p.366).
3. Political. Politics is the first ideologically organized social force. Setting in motion classes and the masses, it becomes a means of resolving the pressing social contradictions, including the contradictions of the economic sphere. The policy sets dependent on political decisions and actions, the way how to implement their demands, accelerating, delaying or speeding up in one plan, and in another delaying economic development. In a class society, economic relations cannot exist without state-legal services (Paolucci, 2008, p.358).
4. Spiritual – purposefully organized society, the spiritual life. It is divided into subsystems: the ideological, scientific, artistic and aesthetic life, education, education. Important role in the spiritual realm is a religion (Saudi Arabia). Each of the subsystems of the sphere covers a certain fragments of the public consciousness. However, these subsystems are not limited to public consciousness. They presented in activities of the productive side of the spiritual life, ie, the very activity of production, distribution, circulation and consumption of spiritual values. It is institutionalized, i.e, organized in the form of certain social institutions. This area grows from literally all aspects of social life. Synthesizing the most common measure of all entities of the spiritual sphere is that in each of consciousness is a kind of center around which they unite with each other. Consciousness is the result of certain activities (it is), and the product (it is consumed) and means (it is – then, by what we get new spiritual values), and the immediate goal (for the sake of it are academic institutions, education, art, Church, etc.) (Paolucci, 2008, p.371).

To study the functioning and development of major areas of public life, which is based on the allocation of the most important and generally homogeneous social processes, it is essential to the characterization and analysis of society as a social organism. The division of social life on these areas allows people to study society as it is structural integrity, to identify the contents and features of the functioning of these spheres, their objective relationship and mutual dependence. Based on the scientific understanding of the nature of their interaction can consciously influence on the development of society. The problem of the scientific management of society is one of the central problems in Marxist sociology, although it has not been effectively solved in practice (Paolucci, 2008, p.369).

Foucauldian Social Theory

Foucault has updated the methodology of the research of the society (Owen & Powell, 2006, p.118). He believed that the traditional analysis of state institutions does not exhaust the field of functioning of government. Open question remains: who has the power and where? According to Foucault, the nature of power can be understood only in the context of historically defined social practices. Archaeological findings of the Foucault offers us a history of bodies: psychic, erotic, and the condemned prisoners, obedient and rebellious, or rather not so much the same body as the history of a certain type of bodily practices. According to Foucault, European “identity” would be impossible without various technologies of supervision, training, education, exams (surveillance) (Owen & Powell, 2006, p.118).

Individual, of course, is imagined as an atom of “ideological” picture of society, but also, it is present in a reality and set up for action – the specific technology of power, called “discipline”. By definition of Foucault, “discipline” cannot be identified either with some kind of institution, or with some device; discipline is a type and art of power, how its implementation is linked with a whole set of tools, methods and techniques. Not that kind of disciplinary authorities replaced the rest of varieties – it just could cultivate in them and at the same time made it possible to prove the influence of authority up to the most remote, least important elements of the society (Owen & Powell, 2006, p.112).

Disciplinary (control) society makes the individual carefully, following the tactics of the required forces and bodies. The disciplinary authority finds its own power largely through organizing objects. Therefore, those on whom it operates, seeking to individualize louder – through supervision, observation, comparative measures as a starting point rules “norm” (Owen & Powell, 2006, p.115). At the end of the classical era normalization power standards was one of the great instruments of power. In a sense, “norm” makes for uniformity, but it also can individualize, allowing measurement of the indentation, to determine the level specialization register and use differences. “Norm” was confirmed together with the introduction of standardized education and establishing educational institutions, established a rate of adjusting production processes. Government standards combined with other types of power (power law, power words, tradition), forcing them to new era of command (Owen & Powell, 2006, p.117).

The principle behind the schedule time, in traditional form, is inherently negative. This is a principle of avoiding idleness: forbidden to waste time that it dismissed by the Lord of time and routine is to prevent dangerous waste – moral issues and economic dishonesty. Instead, discipline make positive economics, in theory puts forward the principle of increasingly better use of time. This means that the attempt to intensify the use of the slightest moment, as though as a detailed internal arrangement can attain the ideal point where the maximum speed combined with maximum efficiency.

Exams are normative control, supervision, allowing qualified to classify and to punish. In all disciplinary institutions exams are much ritualized, they are combined with the ceremony of power, manifestation and detection power of truth (Owen & Powell, 2006, p.111).

Training was characterized by individual and complete dependence with the aim of mastering constant length of study. Moreover, it contained family aspects. Discipleship in this tradition is an ending challenge – a “masterpiece” which reaffirmed the already carried out the transfer of knowledge, but this test did not meet certain program.

Exams radically change the visibility of the exercise of power. Traditionally, government – is that visible that show and those on whom power operates, may remain in the dark, they can illuminate and perhaps share power, they retreat, or instant glare effect that makes them the power. Instead, disciplinary power operates, while remaining invisible, but they raised their obnoxious principle of compulsory visibility. Exam was the mechanism, using which the government catches and drives to subjects in the mechanism of objectification (Owen & Powell, 2006, p.116).

In Foucauldian theory, regardless of the patient visiting a specialist endocrinologist GPs continues to regularly monitor patients, in case it is necessary to forward the patient to other relevant specialists for other diagnostic tests. Based on the results of laboratory and other studies, patients can learn about their condition from their GPs. If desired (this makes a remark of GPs in the appropriate blanks on the direction of analysis) the patient can quickly get an analysis on home fax or mail. (Owen & Powell, 2006, p.114)

Due to the Marxists social production theory – healthy food costs more and this is why diabetes is over represented in low SES communities (Owen & Powell, 2006, p.116). Relating food with diabetic patients is an important element of their therapeutic and prophylactic treatment. An extensive range of commercially available variety in composition and cooking properties of foods and products allows knowledgeable patients to buy those that are recommended for consumption among diabetes mellitus patients (Owen & Powell, 2006, p.116). Patients with diabetes are recommended that the ratio of the major energy-consuming nutrients is as follows: carbohydrates – 45-60% (including the share of sugar – no more than 10%), protein – 12-15% (in Japan – 15-20 %), fat – less than 35% (including saturated – up to 10%).Widely exhibited and well-known in Australia is the “food pyramid” with a list of foods according to their biological value and usefulness, which includes three grades: acceptable in small quantities or even excluded from the daily diet foods (animal fats, sugar, fatty meats, etc.); moderate consumption of foods (fish, chicken, eggs, dairy, etc.), healthy foods (fruits, vegetables, whole meal bread, etc.) (Australian Institute of Health and Welfare, 2006, p. 28). In order to maintain the familiar taste of foods and products some of them added by various sweeteners, often aspartame, sucralose, saccharin, acesulfame potassium, isomalt. DM patients have available popular literature and reference books with recommendations on diet for diabetes (Owen & Powell, 2006, p.117).

Conclusion

In a nutshell, it is imperative to note that diabetes epidemic may gradually transcend into one of the worst killer if appropriate measures are not taken to contain further spread. On the same note, early diagnosis of diabetic patients is necessary in order to contain its devastating effects. However, this might prove to be difficult in low income countries such as Saudi Arabia largely due to financial constraints among most of the population. From the essay, it is evident that the possibility of early diagnosis of diabetes among Australian population is higher than Saudi Arabia due to improved health measures courtesy of the Queensland government. Correspondingly, the negative effect of financial constraints on population’s health as highlighted in the essay should be viewed from the wider scope of Marxists and Foucauldian social theory.

On the same note, it is evident that both Australia and Saudi Arabia are afflicted by this epidemic although the latter is hard hit owing to the rapid rate of new diagnosis. As evident in the above analysis, the emerging prevalence of diabetes among Saudis can be attributed to unhealthy eating habits. The above notion can also be analyzed under Marxists social theory due to the fact that most of the inflicted population is unable to afford healthy meals; thus accelerating diabetes epidemiology in this region. Additionally, diabetes prevalence among women is higher in Saudi Arabia than Australia and this situation can be attributed to negative religious practices that discourage women from taking part in outdoor activities. The negative impacts of religion on women’s health in Saudi Arabia emphasize that Durkheim’s view on the unifying element of religion has no place in modern society. Similarly, the increasing diabetes prevalence among women in Saudi Arabia implies that feminism movements are highly significant in Saudi Arabia in order to liberate women from religious and societal oppressive practices that tend to accelerate their prevalence to diabetes. Finally, Goffman’s view on stigmatization can be used to capture societal and practitioners’ stereotypical perception that obesity is a self inflicted condition. Perhaps, by eliminating this negative view, both the society and practitioners will commence positive journey towards the reduction of incidents of obesity among affected populations and by so doing, reduce prevalence of diabetes.

References

Alqurashi, KA, Aljabrin, K.S. & Bokhari, S.A. 2011. Prevalence of diabetes mellitus in a Saudi community. Ann Saudi Med, 31, 19-23.

Australian Institute of Health and Welfare. 1999. The burden of disease and injury in Australia. Web.

Australian Institute of Health and Welfare. 2006. Diabetes Hospitalisations in Australia 2003-04, Issue 47. Web.

Eckel , R.H. et al. 2004. Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: executive summary. Circulation, 110(18), 2968-2975.

Ferri, F. 2009. Diabetes Mellitus Ferri’s Color and Text of Clinical Medicine.Philadelphia: Elsevier.

Harkess, S. 2000.The impact of feminism on mainstream medical sociology: An assessment. Sociology of Health Care, 17, 153-172.

Owen, T. & Powell, J. L. 2006. “Trust”, professional power and social theory: Lessons from a post-Foucauldian framework. International Journal of Sociology and Social Policy, 26, (3/4), 110 – 120.

Paolucci, P. 2008. Public sociology, Marxism, and Marx. Current perspectives in social theory, 25, 353 – 382.

Rochon, D. 2008. HIV-Positive Women and Health Care. Web.

Walker, L. 2009. The right to health in Saudi Arabia. Web.

A community is established when a group of individual’s band together because of shared values. The concept of community has been brought up in the context of health promotion. Healthcare professionals are aware that there are limitations when it comes to using conventional methods in health promotion. Thus, it is extremely difficult to help those who are in need. This is especially true when it comes to lifestyle-related diseases such as Type 2 diabetes. It is imperative that healthcare workers to promote health in the context of a community in order to ensure effective communication and better results.

Background

In the past, Type 2 diabetes was linked to old age. However, in the past few decades, a sedentary lifestyle coupled with excessive consumption of high-calorie food has brought about a health crisis. Men and women under the age of forty are suffering from Type 2 diabetes. In the United States alone, 85 to 90 percent of people with type 2 diabetes are overweight (Metzger & Kotulak, 2006, p.10). It is nearing epidemic levels and many families are suffering because of medical expenses and shortened lifespan. It is therefore imperative to inform the public on how to prevent Type 2 diabetes. But it was discovered that traditional means of health promotion is not effective. There is a need to go to the community level in order to increase the effectiveness of health promotion.

Community and Health

According to experts in community healthcare, communicating with the community is the most rewarding when it comes to public health because successful communication results in protection or promotion of the health of the community (Novick et al., 2008, p.575). Applying principles of community-based health promotion it is important to focus on Type 2 diabetes and the people that are prone to acquiring this medical condition (Lundy & Janes, 2009, p.304). It is also imperative to recognize the bitter truth that “poorer health status is correlated with race/ethnicity and socioeconomic status” (Maurer & Smith, 2005, p.46). Health promotion must be tailor-made so that it can be understood by the target audience.

It has now been made clear why conventional methods of health promotion are ineffective. Failure is due to the non-consideration of social factors. A community-based health promotion campaign can easily deal with race, ethnicity and socioeconomic status and even the shared culture of the community members. Healthcare professionals are then made sensitive to the circumstances of the people that they are trying to help. It is easy to put up walls and be antagonistic to strangers that appear to intrude into the lives of the people. By being sensitive to the culture and needs of the community, healthcare workers are no longer viewed as threats but people that are sympathetic to the community. As a result they are welcome with open arms.

Conclusion

Type-2 diabetes is a lifestyle-related disease that is oftentimes the result of a lack of exercise and overeating high-calorie food. In order to deal with this problem healthcare professional must initiated a health promotion campaign. The best way to do it is through a community setting where they can adjust their communication strategies so that it would be sensitive to the needs and culture of the community members. Thus, they can expect effective communication and as a result the whole community would listen to what they have to say.

References

Lundy, K. & S. Janes. (2009). Community Health Nursing: Caring for the Public’s Health. MA: Jones and Bartlett Publishers.

Maurer, F. & M. Smith. (2005). Community/Public Health Nursing Practice: Health for Families and Populations. MO: Elsevier-Saunders.

Metzger, B. & D. Kotulak. (2006). American Medical Association Guide to Living with Diabetes. New Jersey: John Wiley & Sons, Inc.

Novick, L., et al. (2008). Public Health Administration: Principles for Population-based Management. MA: Jones and Bartlett Publishers.

Introduction

Diabetes mellitus is a metabolic disorder characterized by glucose intolerance. It is a systemic disease caused by an imbalance between insulin supply and insulin demand. Insulin is produced by the pancreas and normally maintains the balance between high and low blood glucose levels. In diabetes mellitus, either there is not enough insulin or the insulin that is produced is ineffective, resulting in high blood glucose levels. It also causes disturbances in protein and fat metabolism. These abnormalities are associated with micro-and macrovascular and neuropathic changes (Carol, 2005; Freshwater & Bishop 2004).

There are two types of diabetes mellitus namely insulin-dependent (IDDM/Type I) and non-insulin dependent (NIDDM/Type II). Research has shown that obesity is one of the most important determinants for the development of NIDDM. It is estimated that 80% of all clients with NIDDM are obese (20% over ideal body weight). Increasing age may be a risk because the pancreas becomes more sluggish with age in clients who are already predisposed to diabetes (Black, & Matassarin, 1993). NIDDM is due to the insensitivity of the glucose-sensing mechanism of the beta cells, and in obese patients, there is a decrease in the number of insulin receptors on the cell membrane of muscle and fat cells. Obese people do secrete a lot of insulin but it is ineffective because of the decreased number of receptors (Clark, 2003). Its development is consistent with all the pathophysiologic changes seen in long-term obesity, with the pancreas failing to compensate for insulin due to problems of the receptors (Black, & Matassarin, 1995). Type II diabetes has no symptoms in the early stages. Later symptoms include polyuria, polydipsia, and polyphagia followed by weight loss, weakness, and fatigue; hyperglycemia leading to glucosuria, osmotic dieresis, and the loss of water and electrolytes; excess ketogenesis; slow healing of cuts, blurred vision, cramps in the legs, feet, and finger itching. It is worth noting that type II diabetes is common in people aged 40 years and above but may be seen in obese children (Carol, 2005; Sally, & Rosamund, 2004).

Community Diagnosis

Community Profile

In this project, I will be discussing the state of Kuwait in relation to health issues with a special interest in Diabetes type II (NIDDM). This is a state that has in the recent past reported increasing cases of diabetes type II.

Geographical Profile: the state of Kuwait is located on the western side of the Persian Gulf and it borders Iraq to the north and west and Saudi Arabia to the south. It has a coastline totaling 499 Km with its territory largely made up of desert. It experiences hot summers and short cool winters with average temperatures of 38c in august and 13C in January. Rainfall is hardly experienced with 26 rainy days annually. The state of Kuwait covers an area of 17,820 square kilometers and a population density of approximately 126 per square meter. The state is located in a desert region and therefore experiences tropical weather. According to a censure carried out in 2001, the total population was found to be 2.25 million with a life expectancy of 73.8 years (the State of Kuwait, 2009). Political Profile: Kuwait is a sovereign state and has its own constitution under the presidency of his highness the Emir of the country. The state is a national assembly composed of fifty members who are elected through a democratic election which are held every four years. The national assembly is also known as the ‘state council’ and is charged with the responsibility of legislation. Laws and policies on health are passed and amended in the national assembly and therefore political leaders have a great impact on the health care system in Kuwait (the State of Kuwait, 2009). Socio-Economic Profile: Kuwait is predominantly a Muslim state with Islam being the official religion of the state. Other religions do exist such as Christianity which is practiced largely by expatriates. Non-Muslims enjoy the freedom of practicing their religion without interference from any quarter. Kuwait is endowed with oil resources and natural gas which have made it one of the highest per capita incomes in the world. This led to a crease in its population by 25%, including immigrants for the last six years. There is rigid segregation and extreme nationalism in that more than half of the population is non-Kuwaiti. The youth (under 20 years) forms the majority of the population as they comprise 60%. In the recent past, the Kuwaiti government embarked on a strategic plan aimed at distributing wealth amongst its citizens with a substantial amount being spent on the health care system, education, and public works. The ministry of health accounts for approximately 20% of the total budget. The Kuwaiti education system represents an integration of development with the provision of medical clinics for students. Available data shows that there has been a steady increase in the number of enrollment in schools and colleges at all levels with the increasing number of teachers, lecturers, and tutors. The government of Kuwait has been ensuring the provision of social care services in all fields in order to provide and improve the living standards of its citizens in order to create a sense of social togetherness and cohesiveness. This has in turn protected them against instability and created a sense of belonging (the State of Kuwait, 2009).

Health Care System: The state of Kuwait has a health care system based on the provision of primary health care with the centers being at the lowest level of the health care system. This type of system allows all sectors of the population to be reached. Combinations of clinics offer primary care and specialty clinics (MOH, 2007). Public Health care system

Central MOH: The ministry of health is charged with the responsibility of the planning, financial, resource allocation, regulation, monitoring, and evaluation in addition to health care service delivery. Health Regions: Kuwait is divided into 6 health regions namely Capital, Hawal, Ahmadj, Jahr, Farwanja and Suabah. These regions offer health care services as per the ministry’s guidelines. The main responsibilities of the regions are provision of health care services to its residents through putting into action the MOH’s action plan; provision of health care at different levels and types; ensuring training of different medical staffs; and ensuring a computerized database for health information. The health regions are headed by the director of health. The regions have general hospitals and several primary health centers and specialty clinics. Primary health care is delivered to the consumers through the health centers with family clinics, MCH & FP clinics, Diabetic Clinics, dental and preventive care clinics. The six regional hospitals provide secondary health care through a network of national specialized hospitals and clinics (MOH, 2007).

Private Health Care System:

Modern, for-profit: The private sector focuses on curative services rather than preventive services. That is not much information on the number of private clinics.

Modern, not-for-profit: these basically include hospitals owned and managed by oil companies and they include Ahmadi, Texaco, and Kuwait National Petroleum Company (KNPC) hospitals. By the year 2001, the number of health institutions and units was 97 hospitals and units, physicians were 3000 with a bed capacity of 5,000 (MOH, 2007).

From the above profile, we can deduce that the health care system is so widely and equally distributed across the country and therefore it is possible that each and every individual can access health care within a radius of 5 KM. the health care system focuses on primary health care which is generally at the community level meaning that the community members even at the lowest level and remote areas can still benefit from health care services being provided for by the government. According to a report by Al-Hooti (2008), diabetes and other related nutritional diseases were found to be the leading causes of death in government hospitals. Another study by the Kuwait Foundation for the Advancement of Sciences (KFAS) found out that type II diabetes was the fastest growing in Kuwait. KFAS, therefore, financed the development of the Dasman Center for Research and Treatment of Diabetes in 2001. This center dedicates 30% of its effort to the education and training of the community and health professionals. A number of regional diabetic clinics have been established to help curb diabetes. This shows the seriousness with which the government working to tackle diabetes (Al-Hooti, 2008).

Community Assessment Plan

The process of community development is one of the fundamental roles of nurses who work in the community for purpose of helping the communities to realize their weaknesses and how to overcome these weaknesses. As mentioned earlier, diabetes type II is a problem in Kuwait and therefore needs to be handled at all levels. Community assessment is a systematic process in which the nurse together with the members of the community determines the health problems & needs of the community & develops plans of action and implements those plans. The process is outlined below (Zerwekh, 2003; Holloway, & Wheeler, 2002; Grol 2000). Exploration: During the initial stages of planning the community assessment, the nurse carries out a community inventory; this is described as a step of mapping out the community with the purpose of obtaining baseline information that helps plan for the rest of the assessment process. The nurse meets government officials and local leaders to brief them on the planned assessment; this will allow the nurse to have clearance from the relevant people. This also enables the nurse to have general knowledge of the terrain, roads/paths, and the kind of people he/she will encounter (Mwangi, 2008). Planning for Assessment exercise: the following will be the objective of the assessment: to determine the disease (diabetes type II) burden on the community; to determine the most affected by diabetes type II in terms of age, sex, socioeconomic status; to determine the etiology and associated factors of diabetes type II; to determine the predisposing factors; to determine knowledge and attitudes of the community on diabetes type II and to determine what is currently being done by health care system, and community to curb diabetes type II. An assessment tool (refer to appendix) will be used to collect the required information from the community members and any other relevant person (ICN, 1987 & 1997).

Recruitment and training of assistants: the nurse in charge of the assessment trains a few locals who will assist in data collection using the assessment tool. The trainees will also be involved interpreting of questions in the tool to the community members and therefore they need thorough training. Pretesting and reworking of the tool: the nurse takes the initiative of pretesting the tool using people with similar characteristics as those of the community where the assessment will be done. This helps to detect faults and shortcomings after which corrections are made.

Execution of the Assessment: this stage involves actually going to the community and engaging the community in discussions and giving them the assessment tools so that they can feel it with relevant information. The nurse and her/his assistants help the community members fill the assessment tool through interpreting questions that one does not understand. The collected information is coded, grouped, and analyzed. During the process of assessment, some of the people who will be consulted apart from the community leaders and government representatives are community health workers working with the community. This is a group of people who are knowledgeable and understand better the disease burden and process within the community. The health centers within the community will be a major stakeholders in the assessment process. The target group for the assessment will be adults aged 40 years and above and obese young adults as they are at risk group. Type II diabetes is known to affect these two groups and therefore the need to focus on them.

Critical Analysis of the Findings and Recommendations

From the collected data, it is evident that poor nutrition and lack of exercise are the major causes of type II diabetes in Kuwait as most of the individuals assessed were overweight. This is confirmed by a study carried out by Al-Hooti, (2008) titled “food consumption pattern for the population of the State of Kuwait based on food balance sheets” this study concluded that; “the food supply in Kuwait provided an excess of RDAs at a rate of 1.19 times of energy, 2.1 times of protein, 2.59 times of vitamin A, 1.37 times of thiamine, 1.39 times of riboflavin, 1.41 times of niacin, 2.52 times of vitamin C, 1.56 times of iron, and 1.10 times of calcium daily requirements”. This excess provision of nutrients is likely to lead to overweight putting the individual at risk of type II diabetes. The assessment also revealed that the community members have knowledge deficits concerning diabetes as they could not differentiate between the different types of diabetes and predisposing factors, causes, treatment, and management. The lack of knowledge is reflected in the poor eating habits and lack of exercise leading to overweight. Diabetes is also a burden to this community in terms of productivity and financial constraints in that the affected individuals spent more time in health care facilities instead of going to work hence spending more money on treatment with the government using a lot of its revenues directly or indirectly in the management of diabetes. The assessment has also revealed that a lot is being done in terms of prevention and treatment of diabetes although these interventions are not effective as they do not involve the community members hence no sense of belonging. The community is only viewed as consumers of the health care services instead of being viewed as major stakeholders in the management and prevention of type II diabetes and also as managers of their own health.

From the above, it is clear that the following needs to be done: involving the community in issues concerning their health; health education and promotion programs on diabetes (etiology, risk factors, signs and symptoms, treatment and management, complications and prognosis); rehabilitation of affected individuals to avoid readmissions; establishment of Diabetic clubs where the affected individuals can be meeting occasionally to share their feelings, new ideas and personal experiences. Health Education and Promotion is one of the major interventions that will be carried out within the community. As already mentioned, knowledge deficit is a lethal weapon against the prevention, management, and control of type II diabetes. It is therefore the duty of the nurse to organize awareness campaigns amongst the community with the purpose of educating them on all relevant issues on diabetes (type II). Health education/promotion empowers an individual with the much-needed and relevant information that can be of great assistance in the management of his/her health and other related issues (Thompson, 2004). The nurse can carry out this activity with the help of the local health professionals working within the community and even train some community members who will be educating their colleagues; this creates a sense of belonging and ownership among the community members in that they will participate in the health education/promotion activities as their own. This empowers the community and the information stays with them even years after the time of carrying out the assessment.

Evaluation

Just as in the nursing process, evaluations help in checking if the assessment was a success and whether there has been any positive impact, and if interventions put in place had desired results. The evaluation also helps in knowing if the set goals and objectives were met, determining the success or failure of the problem, and to put the corrective measures into place (Elaine, 2005; Jorsen, 1999). This assessment was a success as the objectives were met and findings implemented.

From this assessment, the following have been brought out as some of the roles of the nurse during community assessment: management role-planning, organizing, controlling, staffing, and directing; Technical adviser -Sharing technical information with individuals, and communities; Assessor/ identifier – assessing the health status of the community. Identify existing & potential health problems; Health promoter – Sharing of prime health messages to promote the health of individuals, families, and the communities; Evaluator – Determines performance and outcome of community healthy activities; Trainer – He/she has the responsibility to train the community members on issues related to diabetes (Field, & Lohr, 2000, ICN, 2007).

References

Al-Hooti, S. N., (2008). Food consumption pattern for the population of the State of Kuwait based on food balance sheets. Safat, Kuwait: Kuwait Institute for Scientific Research.

Black, M. B. & Matassarin, E. J., (1993). Medical surgical nursing: A psychophysiologic approach. 4^th Ed. London: W. B. Saunders Company.

Black, M. B., & Matassarin, E. J., (1995). Adult nursing: A psychophysiologic approach. London: W. B. Saunders Company.

Carol, T., (2005). Fundamentals of nursinmg: The art and science of nursing care. Philadelphia: Williams and Williams.

Clark, M. J., (2003). Community Health Nursing; Caring for populations. 4^th Edition. New Jersey: Pearson Education Inc.

Elaine, M. M., (2005). Health Bulletin – Promoting Healthy Behaviour. Washington DC: Population Reference Bureau.

Field, M. J., & Lohr, K. N., (2000). Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press.

Freshwater Dawn., & Bishop Veronica., (2004). Nursing Research in Context; Appreciation, Application and Professional Development. New York: Palgrave Macmillan.

Grol R. (2000). National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. Br J Gen Pract ; 40:361–4.

Holloway, I., & Wheeler, S., (2002). Qualitative Research in Nursing (2nd Ed.) Oxford: Blackwell Publishing

International Council of Nurses (2007). Management of Nursing and Healthcare Services.

International Council of Nurses, (1997). Nursing Research: Building International research Agenda. Report of the Expert Committee on Nursing Research. Geneva: ICN.

International Council of Nurses., (1987). Blueprint for ICN Programme 1988-1993 toward more effective participation in Health Policy Making and Healthcare Delivery. Auckland, New Zealand.

Jorsen, D. (1999). History and Trends of Professional Nursing. Washington DC: Mosby Company.

Ministry of Health, State of Kuwait, (2007). Ministry of health; health care service provision and delivery. Kuwait: Government Printer.

Mwangi, K. N., (2008). The Process of Community Diagnosis. Naorbi, Kenya: Upendo Publishers.

Sally, K., & Rosamund B., (2004). Primary Health Care Research and development. London: Arnold, Hodder Headline Group.

State of Kuwait, (2009). General information about Kuwait.

Thompson, D., (2004). Nursing fundamentals: Caring and clinical decision making. New York: Rick Daniels.

Zerwekh, J., (2003). Nursing Today: Transition and Trends. Philadelphia: W. B. Saunders Company.

Appendix: Tool of Data Collection

Introduction

Diabetes mellitus (DM) is one of the most important metabolic disorders affecting the cellular and biochemical within the body. Patients with diabetes often exhibit depressed host defense, resulting in increased susceptibility to infection. Failure for the pancreas to secrete insulin leads to diabetes mellitus, a disorder characterized by hyperglycemia. Diabetes mellitus is an integral disease that prevails in a wide range of populations in America. About 100 million persons are feared to have this disorder all over the world. Diabetes mellitus has varied effects on oral tissue and it influences the prevalence and severity of periodontal disease. It has been reported that periodontal disease is more severe in diabetics compared to the non-diabetics. Other investigators have reported that periodontitis is a leading complication of diabetes mellitus (Aldridge et al, p. 271). Periodontal disease is a chronic inflammatory disease of the tissues that support and attach the teeth to the jaws. They are caused by gram-negative bacterial infections and are, for the most part, asymptomatic, although much of the actual destructive tissue changes which are observed clinically are result of the inflamatory host response. Periodontal disease (PD) is the second main cause of oral cavity disorders affecting the population with diabetes due to its oral cavity disorders affecting the population due to its high prevalence. It is more frequent in adults in contrast to cavities which are more common and much more frequent in children.

PD is also seen as a mixture of endogenous infection which is caused by microorganism that colonizes the sub-gingival dental-bacterial plaque, in a structure known as a biofilm. Biofilms are bacterial communities that adhere to oral surfaces. An accumulation of about 700 bacterial species capable of colonizing the mouth have been described. Further, research has shown that a person may store up to 150 different species (Taylor and Becker, p. 194).

Diverse studies carried out by the WHO confirm that the prevalence and severity of PD tends to be on the rise in the adult population compared to younger groups. Persons with diabetes mellitus (DM) are at greater risk of developing PD. PD has been ranked as the 6^th complication of DM. Not only is it more prevalent in this population, but also the progression of symptoms, in a more aggressive and more rapidly setting mode. The main reasons for this prevalence is inherently lack of information on the importance of oral hygiene, poor metabolic control and the irregularity in visiting dentists, among others. PD causes the loss of dental organs, thereby making the chewing of food difficult. In addition, more pain results and this will eventually lead to inadequate nutrition. Those people with DM experience a difficult time tolerating false dentures due to total bone loss and the sensitivity of the alveolar mucosa tissue (Aldridge et al, p. 271). Oral hygiene plays a vital role in periodontal health and one self oral care determines the extent and prevalence of the disease. This are is not fully studied despite the fact that self care have proved to be important in periodontal health. There is substantial evidence that the control of periodontal inflammation has the potential to influence glucose metabolism. On the contrary, partial work has been done on the capability of periodontal health care in improving diabetes. A literature review has suggested the importance of maintaining oral hygiene especially in patients with diabetes. This will definitely lower the risks of developing the disease. 1.1.1 Anatomy of the tooth The tooth is embedded in and attached to the alveolar process of the mandible. The embedded portion is the root and the visible part is the crown. The nerves and blood capillaries are situated in the innermost part of the tooth referred to as the pulp. The next layer of the tooth is the dentin which contains connective tissue containing tubules that house the cellular processes of the odontoblasts. The enamel is covered by the crown as shown on figure 1. Enamel is a hard substance with connective tissue whereas the cementum covers the root part of the tooth. The tooth is attached to the alveolar bone by periodontal ligaments. The gingiva functions as the protective tissue for the alveolar process. There is a space between the gingival epithelium and the tooth which is referred to as the gingival sulcus. The depth of the sulcus is approximately 2-3 mm. However, the damage of the periodontal ligaments in PD, may lead to the expansion of the sulcus, and such a case is referred to as a gingival pocket (Diaz and Belmont, p. 44).

Effects of Diabetes Mellitus on the Periodontal State

The function of immune cells, neutrophils, monocytes and macrophages is often altered in cases of diabetes. Neutrophilic adherence, chemotaxis and phagocytosis are changed, inhibiting an adequate defense against bacteria in the periodontal pouch and significantly increasing the destruction of the periodontal membrane (Diaz and Belmont, p. 43). Although neutrophil function is decreased in diabetics, the monocyte/macrophage cell line may be hyper-responding when faced with the bacterial antigenic contact. This hyper-response results in a greater production of pro-inflammatory cytokines. Peripheral monocytes in diabetic patients produce high levels of the tumor necrosis factor-α (TNF- α) in response to the Porphyromonas gingivalis antigens compared to the monocytes of non-diabetic patients. The level of inflammatory cytokines in the crevicular fluid is also related to glycemic control. Loos reported that diabetic patients with periodonitis, whose HbA1c levels were over 8%, had approximately twice the amount of interleukin-1β (IL-1β) in their crevicular fluid in comparison to patients with indexes below 8% (2109). The net effect of these changes in the immune response of diabetics is an increase in periodontal inflammation, a loss of epithelial insertion and alveolar bone.

The gingival sulcus is a labile site for the body to present a hermetic closure to the external environment. In this space, the crevicular fluid increases in the presence of inflammation. The increase in the loss of periodontal insertion and the alveolar bone in diabetic patients are linked to changes in the metabolism of connective tissue where there is a lack of response in resorption and formation. The effect of the hyperglycemic state includes the inhibition of osteoblastic proliferation and collagen production resulting in a reduction in the formation and decrease in mechanical properties of the newly formed bone.

The changes mentioned above might contribute to the pathogenicity of periodontal disease and changes in healing since collagen is the predominating structural protein in the gums. In addition, collagen is vulnerable to degradation due to the action of MMPs as collagenases which are suggested to be in high amounts in the tissues of persons with diabetes. 1.3 Effects of periodontal disease on the state of diabetes

Periodontal disease has a significant impact on the metabolic state of diabetes. The presence of PD increases the risk of worsening glycemic control in time. The increase of HbA1c values are associated with severe periodontal disease in pregestational type 2 diabetic women. Current research has shown the likelihood of periodontal disease inducing or perpetuating an elevated inflammatory state not only locally, but severe periodontitis with the risk of mortality due to cardio-renal disease. Accumulated studies demonstrates that patients with periodontitis, particularly those colonized with Gram negative bacteria such as P. gingivalis, Tannerella forsynthesis, and Prevotella intermedia, have greater inflammatory serum markers such as C-reactive protein (CRP), IL-6, and fibrinogen than patients without periodontitis. Similarly, there is an increase in resistance to insulin which decreases glycemic control. People with periodontal disease are disadvantaged by depressed immune system which fails to remove the main source or cause of inflammation. The main source is the gram negative bacteria which may lead to continuous activation of the immune making the patient more susceptible to chronic inflammation. At this point, the patient produces species that are reactive in oxygen which in turn triggers production of matrix metalloproteinases. The metalloproteinases enzymes damages the collagen of the periodontal ligaments, which loosens the linkage of the tooth to the alveolar process as well as deepening the gingival sulcus. Gingival pockets forms a place where bacteria can potentially proliferate. This leads to an eventual worsening of infection or inflammation. In addition, the condition of low oxygen fosters the growth of anaerobic bacteria, resulting in worsening of infection and/or inflammation. 2.0 Treatment Since improvement in glycemic control is associated with a major decrease in the risk of diabetic complications, it is important to assure normal or near normal glucose levels. There are different tools to determine the level of glucose control, but a safe glycemic range must be considered for each patient, taking into account coexisting medical conditions, age of the patient, ability to follow a treatment program and possible presence of hypoglycemia unawareness. Basically, treatment of patients with periodontal disease involves mechanical methods. Typically, both professional and mechanical cleaning of the plaque or calculus should be observed. This includes the supragingival and infragingival plaque, (which is a part inside the gingival pockets). If the gingival pockets are deep, surgery may be performed to reduce the growth of bacteria (Skaleric et al. 161). Further research has suggested that apart from mechanical cleaning antimicrobial agents should be applied. The widely used antimicrobial agents are the topical and systematic. The reason for using such treatment is to curb the disease since it involves both the growth of bacteria and shift in the microorganisms species. Topical medication with antiseptics and antibiotics is highly recommended since it has the advantage of delivering the antibacterial agent directly to where there are needed. Tetracycline drugs are examples of topical medication and include the doxycycline, metronidazole and minocycline. A topical antiseptic contains chlorhexidine or sodium hypochlorite. Periodontal treatment decreases local inflammation and as a consequence, decreases chemical mediators involved in inflammation, among them IL-6 and CRP, positively contributing to proper glycemic control. It is evident that PD exceeds the local environment affecting the systemic one. The tissue demand for insulin in type I diabetic patients decreases after periodontal treatment including scraping and radicular smoothing, local gingivectomies and selective extractions, scaling and root planning in addition to the use of antibiotics such as penicillin and streptomycin (Skaleric et al, p. 163). 2.1 Conclusion It is clear that periodontal disease and diabetes have a dependable relationship between them. Not only does diabetes increase the chances of developing periodontal disease, it also supplements the progression of more antagonistic and rapid defining signs. There is therefore a bidirectional relationship between the two principals.

The most important concern for applying evidence in the early diagnosis of periodontal disease is educating the patient. Periodontal disease is a silent condition. Diabetics need to be aware of the signs of periodontal disease. Bleeding of the gums is the first sign of subgingival infection. This is when all the personnel involved in the care of diabetic patients should take active participation and therefore opportunely refer patients to the dentist.

Work Cited

1. Taylor, G., Burt, B. A., and Becker, M. “Severe periodontitis and risk for poor glycemic control in patients with non-insulin – dependent diabetics”. Journal of Clinical Periodontal 23 (1996): 194−202. Díaz, R., Casanova, R., Belmont, J. “Oral Infections and Glycemic Control”. Archives of Medical Research. 36 (2005): 42−48.
2. Loos, B. G. “Systemic markers of inflammation in periodontitis”. Journal of Periodontol 76.4 (2005): 2106−2115.
3. Aldridge, P., Lester, V., Watts, T., Collins, A. et al. “Single-blind studies on the effects of improved periodontal health on metabolic control in type 1 diabetes mellitus”. Journal of Clinical Periodontol. 22.8 (1995): 271–275.
4. Skaleric, U., Schara, R., Medvescek, M. et al. “Periodontal treatment by Arestin and its effects on glycemic control in type 2 diabetes patients”. Journal of International Academy of Periodontol. 6.4 (2004): 160–165.

Title

The title of the article is Draft Program of Prevention of Diabetic Foot Development and Lower Extremity Amputation in Persons with Diabetes Mellitus (Poljicanin, Pavlic-Renar, Metelko, & Coce, 2005, p. 43). The title is very descriptive, appropriate, and accurate because it effectively summarizes the content of the research article. The content of the article describes how comprehensive education of patients on management of diabetes mellitus and foot care practices are central in the prevention of diabetic foot and amputation of lower limbs.

Abstract

The purpose of the study is to enhance foot care practices in patients with diabetes mellitus over a period of five years to reduce incidences of lower limb amputations by 50%. Prior studies have confirmed that diabetic patients are 20 times more susceptible to diabetic foot than the general population because high glucose levels in diabetic patients damage the blood vessels and nerves of the feet causing poor circulation of blood and insensitivity respectively. This damage leads to the development of diabetic foot and the subsequent amputation of lower limbs. Hence, the study aims at enhancing foot care practices and management of diabetes mellitus to reduce increasing cases of diabetic foot and amputation of lower limbs among the population.

The article presented the major results as it showed that proper management of diabetes mellitus and effective foot care practices significantly reduce the development of diabetic foot in patients with diabetes mellitus.

Comprehensive education of patients with diabetes mellitus on the essence of managing diabetes mellitus and foot care practice is critical in the prevention of diabetic foot and amputation of lower limbs.

Methods

The study population is patients with diabetes mellitus and diabetic foot who attend hospital regularly.

The study does not effectively represent other populations because it entails the study of a small sample of the population derived from one clinical center, yet there are many patients out there suffering from diabetes mellitus and diabetic foot.

There is no flowchart of recruiting subjects and there is no need for one since the population of the study is too small for random selection, hence the study employed the chance method of sampling. The chance method was appropriate in recruiting subjects since the study sought to educate all patients in health institutions without any discrimination.

There is no information on both inclusion and exclusion criteria as the study dealt with a small number of diabetic patients who attended the clinic.

The research type is qualitative as it entailed continuous monitoring of glucose levels in the blood to determine whether the trend of managing diabetes mellitus through comprehensive education was positive or negative. Moreover, the study also involved regular screening of diabetic foot to monitor its occurrence in response to foot care.

The research is descriptive for it describes how diabetic patients can effectively take care of their feet and prevent the development of diabetic feet and amputation of lower limbs.

Patients with diabetic feet acted as a control group to ascertain if there was significant prevention or slowed the development of diabetic foot in patients with diabetes mellitus after comprehensive education on foot care.

There is no blinding used because the study assumed that there are no confounding variables that may necessitate blinding of subjects or researchers. Thus, both the researchers and subjects knew the objective of the research and the roles they played in the study.

The study employed correlation statistics to analyze data and determine whether there was significant prevention or slowed the development of diabetic foot in diabetic patients. The study sought to establish if comprehensive education of patients on management of diabetes mellitus and foot care practices negatively correlates with the development of the diabetic foot.

The research design is designed appropriately because the duration of five years is suitable to enhance the eternal validity of findings and in minimizing the effects of extraneous variables. Moreover, a random selection of patients using the chance method was appropriate in enhancing both the internal and external validity of the study.

Correlation statistics used in the analysis of the data were appropriate because the study sought to establish if comprehensive education significantly prevented or slowed down the development of diabetic foot at the end of the five-year period. Hence, the correlation was appropriate in establishing a relationship between comprehensive education program and development of the diabetic foot.

Results

The study presented results clearly through description, making it easy to interpret that comprehensive education of people with diabetes mellitus and diabetic foot is very effective in preventing amputation of lower limbs. The results explicitly show how patients with diabetes mellitus and diabetic foot can manage their diabetic condition and prevent amputation of lower limbs.

The research article did not clearly outline the results using tables and figures, which made it difficult to understand them without reading the description first. To enhance clarity and understanding, the study should have presented the results using tables and figures, for such communicate results more effectively to the readers. However, the description of the results is very clear and easy to understand.

The major results showed that comprehensive education of patients with diabetes mellitus on foot care practices could significantly reduce the development of diabetic foot and amputation of lower limbs in patients with diabetes mellitus.

Discussion

The authors discussed that since incidences of diabetes mellitus and diabetic foot are gradually increasing across the world, the research findings are very important since they proved that comprehensive education on diabetes and foot care is critical in the prevention of diabetic foot and subsequent amputation of lower limbs. In addition, the authors recommend simple preventive measures such as a healthy diet, regular physical exercise, and foot care play a significant role in preventing the development of the diabetic foot, thus the healthcare system needs to carry out comprehensive education of diabetic patients.

The data showed that there was a significant reduction in the incidences of diabetic foot during the five-year period hence supporting the conclusion that comprehensive education of diabetic patients is an effective preventive measure of diabetic foot. The data revealed that comprehensive education negatively correlates with the development of diabetic feet among diabetic patients.

The limitation of the study is that it only dealt with diabetic patients who attend a certain clinical center making it have a negligible sample of the population that does not effectively represent an entire population of diabetic patients who attend various healthcare institutions. In this view, the study was biased in selection of subjects because maybe, diabetic patients from a given social and economic class attended the clinical center to obtain the medical services they could afford. Thus, the study had low external validity, which restricts the extrapolation of results to the entire population.

The findings relate with other studies, which have concluded that proper management of diabetes mellitus and effective foot care practices are central in the prevention of diabetic foot. A comprehensive education program is a feasible approach to preventing and managing diabetes mellitus and diabetic foot because increased awareness of the conditions in the population will enhance the efforts of the health care systems. According to World Health Organization, people can prevent and manage most diseases if they have enough information concerning causes, prevention, and treatment of varied diseases. Thus, the study relates with other research studies, which have established that comprehensive education of patients and the public is a feasible approach of preventing and managing diabetes mellitus and related conditions.

The discussion is important as the authors contend because diabetes and diabetic foot are health issues that need comprehensive education of diabetic patients to significantly reduce their incidences. Changing health lifestyles in society has predisposed many people to diabetes and diabetic foot as trends in diabetes mellitus are increasing alarmingly. Type II diabetes, which was an exclusive disease of adults is gradually becoming dominant in young adults and adolescents. Moreover, statistics have revealed that diabetic patients are 20 times more susceptible to diabetic foot than the general population; thus, prompting the application of comprehensive interventions to reverse the alarming trends of diabetic foot among the population is paramount. Hence, comprehensive education of diabetic patients is one of the effective interventions that are critical in prevention of diabetic foot and amputation of lower limbs.

Reference

Poljicanin, T., Pavlic-Renar, I., Metelko, Z., & Coce, F. (2005). Draft Program of Prevention of Diabetic Foot Development and Lower Extremity Amputation in Persons with Diabetes Mellitus. Diabetologia Croatica, 34(2), 43-49.