Category: Diabetes

Abstract

Gestational diabetes is a prevalent obstetric problem. The outcome may affect both the mother and the neonate. This essay aims at providing a brief, yet, comprehensive review on gestational diabetes, clarifying the key caring components, discussing the role a midwife can play as a part of a health care team, and finally inferring the challenges that face midwives dealing with this condition.

Introduction

Although childbirth is a natural process; yet, midwifery is the art and science of practicing care to assist females at all stages of the childbirth process (pregnancy, delivery, and postpartum) (Liburd 1999). The word challenge carries many connotations, it points to the demanding task of proving, as well as winning a situation against opposing or difficult circumstances (Soanes and Hawker 2008).

Vibeke and colleagues (2009, p. 1349) defined gestational diabetes mellitus (GDM) as glucose intolerance detected for the first time during pregnancy. They considered GDM a significant forecaster for type II diabetes mellitus (DM) since females with GDM are sex times prone to develop type II DM than non-GDM mothers.

Professional midwifery aims to enhance maternity care through capitalizing on maternal and fetal outcomes. This concept reveals a promising model of maternity care systems where midwives are key members of primary care providers and a significant link between community care providers and the healthcare system (ICM 2003). This essay aims to look at the problem of GDM and accept the challenge of clarifying a management framework from a midwifery viewpoint.

Gestational diabetes mellitus (GDM)

Glucose is an important metabolic substrate for the fetus as it is for the mother. Since it crosses the placental barrier by facilitated diffusion, GDM is a risk to the mother and the fetus. (Habermann and Ghosh 2008).

Etiology and pathogenesis

Diabetes is the result of inadequate insulin supply to meet the needs of the tissues for blood glucose regulation. Regarding GDM, two specific points are worthy to mention; first, pregnancy is associated with increased insulin resistance starting in the second trimester, progressing through the third trimester to reach levels similar to type II DM. Insulin resistance in GDM is likely to be the result of a combination of lifestyle factors (nutrition and overweight) and the insulin-desensitizing effect of chorionic gonadotrophins (placental hormones). This is evidenced by the fact that GDM subsides in many cases after delivery (Buchanan and Xiang 2005).

Second, to compensate for increased insulin resistance in pregnancy, the pancreatic B cells increase their insulin secretion. Therefore, changes in blood sugar levels during pregnancy may be small especially when compared with the larger changes in insulin resistance (Buchanan and Xiang 2005).

The American Diabetes Association (2003) identified three risk groups of GDM and recognized the assessment clinical characteristics for each one. First, the high-risk group where only one of the following criteria is sufficient: marked obesity, DM in a first-degree relative, history of glucose intolerance, current glycosuria, or history of delivery to an overweight child (macrosomia). Low-risk group mothers should have all the following criteria to be at risk of GDM: age less than 25 years, no history of macrosomia, no history of glucose intolerance or glycosuria, and normal pregnancy weight.

Prevalence

Dabella et al (2005, p.579) suggested that 3-8% of all pregnant mothers in the USA show GDM; however, the impression is this rate is increasing because of increased obesity prevalence. Further, the authors stressed that different ethnic show different prevalence rates, being more common in African Americans, Hispanic and Native Americans.

In the UK, Hanna et al (2007, p. e 64) noticed that different studies reported different prevalence rates ranging from 3-4% to 2-9%, the reason is that rates vary in England, Wales, and Northern Ireland. However, they noticed that areas with the highest prevalence of GDM do not automatically match those with the highest rates of DM in the general population.

Link and McKinlay (2009, p. 288) inferred socioeconomic status shows a stronger association with GDM than racial or ethnic factors. They clarified that continuing stress on biomedical factors of different races or ethnic groups would circumvent efforts of socio-medical interventions.

Diagnosis

Clinically, cases of GDM may show symptoms similar to those of type II DM like thirst, increased urination frequency, fatigue, frequent infections, unexplained weight loss, and nausea and vomiting. However, these symptoms can be attributed to pregnancy or the condition is asymptomatic and detected only on screening. Therefore, although screening is recommended at 24-28 weeks of pregnancy; yet, it is advisable to consider each case separately based on the classification of risk provided by the American Diabetes Association (2003), (Boinpally and Jovanovich 2009).

GDM is screened by oral glucose tolerance test (OGTT) of either the 1-step or 2-steps method. One-step OGTT is a glucose load of 75-100 grams of glucose taken orally after a fasting period without previous plasma screening. The two-step approach to administer a first 50 grams OGTT if the glucose level result equals or more than 130mg/dL, the test is followed by a one-step OGTT to confirm the diagnosis (Boinpally and Jovanovich 2009).

OGTT is recommended mostly between 24 to 28 weeks of pregnancy, however, some authorities recommend in addition a first antenatal visit screening test, while others recommend screening at 20, 28, and 34 weeks gestational age. This discrepancy is because GDM may progress as pregnancy advances (Coustan 1995).

Diagnostic criteria varied in different studies but the commonest in use are O’Sullivan and Mahan Diagnostic Criteria, National Diabetes Data Group Conversion of O’Sullivan and Mahan Diagnostic Criteria, and Carpenter and Coustan Criteria for Gestational Diabetes.

Maternal and fetal outcomes

Mothers with GDM are more prone to develop type II DM after delivery; further, they have high recurrence rates (30-69%) of developing GDM in subsequent pregnancies. There is a strong association between GDM and hypertension; therefore, GDM mothers are liable to develop further complications of pregnancy like preeclampsia (Evans and Patry 2004).

There is a belief that GDM is associated with higher rates of fetal death; however, there are no well-designed trials to support this opinion. The characteristic fetal complication of GDM is macrosomia defined as an infant born weighing more than 9 lb (8.8-9.lb). Evidence shows that the prevalence of macrosomia is 14 to 23% in GDM mothers.

The main complication associated with macrosomia is shoulder dystocia (obstructed labor secondary to impaction of the anterior shoulder under the maternal symphysis pubis). This complication may lead to fatal injury or serious maternal hemorrhage secondary to injury or uterine atonia (Evans and Patry 2004). Another serious fetal complication is neonatal hypoglycemia which may lead to neonatal coma or death if not detected (Evans and Patry 2004).

Philips and Jeffries (2006 p. 701) showed that shoulder dystocia occurs in 3% of deliveries to mothers with GDM, and in this group, 71% of the infants are admitted to a neonatal nursery. They also showed that if a GDM mother is not given care, the risk of serious pregnancy complications rises threefold that in non-GDM mothers.

Management outline

There are two essential cornerstones for proper management, first, is lifestyle interventions which include diabetes nutritional therapy and encouraging exercise. The second is achieving a normal blood glucose level through medication therapy. For this purpose, insulin is still preferred over oral hypoglycaemic agents mainly because of its large molecular weight which prevents crossing the placental barrier to the fetus. Of importance is to look for impending complications or coexisting medical disorders like hypertension (Habermann and Ghosh 2008).

Key GDM caring components

Before discussing the key care components, it is essential to clarify that management of GDM needs a team approach of which a nurse-midwife is an indispensable member. The care plan should be tailored individually considering factors like the mother’s age, work schedule and environment, lifestyle pattern, social situation, personality, cultural norms, and the presence of diabetes complications or coexisting disease. The care planning process should include evaluation of the patient’s individual education needs and identify the potential of the mother’s self-management (Belfiore and Mogensen 2000).

The American Diabetes Association (2007) identified seven pillars for diabetes care, initial evaluation, glycemia control, medical nutrition therapy (MNT), diabetes self-management education, encouragement of physical activity, psychosocial assessment and care, and referral for diabetes management. The report emphasized the team approach for providing care and that the best possible diabetes care needs an organized systematic approach with the effective participation of each member of the healthcare team.

Midwifery care to mothers with gestational diabetes

Cheung (2009) summarised the area a midwife can participate in providing healthcare to a GDM mother as patient education, dietary and exercise therapy, diabetes self-management education.

Patient education

Patient education about diabetes is essential in GDM as during pregnancy the healthcare team is working on two patients simultaneously; the mother and the fetus. An education program should focus on the importance of maintaining treatment and changing the lifestyle, it should also focus on possible complications if management is neglected. The program should have a goal e.g. reduce the risk of complications, decrease hospitalization to control diabetes, or constant reevaluation of the treatment plan. On implementing an education program there should constant evaluation of the outcome based on the benchmarks determined earlier (Pagano et al 2006).

Kim et al (2007) considered GDM a teaching moment where patients are receptive to education to decrease the risk of GDM. In their series, they found that patients who had GDM in a previous pregnancy remembered health care providers’ advices facilitated by brochures or lab slips on screening. They inferred that in cases of the previous history of GDM, preconception preventive counseling is an important area to look at. Understanding the working environment, cultural, social, and patient’s self-care behavior is essential to reduce escape from educational settings (Gucciardi 2008).

Encouraging exercise and physical activity

The American Diabetes Association report (2007) acknowledged exercise as an important means of controlling diabetes and preventing possible cardiovascular complications. The report suggested an exercise dose of 150 minutes per week of moderate-intensity exercise or 90 minutes per week of intense exercise. Regarding frequency, the report suggested that exercise should be maintained at least three times per week with no more than two consecutive days without exercise. In absence of cardiovascular complications, patients are encouraged to practice resistance exercise gradually increasing to reach 8-10 minutes three times per week.

Downs and Ulbrecht (2006) examined exercise beliefs and behaviors in postpartum females who had GDM in a recent pregnancy. They inferred the main motive during pregnancy was to control GDM, while in the postpartum, it was weight control. Only 7% of exercising females in the postpartum were aware this may prevent type II DM. The husband or partner encouragement had the strongest influence, while the main barrier during pregnancy was fatigue and during the postpartum was lack of time. This information would enlighten designing proper exercise education programs.

Dietary management

Dietary therapy aims to provide enough mothers and fetuses nutrition in terms of calories and various food elements; however, the diet must be planned to allow weight gain yet maintain suitable blood glucose levels avoiding the risk of complications e.g. coma or kentonuria. Regarding weight, a gain diet should be planned according to body mass index (BMI) allowing lesser weight gain for females with higher BMI indices. How nutrients are distributed all through the day is controversial (Di Cianni et al 2008).

The indication for medical treatment whether insulin or oral hypoglycaemics is when the patient fails to achieve a balance between nutrient needs and glucose level. Medical nutrition therapy should be looked at as a self-management therapy; therefore, GDM patients need education and support for a successful outcome (Reader 2007).

Diabetes self-care management

Diabetes self-care management means providing the patient with information and education on how to self-monitor blood glucose, dietary counseling, how to achieve a healthy lifestyle. Therefore, a midwife may be able to fulfill these goals and the health care team may then need a dietitian and or a diabetes educator (Cheung 2009).

Cultural support

Providing support that crosses cultural diversity and considers psychosocial factors influences, to a great extent, the patient’s acceptance of health care services especially in a culturally diverse population. This is by no means an easy task as the difficulty is not societal diversity but within a specific group, the degree of culture absorption and changeability (acculturation) varies (Mendelson et al 2008).

Mendelson and colleagues (2008) inferred that acculturation has an impact on pregnancy beliefs and practices in different ethnic groups. The authors suggested a tendency towards living by two cultures (biculturalism) rather than absorbing the new cultural value and coming up with a unified culture.

Conclusion

Midwives face three challenges regarding gestational diabetes, first, can they meet the basic belief of the midwifery care model that is childbirth is a natural procedure and they should only interfere when necessary? Second, can they provide GDM patients’ care as a part of a team whose primary concern is the patient’s welfare? Third, can they be practical; yet creative to cross barriers and provide better health care to GDM mothers.

References

American Diabetes Association (2003). Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 26(Suppl. 1), S5-S20.

American Diabetes Association (2007). Position Statement: Standards of Medical Care in Diabetes. Diabetes Care 30 (Suppl. 1), S4-S41.

Belfiore, F., and Mogensen, C. E (2000). New Concepts in Diabetes and Its Treatment. Basel: Karger.

Boinpally, T., and Jovanovich, L (2009). Management of Type 2 Diabetes and Gestational Diabetes in Pregnancy. Mount Sinai Journal of Medicine, 76, 269-280.

Buchanan, T. A., and Xiang, A. H. (2005). Gestational diabetes mellitus. The Journal of Clinical Investigation, 115(3), 485-491.

Cheung, M. W (2009). The Management of Gestational Diabetes. Vascular Health and Risk Management, 5, 153-164.

Coustan, D (1995). Gestational diabetes. In Diabetes in America (2nd edition). [NIH Publication no. 95-1468]. US Govt. Printing Office. Washington, DC.

Dabella, D., Snell-Bergeon, J. K., Hartsfield, C. L., Bischoff, K. J., et al (2005). Increasing Prevalence of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care, 28(3), 579-584.

Down, D. S., and Ulbrecht, J. S. (2006). Understanding Exercise Beliefs and Behaviors in Women with Gestational Diabetes Mellitus. Diabetes Care, 29, 236-240.

Evans, E., and Patry, R (2004). Management of Gestational Diabetes Mellitus and Pharmacists’ Role in Patient Education. American Journal of Health-System Pharmacy, 61(14), 1460-1465.

Di Cianni, G., Fatati, G., Lapolla, A., Leotta, S. et al (2008). Dietary therapy in diabetic pregnancy: recommendations. Mediterr J Nutr Metab, 1, 49-60

Gucciardi, E (2008). A Systematic Review of Attrition from Diabetes Educational Programs: Strategies to Improve Attrition and Retention Research. Canadian Journal of Diabetes, 32(1), 53-65.

Habermann, T. A. and Ghosh, A. K (2008). Mayo Clinic Internal Medicine Concise Textbook. Rochester, MN: Mayo Clinic Scientific Press.

Hanna, F. W. F., Peters, J. R., Harlow, J., and Jones, P. W. (2007). Discrepancy between Postnatal and Antenatal Management of Gestational Diabetes in the U.K. Diabetes Care, 30(7), e64.

ICM (2003). The essential competencies of midwifery practice. Geneva: International Confederation of Midwives.

Kim, C., McEwen, L. N., Kerr, E. A., Piette, J. D., et al (2007). Preventive Counselling among Women with Histories of Gestational Diabetes Mellitus. Diabetes are, 30, 2489-2494.

Liburd, A. (1999). The use of complementary therapies in midwifery in the U.K. Journal of Nurse Midwifery 44(3), 325–9, 183–188

Link, C., and McKinlay, J. B (2009). Disparities in the Prevalence of Diabetes: Is It Race/Ethnicity or Socioeconomic Status? Results from the Boston Area Community Health (BACH) Survey. Ethn Dis, 19, 288-292.

Mendelson, S. G., McNeese, D., Koniak, D., Nyamathi, G. A., et al (2008). A Community-Based Intervention Program for Mexican American Women with Gestational Diabetes. JOGNN, 37, 415-425.

Pagano, M., Luressen, M., and Esposito, E (2006). Sustaining Diabetes in Pregnancy Program: A Continuous Quality Improvement Process. The Diabetes Educator, 32(2), 229-234.

Philips, P. J., and Jefferies, B (2006). Gestational diabetes: Worth finding and actively treating. Australian Family Physician, 35(9), 701-703.

Reader, D. M (2007). Medical Nutrition Therapy and Lifestyle Interventions. Diabetes Care, 30 (Suppl. 2), S188-S193.

Soanes, C. and Hawker, S (2008). Oxford Compact English Dictionary of Current English (third edition). London: Oxford University Press.

Vibeke, A., van der Ploeg, H., P., Cheung, A., W., Huxely, R., R. et al (2009). Sociodemographic Correlates of the Increasing Trend in Prevalence of Gestational Diabetes Mellitus in a Large Population of Women between 1995 and 2005. Diabetes Care, 32, 1349-1352.

Abstract

Diabetes Mellitus is a nutritional disease affecting millions of Americans and people worldwide. Recent studies have shown where there might be more people suffering from diabetes than those who have been diagnosed and are actually treated presently. ((Wild, 2004). The onset is insidious and asymptomatic in many instances. Lifestyle habits have been predisposing factors for its development in the absence of any sound etiology. Twenty-first-century dietary practices among a growing fast-food culture have increased the incidences greatly as more children are being diagnosed with type one diabetes. Therefore, paramount to Public Health importance is intense education which should be undertaken in addressing key elements of prevention, generally, of this pancreatic dysfunction. The following pages of this document will project measures that can be adopted as educational strategies are implemented in health promotion and prevention disciplines.

Introduction

The writer would advance that supportive intervention in the control of diabetes mellitus necessities an integrated approach. To be most effective embracing many other disciplines outside health care itself would be rather beneficial in a public education campaign as it relates to the magnitude of this pandemic we have cultured in societies around the world.

World Health Organization anticipates, based on current trends that by the year two thousand and thirty the incidence of Diabetes Mellitus in the world would double. It means that there would be approximately two hundred million people with this condition. (Wild, 2004) Health educators then have a huge task ahead. Health promotion programs must be geared to reach these millions who are potential targets to halt this assault on their health.

Therefore, the purpose of this document is to offer conscientious alternatives to diabetes mellitus through massive community education involving the entire family. Most importantly, for families to know that eating determines the quality of our health. While food and eating are cultural, they must be healthy too.

This program is aimed at sensitizing the public concerning the real impact of diabetes on population growth, the number of people who die from untreated or complications of the disease, and the impact altered production and productivity levels have on psychosocial well-being.

In collaborating with other members of the community it would be beneficial to involve nutritionists, therapists, optomologists, phlebotomists, sociologists, business people, particularly, fast food chain owners as members of the audience in a teaching/ learning discussion forum setting. Hopefully, bringing together these essential knowledge skills can be achieved through discovery learning techniques.

How relevant is education in Diabetes Mellitus to current concepts of health promotion and disease prevention? This is a burring issue among many health educators including public health initiators in our global community. The Seventh Global Conference on Health Promotion revealed three concepts of health promotion and prevention, which are pertinent to this discussion.

Health Promotion Concepts

It was agreed that health promotion has specific expertise that can accelerate progress towards attainment of achievable goals; address the emergence of non-communicable diseases, injury, and mental disorders, a group of conditions that are growing at epidemic rates in low and middle-income countries; and assume responsibility “to tackle the issue of inequities in the distribution of health by gender, social class, income level, ethnicity, education, occupation, and other categories.” (“Health Promotion,” 2011).

These are, certainly, commendable concepts of health promotion and prevention applicable to diabetes mellitus, which is one of the non-communicable diseases obviously targeted by the Seventh Global Conference on Health Promotion held in Nairobi, Kenya during 20-30^th October of 2009. (“Health Promotion,” 2011).

A precise conceptual framework reiterates that “health promotion strategies are not limited to a specific health problem, or to a specific set of behaviors.” (“Health Promotion,” 2011). “WHO as a whole applies the principles of, and strategies for, health promotion to a variety of population groups, risk factors, diseases, and in various settings too. More importantly, it encompasses the associated efforts put into education, community development, policy, legislation, and regulation.” (“Health Promotion,” 2011). This statement is supportive of all health promotion ventures, internationally, specifically confirming the World Health Organization’s philosophy of ‘health not being merely the absence of disease, but the total wellbeing of each individual.” (“Health Promotion,” 2011).

Evidence-Based Best Practice

As such, current evidence-based best practice trends in Diabetes Mellitus education programs are aimed at control of glucose levels, beta-blocker drug intervention, and cessation of smoking, mainly. These regimes have been adopted after extensive research, which proved that control of blood glucose levels alone does not prevent cardiovascular complications. Hence, a three-dimensional approach towards the prevention of complications was adopted. (Wong, 2006).

Subsequently, as nurses deliberate on evidenced-based best practices in the promotion of control, it became necessary that a round table discussion bringing together diverse skills and backgrounds in the profession be undertaken. Nurses analyzed best practices from the perspective of promoting self-management of diabetes. (Lewis, 2007).

An astounding discovery significant to this phenomenal educational approach was that each person needed to identify their role as a professional in health promotion and prevention of diabetes and harness appropriate resources that would adequately resolve the education puzzle. (Lewis, 2007). Theoretically, collaboration of skills for most favorable outcomes is advocated.

Cultural sensitivity was exposed as being vital to amending the education puzzle crisis. A study revealing experiences of three nurses on the team in review confirmed that shared heritage between providers and recipients fostered comfort and trust, but establishing this outside the boundaries of ethnicity was a huge challenge to be overcome. (Lewis, 2007). Therefore, educators must always be conscious of this aspect of cultural diversity impingement on race as groups are integrated.

While assessing best practices in the many facets of care for Type 11 diabetes mellitus, beside drug therapies and glucose monitoring lifestyle adjustments were highly recommended. These included diet, exercise and weight reduction. (Hall, 2008). Precisely, everyone has heard about this previously and it has profoundly become common sense health promotion jargon. This message is transmitted daily from almost all categories of health care providers. Yet still, obesity is on the rise. Definitely, it is indicative that more appropriate strategies towards public education regarding the debilitating consequences of diabetes mellitus are imperative.

Meanwhile in the presence of frightening prognoses surrounding the evolution of diabetes mellitus there is theoretical proof that with implementation of evidence based best care practices there are earthbreaking improvements in control of the disease. Conjoined studies between the American Diabetes Association and European Association for the Study of Diabetes confirmed that pre screening, diagnosis and therapeutic management were the foundations pillars of control. (Hill, 2009)

Further, more conclusive empirical evidence from American Association of Diabetes Educators through delivery of theoretical assumptions declared that “ physical activity, diet, adherence to medication regime; blood glucose monitoring; problem- solving intervention in cases of low blood sugar levels readings; risk reduction of complications and psychosocial adaptations were integral health promotion and preventions strategies for educational considerations.” (Hill, 2009).

Teaching- Learning Strategic Implementation

Therefore, collaborating nutritionists, therapists, optomologists, phlebotomists, sociologists, business people, particularly, fast food chain owners as members of an audience in a teaching/ learning discussion forum has proven essential to sensitizing the public concerning the real impact of diabetes on population growth. Besides it is important for the public to acquire information concerning the number of people who die each year from untreated or complications of the diseases and the impact of altered production and productivity levels has on the social structure as a whole.

The cultural and professional diversity of this group is vital to educating the community concerning pre screening, diagnosis and therapeutic management. It is the intention of this facilitator to adopt a discovery learning teaching technique. Education would be focused primarily at sensitizing members of the public to engage in annual prescreening for diabetes mellitus.

Besides professionals, among this group would be clients affected with the disease. They would serve as case study examples telling their story of coping as diabetics. Group discussion pertaining to any concern expressed by clients would be entertained. Concerns would be channeled to the appropriate professionals in the group for clarifications. These sessions are catered to last no longer than one to one and a half hours to facilitate attention deficits.

Squealing, this event consideration is given to have same group continue as a community based organization championing the cause for public education about diabetes prevention and control. It would then become necessary as an educator to target other communities and continue the teaching learning process.

Conclusion

Conclusively, in summarizing the teaching learning techniques to be employed as education regarding “Supportive Intervention in the Control of Diabetes Mellitus” is pursued, it must be emphasized that collaboration of community skills and expertise is vital for success. As such, the researcher has embraced in this discourse that nutritionists, therapists, optomologists, phlebotomists, sociologists, business people, particularly, fast food chain owners as valuable participants in a teaching/ learning discussion forum.

This strategy has been supported by round table discussion typology, which has been observed to not merely being beneficial, but important considerations for adequate dissemination of knowledge. Precisely, “the need to identify roles as professionals in health promotion and prevention of diabetes is extremely important in harnessing the most appropriate resources that would adequately resolve the education puzzle.” (Lewis, 2007). Theoretically, collaboration of skills for most favorable outcomes is advocated

“Health promotion and prevention concepts encourage such strategies in the realization that they encompass the associated efforts put into education, community development, policy, legislation and regulation.” (“Health Promotion,” 2011).

Evidenced based best care practices reiterate the need for teaching in physical activity management, diet, adherence to medication regime; blood glucose monitoring; problem- solving intervention in cases of low blood sugar level readings; risk reduction of complications and psychosocial adaptations. Conjoined studies between the American Diabetes Association and European Association for the Study of Diabetes confirmed that pre screening, diagnosis and therapeutic management were the foundations pillars of control. (Hill, 2009)

Therefore, any teaching learning program must not be limited to an individual client and the family, but massive education across communities being aware that the number of people with a predisposition to diabetes will double by twenty thousand and thirty. (Wild, 2004) Hence, a culturally diverse professional group is vital to educating the community concerning pre screening, diagnosis and therapeutic management. Intentionally, this facilitator will adopt a discovery learning teaching technique. Education would be focused primarily at sensitizing members of the public to engage in annual prescreening for diabetes mellitus.

World Health Organization anticipates, based on current trends that by the year two thousand and thirty the incidence of Diabetes Mellitus in the world would double. It means that there would be approximately two hundred million people with this condition. (Wild, 200). Importantly, this could mean millions alive today who are unaffected. Education is a powerful tool in reversal of this fallacy.

References

Hall, M, (2008). Type 11 diabetes: the many facets of care: Home Health Care Nurse, 26(6), Web.

Health Promotion. (2011). World health organization. Web.

Hill, A. Diabetes management: 2009 update. The Nurse Practitioner, 34(6), Web.

Lewis, L. (2007). Round table: promoting self management of diabetes. AJN, 107(6), Web.

Wild, S. (2004).Global Prevalence of Diabetes. American diabetes association. Web.

Wong, M. (2006). Clinical evidence review: best practices. Permanente Journal, 10(3), Web.

Gestational diabetes mellitus (GDM) is a very serious condition that affects the health of the mother, as well as her baby in varying time periods: immediate, short-term, or long-term. It is a type of diabetes that affects pregnant mothers and has the potential to recur despite the fact that it mainly disappears after birth. This paper is aimed at enhancing the understanding of GDM among Australian pregnant mothers with a focus on its prevalence, causes, health implications, established policies and public initiates aimed at addressing it, as well as future strategies and approaches that could help reduce its incidence and prevalence.

The prevalence of gestational diabetes worldwide has shown a general increasing trend in the last 20 years across race/ethnicity groups. According to recent data by Ferrara (2007), an increase of approximately 10 to 100% has been reported in various race/ethnicity groups. In Australia, the prevalence of GDM is estimated to range between 5.2 and 8.8% (Cheung & Byth 2003). The 2005-6 gestational diabetes mellitus in Australia report gave a figure of 4.6% to represent the fraction of pregnant women aged 15-49 years with GDM. This was a 20% increase compared with what had been recorded in 2000-1 (Templeton & Pieris-Cladwell 2008). According to this report, the incidence of gestational diabetes was increasing. This is seconded by Ferrara’s (2007) in his research work, in which he showed increasing trends in the prevalence of GDM in various geographical regions where South Australia was part. On an annual basis, 16,500 women are diagnosed with GDM (Dodd et al. 2007). Unfortunately, this is expected to continue growing.

There is no definite known cause for GDM but there are different facts and theories presented to guide this. One version is that during pregnancy, the hormones responsible for foetal growth and development impede the action of insulin hence insulin resistance (Australian Government and Diabetes Australia 2010). Based on this theory, it is automatically presumed that when the release of the blocking hormones stops, then the insulin levels go back to normal. As a result, it lacks a definite cause. Alternatively, risk factors are used to explain the cause of GDM as stated by Jovanovic & Pettitt (2001). These risk factors among others include obesity, maternal age, and a family history of diabetes. The fact that a pregnant woman gets GDM for the first time during their pregnancy is a risk factor in itself because histories of GDM are associated with high chances of developing the disease in subsequent pregnancies (Hall 2001).

Racial differences are also very imperative in determining the occurrence of GDM. This can be supported by the fact that the prevalence of GDM was reported to be higher in Chinese and Indian women residing in Australia compared with the women of European or Northern African descent, who were residing in Australia as well (State Government of Victoria 2012). In addition, the Aboriginal women rather than the non-Aboriginal women were more exposed to this type of diabetes (Ishak & Petocz 2003). The 2005-6 GDM report simply states that the incidence of GDM among women who had been born from other countries was twice as large as the incidence of those women born in Australia. Those born in Southern Asia were 3.4 times more at risk of getting the disease compared with those born in Australia (Templeton & Pieris-Caldwell 2008).

Gestational diabetes mellitus is a public health issue with serious implications. As stated earlier, its implications are felt almost immediately, in the short-term, or long-term. The implications of GDM are mainly felt by the infants in the newborn period. This is because of the current patterns that show an increase in the prevalence of diabetes in offspring born to mothers with GDM (Ferrara, 2007). Short-term-effects mainly include those that are observable or detectable during pregnancy, labour and a short time after birth and inexhaustibly include outcome of pregnancy, intensive care admissions, duration of pregnancy, need for resuscitation, method of delivery, foetal growth characteristics, and type of labour (Australian Institute of Health and Welfare 2010).

Neonates born to mothers with GDM experience the implications of GDM in the following ways: increased exposure to stillbirth, respiratory distress syndrome, caesarean section, shoulder dystocia, and macrosomia (Gonzalez-Quintero et al. 2007). Stone et al. (2002) implies that babies born to mothers with GDM are more at risk of going through the effects of this disease compared with babies of non-GDM mothers. This is due to the facts presented; whereas 17% of neonates from mothers with GDM were macrosomic, only 10% of the neonates from mothers without GDM had the condition, 13% of the newborns from mothers with GDM had neonatal jaundice compared with 7% of non-GDM mothers, and 32% of the newborns from mothers with GDM were delivered by caesarean compared with 19% of newborns belonging to mothers without GDM. Suhenon & Teramo (1993) indicate that GDM exposes pregnant mothers to pregnancy-induced hypertension and pre-eclampsia, operation during delivery, and induced labour. According to a study carried out in Victoria in 1996, 37% of women with GDM compared with 23% of women without GDM had induced labour. In addition, 41% of the women with GDM underwent operative delivery by means of vacuum extraction, forceps, or caesarean as opposed to 29% of women without GDM (Stone et al. 2002).

The long term implications of GDM to the mothers include increased risk of recurrent GDM in subsequent pregnancies. In addition, it results in progression to type 2 in these mothers and a general resultant effect of high prevalence of type 2 diabetes in general. It is has been estimated that 17% of Australian women with GDM are later diagnosed with type 2 diabetes within 10 years. These figures can go up as high as 50% when the timeframe changes to 30 years (Lee, et al., 2007; Metzger 2007). The explanation behind this is that the prevalence of GDM has been indicated as a reflection of the prevalence of type 2 diabetes in the larger population. In addition, it is the attributive risk factor for type 2 diabetes among the pregnant mothers with GDM (Kim, Newton & Knopp, 2002).

GDM posses as a serious health risk for pregnant mothers because it also exposes them to heart diseases according to Retnakaran & Baiju (2009). Women with GDM have an increased risk of neonatal hypoglycaemia, and hyperbilirubinaemia. The babies are also affected in the long term because they tend to have congenital anomalies. They also have an increased risk of obesity, impaired glucose tolerance, and are also susceptible to type II diabetes in early adulthood (Fetita et al. 2007).

As a result of the need to reduce associated co-morbidities and death, there have been initiatives put in place to ensure that GDM is reduced and lives are saved. The government has been involved in funding Diabetes Australia for the successful development and execution of effective mechanisms to reduce the incidence and prevalence of GDM (Australian government 2012). The National Diabetes Services Scheme (NDSS) is a project that was initiated by the Australian government through Diabetes Australia, and its role has been greatly recognized in as far as reduction and prevention efforts of GDM are concerned. Within the National Diabetes Services Scheme, there is the National Gestational Diabetes Register that was set up to enable women with GDM to gain control over their conditions and ensure that their health conditions do not worsen (Diabetes Australia, 2012).

Pregnant women are required to register with this body, the National Gestational Diabetes Register, and in return they are to receive some benefits. Their doctors and they are sent consistent reminders of the need to engage in diabetes checks. In addition, this body is involved in sensitizing and providing information in printed form to the women on the need of, and how they should adopt a healthy lifestyle. However, this does not guarantee that the women will actually read and understand the information. Therefore, it could be a reason for the continued increase because even though there is sensitization, the manner in which it is carried out matters a lot.

As indicated earlier, one’s lifestyle is a great determinant to one’s health and especially diabetes including GDM. Sometimes, individuals are not knowledgeable in as far as healthy diets are concerned, or they may not realize the essence of such diets. Consistent provision and distribution of printed materials on GDM and how it can be controlled is assumed to act as consistent reminders on the need to ensure that one adopts and practices healthy feeding habits. But this medium of passing information is questionable. This registration has been made free and therefore every pregnant woman is not restricted by money to get the reading materials, and engage in medical check-ups. Regardless of this free service, thoroughness in terms of follow-ups should be observed because the women act out of their own will and it might not be consistent. Such free services deserve more emphasis and should not be viewed as opportunities for only the less privileged because they are equally important to everyone.

Registration with NDSS also enhances one’s access to various products such as testing strips, insulin syringes and pen needles, and insulin pump consumables. These devices are very important in the management of GDM through monitoring of one’s glucose levels. It should not just be a matter of distributing these devices because if someone does not know how to effectively and properly use and take of this equipment, it would be a goalless venture. Ensuring that there is available data on the incidence and prevalence rates of pregnant women with GDM is another initiative. This data has been made available in the Gestational diabetes mellitus in Australia report. The first one was developed in 2005-6 and it aimed at providing researchers, scholars or related academicians with information on the incidence of GDM among women giving birth in hospitals. This report also provided information on high-risk sub-groups, which are defined on the basis of their orientation towards the condition. Factors mentioned in this report that determine inclination towards the disease include age and genes (Templeton & Pieris-Caldwell 2008).

A realization is that despite the strategies in place currently, the prevalence of GDM is still increasing. This could mean several things but in future, there is need to carry out researches and establish the effect of each strategy in reducing GDM and therefore establish their effectiveness, as well as what is not addressed by the various strategies. The world is constantly changing and therefore, there is need to constantly review and update data. Researchers should exercise validity because there lacks consistency in the levels of incidence and prevalence of GDM. Yet, this is very important in planning and allocating resources to address GDM in the future. Accurate figures enable the government and various bodies addressing diabetes to focus. I second Lancaster (1996) on the essence of enhancing the research area so as to give consistent and reliable results.

The main challenge is usually maintenance. Once the glucose levels have gone down, there is a tendency for women to assume that they are okay and therefore tend to ignore the monitoring bit. This is a reflection of the NDSS scheme where follow-up lacks and therefore, this element should be given full attention. There is need to clearly point out the essence and ways of maintaining a normal glucose level and especially for those mothers who have experienced GDM before so as to avoid its recurrence. Lack of follow-up is an indication of lack of seriousness. The notion by health care workers that diabetes is just like any other disease, and that they do not put much seriousness are elements that may have certain effects on the patients. As a result, the women may miss out on some fundamental practices that can affect their prognosis and road to recovery.

A lot of emphasis is mainly placed on the pharmacological dimension of GDM yet behavioural interventions such as healthy eating, engagement in healthy physical activity and proper stress coping mechanisms are more effective in reducing the recurrence of the disease but are not accorded the required attention and emphasis (Australian Government and Diabetes Australia 2010). There should therefore be a shift in emphasis where women should be really encouraged to change their lifestyles and adopt healthier ones, or maintain the healthy ones. Counselling services should be offered affordably, or as part of the NDSS package to ensure that all mothers benefit. To enable such utilization of services to enhance behaviour change, there is need to evaluate the accessibility of health care services among the GDM mothers and thereby figure out if there is a way that accessibility could be enhanced. Examples here would include subsidizing health care costs with a focus on the individual’s background financial position.

Future strategies should not focus solely on the GDM but instead, they should also encompass the associated type of diabetes that results. In essence, the strategies to address GDM should be designed in such a manner that also minimizes the occurrence of type II diabetes. The successful implementation of projects and policies is grounded in integration and co-operation among the involved parties. The various health care systems entail various departments and all these should liaise effectively with one another through effective communication to avoid inefficiencies and deficiencies in the system. These inefficiencies and deficiencies are so serious such that regardless of the great advocacy and accessibility to health care, lack of co-ordination results in poor delivery of services and may not produce the desired effect on the patient.

References

Australian Institute of Health and Welfare 2010, Diabetes in pregnancy: its impact on Australian women and their babies, Diabetes series no. 14. Cat. no. CVD 52, AIHW, Canberra.

Australian Government and Diabetes Australia 2010, Gestational Diabetes: Caring for yourself and your baby, Web.

Cheung, NW & Byth, K 2003, “The population health significance of gestational diabetes”, Diabetes Care, vol. 26, pp. 2005-9.

Diabetes Australia 2012, Gestational Diabetes, Web.

Dodd, JM, Crowther, CA, Antoniou, G, Baghurst, P & Robinson, JS 2007, “Screening for gestational diabetes: the effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomes”, Aust N Z J Obstet Gynaecol, vol. 47, no. 4, pp. 307-312.

Ferrara, A 2007, “Increasing Prevalence of Gestational Diabetes Mellitus: A Public Health Perspective”, Diabetes Care, vol. 30, no. 2, pp. S141-S146.

Fetita, L, Sobngwi, S, Serradas, P, Calvo, F & Gautier, J 2007, “Review: Consequences of fetal exposure to maternal diabetes in offspring”, Journal of Clinical Endocrinology and Metabolism, vol. 91, no. 10, pp. 3718–3724.

Gonzalez-Quintero, VH, Istwan, NB, Rhea, DJ, Rodriguez, LI, Cotter, A, Carter, J, Mueller, A & Stanziano, GJ 2007, “The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes”, Diabetes Care, vol. 30, no. 3, pp. 467–470.

Hall, LD, Sberna, J & Utermohle, C 2001, “Diabetes in pregnancy, Alaska 1990–1999”, State of Alaska Epidemiology Bulletin, vol. 5, no. 3, pp. 1–9.

Ishak, M & Petocz, P 2003, “Gestational diabetes among Aboriginal Australians: prevalence, time trend, and comparisons with non-Aboriginal Australians”, Ethnicity and Disease, vol. 13, pp. 55–60.

Jovanovic, L, & Pettitt, DJ 2001, “Gestational diabetes mellitus”, JAMA, vol. 286, pp. 2516–2518.

Kim, C, Newton, KM, & Knopp, RH 2002, “Gestational diabetes and the incidence of type 2 diabetes: a systematic review”, Diabetes Care, vol. 25, pp. 1862-68.

Lancaster, P 1996, “The health of Australia’s mothers and babies—improvements in the collection of perinatal statistics are needed to fill the gaps”, Medical Journal of Australia, vol. 164, pp. 198–199.

Lee, AJ, Hiscock, RJ, Wein, P, Walker, SP & Permezel, M 2007, “Gestational diabetes mellitus: clinical predictors and long-term risk of developing Type 2 diabetes”, Diabetes Care, vol. 30, no. 4, pp. 878–883.

Metzger, BE 2007, “Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring”, Clinical Obstetrics and Gynecology, vol. 50, no. 4, pp. 972–979.

Retnakaran, R & Baiju, RS 2009, “Mild glucose intolerance in pregnancy and risk of cardiovascular disease: a population-based cohort study”, Canadian Medical Association Journal, vol. 181, no. 6–7, pp. 371–377.

State Government of Victoria 2012, Diabetes-Gestational, Web.

Stone, CA, McLachlan, KA, Halliday, JL, Wein, P &Tippett, C 2002, “Gestational diabetes in Victoria in 1996: incidence, risk factors and outcomes”, Medical Journal of Australia, vol.177, pp. 486–491.

Suhonen, L & Teramo, K 1993, “Hypertension and pre-eclampsia in women with gestational glucose intolerance”, Acta Obstetricia et Gynecologica Scandinavica, vol. 72, no. 4, pp. 269–272.

Templeton, M & Pieris-Caldwell, I 2008, Gestational diabetes mellitus in Australia, 2005-06. Cat. no. CVD 44, AIHW, Canberra.

Introduction

Genetic engineering refers to the alteration of genetic make-up of an organism through the use of techniques to introduce a new DNA or eliminate a given hereditable material (Morgan 54). It involves manipulating the genetic make-up of an organism in order to come up with a more superior organism that can easily survive under the given environment where a normal organism may find it challenging. Although genetic engineering had existed before in breeding, 1972 is widely believed to be the time when scientists, such as Paul Berg, started making scientific researches on how genetic engineering can be used in other areas. According to Peacock (54), genetic engineering had existed before this period, especially in breeding. However, it was in the 1970s that the scientists started making tremendous steps in this field. Scientists such as James Watson, Francis Crick, Paul Berg, Herbert Boyer, Stanly Cohen, and Robert Swanson are some of the people who made positive impacts in the development of genetic engineering. At first, these scientists focused on coming up with organisms that were resistant to the new environmental forces. The focus was on coming up with better breeds of plants and animals that were resistant to the changing weather patterns. Then, genetically modified foods emerged as a solution to the changing climatic conditions. Although the issue of genetically modified foods has remained a highly controversial field, Stanley (41) says that scientists have made impressive steps in coming up with a scientific solution to the new problems caused by global warming around the world. Currently, genetic engineering is playing a critical role in the field of medicine. In this essay, the researcher will look at how genetic engineering can be used to manage diabetes.

Research question

When conducting the research, it is always important to develop specific research questions that will guide the process of data collection. Research questions help in defining the specific issues that the researcher seeks to uncover in order to respond to a given issue or address the gaps that exist in the body of languages. In this research, the following are the specific research questions that will guide the researcher when collecting data from the field.

• What is the role of genetic engineering in the management of diabetes?
• What are some of the historical records about how genetic engineering has been used to manage diabetes?
• How acceptable is genetic engineering as a means of managing diabetes?
• What is the future of diabetes in the management of diabetes?

The above research questions will define the kind of data that the researcher seeks to collect from the secondary sources.

The current knowledge about the genetic engineering

The current knowledge of the researcher about the topic is that genetic engineering is wide because it entails wide reading. Genetic engineering has offered solutions in the society, some of which have remained controversial. One area that has attracted the attention of the researcher is that of the genetically modified foods. The advancements in genetic engineering has made it possible for the researchers to come up with plants that are resistant to drought, pests, and other environmental challenges that may affect the development of normal plants. The yields from genetically modified foods are also more impressive than those that are not genetically modified. However, there have been reservations about the long-term effect of such foods in terms of health. The scientists, who are proponents of genetic engineering, have insisted that such foods do not pose any long-term effect on human beings or any other animal for that matter. However, there have been reservations among a section of scientists and some human rights activists, especially those with extreme religious beliefs.

There is an agreement among the scientists that since time immemorial, human beings and other animals have relied on organic plants with DNA that has not been altered. However, genetic engineering involves creation of organisms which have altered DNA, the fact that forms the basis of the controversy. There have been fears that consuming foods with altered DNA may have a long time effect on the DNA of human beings. As Tagliaferro (35) notes, there is a fear that this could lead to gene mutation in human beings or other changes in the genome that may lead to a change in the genetic structure of human beings. However, Peacock (77) says that such fears are unfounded and are largely based on rumors by those, who have personal or religious reservations against genetic engineering. With the emerging hope that genetic engineering offers in the treatment of diabetes, it is the right time for these controversies to be addressed so that the scientists involved in this area can have the moral authority to make advances in their researches.

Importance of understanding genetic engineering

In this section, the researcher will look at the relevance of gathering knowledge about genetic engineering as a student of health sciences. In this study, the focus is on diabetes. Diabetes is one of the most common diseases that are diagnosed in many hospitals in this country almost on a daily basis. As mentioned above, it is unfortunate that most of the cases are always reported at advanced stages, making it difficult to find a lasting solution to these patients. The emergence of genetic engineering as a possible solution to this problem is something that is welcomed both by the patients and doctors. As a student who expects to deal with similar cases in the near future, gathering knowledge on this topic is very critical, especially given the fact that genetic engineering has raised controversies, some of which are yet to be adequately addressed. The researcher considers this to be a research gap that needs scientific research in order to give an appropriate response.

In order to address these gaps, the researcher will need to evaluate the issues that have been surrounding genetic engineering, especially when it comes to its medical aspect. This study is the first step towards developing a comprehensive research about the issue. According to Herring (50), some of the issues that have been raised about genetic engineering have more to do with beliefs and personal perceptions than hard facts gathered through scientific studies. However, it is worrying that some reputable scientists have joined the opponents of genetic engineering. This means that this is an issue that cannot be ignored. At this stage of research, however, the focus will be limited to understanding how genetic engineering can be used to treat diabetic patients, especially those at the advanced stages. To do this, it will be necessary to look at the past successes (or failures), the current state of affairs, and its future when it comes to treating diabetic patients.

Literature Review

The review of the literatures may help in determining the path that genetic engineering has taken as a medical solution for diabetes. Herring (50) says that the emergence of genetic engineering as a solution in managing diabetes is a relatively new knowledge to the researcher that will warrant further research. Kent (56) says that Type I diabetes- which is not the most common one- has been a cause of concern within the medical fraternity, especially when it is detected at an advanced stage. Lack of knowledge among the general public about how this disease can be detected at the earliest stage possible has been the major challenge. According to Manthappa (59), when detected at advanced stages, patients are forced to lead their entire lives under constant medication. This is an expensive process not only to the patient and his or her family, but also to the government. Ghalayini (64) says that this would require hiring of more medical practitioners, purchase of more medical equipment, and having the right systems that will be used by the patients. Genetic engineering offers a lasting solution to these patients. It will be important to investigate how genetic engineering is used to address the problem of diabetes.

According to Kumar and Garg (143), genetic engineering attracted the attention of medical researchers as attempts to use it in treating diabetes became promising. In the early 1990s, scientists gave a massive focus in gene therapy as a means that can help reverse severe immunodeficiency disorder. This involved modification of cells to make them resistant to the disease. The researchers went ahead to alter the cells in the bone marrow to help in improving the therapeutic outcomes during the medication process. However, Morgan (28) says that genetic engineering did not live to its promise during this period. The massive effort of the scientists either resulted in proposals that were either unviable economically, or ineffective in offering a lasting solution to this problem.

According to Brimicombe and Holman (43), researchers did not abandon the attempt to find a lasting solution to the diabetic patients despite the poor results that were obtained in the previous attempts. The concept of gene therapy was further advanced in order to find a way in which it could be used to treat diabetic patients. The breakthrough came with the advent of reverse hyperglycemia. This involved introducing pro-insulin gene into the cells in order to promote the normal production of insulin. According to Gulledge and Beard (67), the recent researchers have realized that the best way of using genetic engineering is to develop cells which are able to produce insulin response. The new cell that is introduced into the body of a diabetic patient should have the same effect as the cells responsible for the production of insulin in the body. As Manthappa (87) observes, these researchers realized that the best way would be to program the gut and pancreatic cells which are largely responsible for the production of insulin. Their aim was to have a cell that will be able to do the same function as the pancreatic and gut cells. According to Peacock (42), this will enable the normal production of insulin, which will facilitate the conversion of glucose without relying on any form of medication.

According to Sizer and Whitney (113), the use of gastrointestinal inhibitory peptide-promoters is successful in mice. It has been proven that mice makes positive response modification. It also boosts the responsiveness of the glucose within the body. However, the application of this technology requires further advancements beyond what is proved to be successful on mice. Manthappa (54) says that one of the major challenges that these researchers have been able to address is the rejection of the modified cells once introduced into the body. When the cell fails to perfectly match the body cells it mimicked, such as the pancreatic cells, then it will be considered a foreign material within the body system. The white blood cells will be released to destroy such cells as soon as it is detected. It took time to come up with mechanisms of developing a perfect match when creating a modified cell before it can be introduced into the body. However, Gulledge and Beard (78) note that although the expectations remain very high, genetic engineering as a solution to the problem of diabetes. This scholar believes that the controversy associated with genetic engineering is one of the main reasons why a breakthrough still remains a dream that is yet to be realized.

Conclusion

Genetic engineering has been beneficial in various other fields, especially in the field of agriculture. Medical researchers have been actively involved in studies aimed at enhancing gene therapy as a way of treating diabetes. As shown in the above discussion, gene therapy promises to offer a lasting solution in the fight against diabetes. However, this will largely depend on the ability of the stakeholders to address the existing controversies that have slowed the progress in this fight. As they struggle to make gene therapy work, these scientists need moral support from the society and fellow scientists. Any misunderstandings should be conclusively addressed before this new form of medication can be rolled out in hospitals.

Works Cited

Brimicombe, Moses, and John Holman. Advanced G Science. Walton-on-Thames: Nelson, 2007. Print.

Gulledge, Jo, and Shawn Beard. Diabetes Management: Clinical Pathways, Guidelines, and Patient Education. Gaithersburg, Md: Aspen Publishers, 2009. Print.

Herring, Mark. Genetic Engineering. Westport: Greenwood, 2006. Print.

Kumar, Anil, and Neha Garg. Genetic Engineering. New York: Nova Science Publishers, 2006. Print.

Manthappa, Moen. How to Manage Your Diabetes and Lead a Normal Life. New Delhi: Peacock Books, 2008. Print.

Morgan, Sally. Genetic Engineering: The Facts. London: Evans Brothers, 2006. Print.

Peacock, Kathy W. Biotechnology and Genetic Engineering. New York: Facts on File, 2010. Print.

Peacock, Kathy. Biotechnology and Genetic Engineering. New York: Facts on File, 2010. Internet resource.

Sizer, Frances, and Eleanor Whitney. Nutrition: Concepts and Controversies. Toronto: Nelson Education, 2012. Print.

Stanley, Debbie. Genetic Engineering: The Cloning Debate. New York: Rosen, 2011. Print.

Tagliaferro, Linda. Genetic Engineering: Progress of Peril? Minneapolis: Lerner, 2007. Print.

Kent, Michael. Advanced Biology. Oxford: Oxford University Press, 2000. Print.

Ghalayini, Rita. Higher Level Biology: For Use with Th Ib. Amman: Fadi Issa, 2008. Print.

Introduction

Type 2 diabetes is a disease that has been affecting many people, both young and old, in recent years. This disease emanates from chronic conditions arising from the inability of the pancreas to produce enough insulin into the bloodstream, leading to excess glucose and other sugars in the body. Here, the body fails to regulate the amount and movement of blood sugar in the bloodstream. Generally, the cost of treatment has always been one of the factors that hinder proper treatment and mitigation of T2D. However, various preventive interventions could be very helpful in managing the occurrence of the disease, especially in relation to psychological proliferation. This paper will discuss the social, behavioral, and psychological causes of type 2 diabetes (T2D) in contemporary society. Specifically, the paper will do a comparison of T2D in the U.S and other developed countries, including its development, proliferation, and the mitigation measures put in place.

Social causes of type 2 Diabetes

To begin with, the disease usually develops when the pancreas fails to secrete sufficient insulin in the body, leading to unregulated blood sugar. This may be due to social factors such as lack of exercise and bad eating habits that can lead to overweight. Generally, when insulin is produced by the pancreas, it is released into the bloodstream where it circulates while regulating sugar in the blood cells. Here, Insulin lowers blood sugar when it is high by converting it into glycogen and other fatty acids. Alternatively, when the sugar level in the body is low, insulin converts glycogen in the body into glucose, thus raising the level of blood sugar. Since glucose in the body is derived from the foods that are converted and stored in the liver, it is important the social eating habits of most individuals be controlled to regulate body weight; indeed, this has been found to be one of the main causes of type2 Diabetes.

Behavioral causes of type 2 Diabetes

Several behavioral factors lead to the disease, one of them being excessive drinking of alcohol. Generally, alcohol is made from barley and sugar, which tend to be deposited in the body if consumed in excess. Again, other behaviors such as fear of taking medications as prescribed by the doctor can increase the incidences of the disease. Therefore, proper behaviors should be adopted in order to contain the proliferation of the disease.

Psychological cause of type 2 Diabetes

Research has established that stress and depression are some of the factors that affect insulin and blood sugar regulation in the body. According to Koppes et al. (2006), an investigation on individuals having T2D in the U.S found that most of them were having it due to stress and depression; indeed, the authors noted that those suffering from depression and stress were more likely to get the disease than those who practice stress-free life and proper self-management practices. Therefore, family social support and counseling may be of critical importance in alleviating social stress as well as the occurrence of the disease.

The development of type 2 Diabetes in U. S

According to the Centers for Disease Control and Prevention (CDC) (2012), statistics for years 2007-2009 show that the rate of diabetes increases with age; indeed, people over 65 years recorded an 18.9% rate while those between 20 years and 44 years rated at 2.6%. Moreover, in relation to ethnicity, Native Americans and American Indians exhibited the highest rate at 16.1% prevalence followed by non-Hispanic blacks at 12.6%, while non-Hispanic whites recorded the lowest at 7.1%. The above statistics show that the proliferation of type 2 diabetes is dependent on the age group and ethnicity of a person. In relation to specific states, statistics for the year 2010 show South Carolina recording a 9.9% rate of adults over 18 years who are diagnosed with T2D (Centers for Disease Control and Prevention, 2013). This rate is above the US national rate that stands at 8.3% as per the 2010 statistics. However, the rate of adults who have ever been informed of having the risk of diabetes in the future in South Carolina stands at 6.6%, which is below the US national rate at 10% according to 2010 statistics. of people in the U.S have diabetes. Out of these, the majority are people aged 20 years to 64 years, accounting for 11.3% of all people in this age group. Again, from 65 years and above, 26.9% of all the people in this age group were found to be having diabetes (Skinner, John, and Hampson, 2000). In addition, the prevalence of the disease is skewed towards men, with the study revealing that more men were found to be suffering from diabetes than women are.

Lastly, only 0.26 of the people younger than 20 years were found with the disease.

Therefore, it is clear from the above data that the older generation is more affected by diabetes in the U.S than the younger generation. Again, from the data, it is also clear that more men are affected and are having the disease than women. In a comparison of the disease in the U.S and other developed countries, it was found that there are more incidences of diabetes in the U.S than in other developed countries for example Canada (Sultan, et al., 2008).

Cost of Treating T2D and Steps to Address Psychological Proliferation

Diabetes is one of the most expensive diseases to treat, mainly due to consistent visits to health care centers and medication. Therefore, medical health insurance plays a big role in eliminating financial stress from people at risk of T2D. In the US, the annual cost of treating diabetes averaged at over 113 billion dollars as per 2007 statistics; indeed, these costs are expected to increase to around 226 billion in 2030 (Huang, Basu, O’Grady, and Capretta, 2009). In South Carolina, the cost of treating diabetes stood at over 5 billion dollars in 2012 against US national costs of 245 billion dollars; this is an equivalent of over 2% (American Diabetes Association, 2013). Generally, the Psychological proliferation of T2D could be addressed through various steps aimed at eliminating psychological stressors.

The first step is to enhance coping skills (Steed, Cooke, & Newman, 2003) for dealing with events that cause stress, especially in persons who have been diagnosed with diabetes or have a risk of contracting diabetes. This could involve providing counseling services that would incorporate training on assertiveness, anger management, and social integration as ways of fighting psychological stressors. The next step would be to encourage community members to provide peer and family support (Steed, Cooke, & Newman, 2003) to persons suffering or at risk of suffering from diabetes; this would give them peace of mind and a feeling of belonging. Thirdly, exercise programs would need to be drawn and followed consistently in order to help in mind and physical fitness. Here, sports events and team sponsorships in the community would play a vital role in ensuring that people are always occupied and have a chance to interact; indeed, stress emanates mainly from boredom. Other exercise disciplines targeting psychological health would include meditation and yoga lessons to the members of the community.

The fourth step would involve community education aimed at enhancing knowledge and self-efficacy would be encouraged. Here, seminars, door-to-door blood sugar testing campaigns and health forums would be undertaken to create awareness of the risk factors and management of T2D. In addition, community groups would be formed and provided with psycho-education on early recognition of stress-induced risks of T2D and effective management of the disease. Lastly, liaising with organizations and agencies that provide health solutions to communities would be encouraged. These agencies include National Diabetes Education Program, community transformation grant program, national Institute of Health, Indian Health Service, and Minority Health Program, all of which work towards creating awareness and providing both financial and psychosocial support to the community.

Steps to Address Diabetes in Workplace

There are various steps to take into account in addressing T2D in workplace in order to maintain a healthy workforce. The first step is to conduct a survey on employees in order to assess the risk or status in relation to T2D; this will also involve blood sugar testing. Another step would involve developing programs that will educate employees on lifestyle change as an intervention to T2D (Centers for Disease Control and Prevention, 2013). Here, programs targeting nutrition and physical activity would be important. Thirdly, a community education program that will also include employees would be drawn to enhance self-management as a way of controlling the proliferation of type 2 diabetes. In this approach, self-management education training would enhance healthy eating, consistent exercising, and regular blood sugar monitoring in order to improve quality of life. A disease management program that focuses on those who are already diagnosed with the disease would also be another intervention step; this will enhance health care delivery by a team of professionals either from nearby health care centers or a permanent unit within the workplace that deals with health matters, especially chronic diseases like T2D. The next step would involve offering employees on-site heath care services, including vaccinations on related health conditions such as influenza and pneumonia, which are usually fatal. Although vaccinations can be offered at any health center, they tend to be very effective and reliable when offered in workplace on regular intervals. Lastly, the administration may organize forums and seminars to be addressed by diabetes prevention and management agencies such Diabetes Education Program in order to create awareness and impart knowledge to all employees in the workplace.

From the above steps, I would recommend the use of multifaceted lifestyle programs. These programs train employees on dietary habits such as avoiding foods with high cholesterol, excess consumption of alcohol and cigarette smoking, all of which are known to exacerbate T2D conditions. In addition, these programs provide exercise and counseling sessions in order to eliminate physical and psychological stressors that may contribute to proliferation of T2D.

Conclusion

This paper has discussed the various causes of type2 diabetes, among them being behavioral, social, and psychological. In addition, the paper has discussed some of the symptoms of the disease and found out that frequent urination and feeling thirsty are some of the common symptoms. Generally, malfunction of the pancreas contributes significantly to the proliferation of T2D, as less insulin is secreted. Nevertheless, proper diet, healthy living lifestyle, and physical exercise have been recommended as appropriate preventive measures of the disease. Lastly, the paper has established that older generation is more likely to suffer from T2D than younger generation due to some of the factors discussed above.

References

American Diabetes Association. (2013). The Burden of Diabetes in South Carolina. American Diabetes Association. Web.

Centers for Disease Control and Prevention. (2012). Diabetes report Card 2012. Web.

Centers for Disease Control and Prevention. (2013) Workplace Health Promotion. Web.

Huang, E., Basu, A., O’grady, M., & Capretta, J. (2009). Projecting the Future Diabetes Population Size and Related Costs for the U.S. Diabetes Care, Volume 32(12), 2225-2229.

Koppes, L. L., Dekker, J. M., Hendriks, H. F., Bouter, L. M., & Heine, R. J. (2006). Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients. Diabetologia, 49(4) 648-652.

Skinner, T. C., John, M., & Hampson, S. E. (2000). Social support and personal models of diabetes as predictors of self-care and well-being: a longitudinal study of adolescents with diabetes. Journal of Pediatric Psychology, 25(4), 257–267.

Steed L, Cooke D, Newman S. (2003). A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns, 51(1):5-15.

Sultan, S., Epel, E., Sachon, C., Vaillant, G., & Hartemann-Heurtier, A. (2008). A longitudinal study of coping, anxiety and glycemic control in adults with type 1 diabetes. Psychology & Health,23(1), 73-89.

Introduction

This study aims at creating awareness on the lethality of diabetes by ensuring that the necessary information about this disease is available to the public. However, in order to achieve this, the study will seek to provide answers to questions about the causes, susceptibility, and preventive measures for diabetes.

Research Questions

1. What is the level of diabetes awareness among the public?
2. What are the common causes of diabetes?
3. Does diabetes have any cure or is it preventable?

Hypothesis to be tested

• H1: Many people are aware of diabetes, its susceptibility, causes, and preventive measures.
• H2: Many people are not aware of diabetes, its susceptibility, causes, and preventive measures.

Problem and Purpose

Even though many people have heard of diabetes, only a few are aware of its causes, preventive measures, as well as what category of people is likely to suffer from diabetes (Shaw, Sicree & Zimmet, 2010). This study, therefore, will offer an insight into the causes, susceptibility, as well as the preventive measures of diabetes. The study will also get quantitative data that relate to the causes from databases in the respective regions in United States of America. This will be supplemented by interviewing nurses and administrators on the overall subject of diabetes. The research will be comprehensive and will combine two study designs including descriptive and cross-sectional study designs.

Population and Sample

In any study, the target population is used to point to the elements for which the study is interested. The number of registered public hospitals in USA is 5686. These targeted people/units will be identified from the sampled hospitals. Furthermore, the study will seek to interview the stakeholders involved in the treatment and prevention of diabetes. These include the nurse, hospital administrators, and hospital district heads.

Sampling Design

A sample is a subsection of the target population. To arrive at a sample size, proper sampling techniques should be applied.

Sample Frame

The sampling frame for this study was the public hospitals. A sample is usually drawn from the target population. Sampling frame represents the working population that is to be utilized in the study. According to Denzin and Lincoln (2008) if a sample frame is taken correctly it will lead to a sample is representative of the whole population.

Sampling Techniques

The study will use simple random sampling procedure. According to Mitchel and Jolly (2010) simple random sampling is very useful in getting a representative sample from a large sample group. In addition, simple random sampling technique is free from human bias and avoids classification errors, by giving each unit an equal chance of being selected.

Sample Size

The determination of the sample size depends on the number of replication applicable in drawing inferences about the population/units. Sample sizes are important in determining the precision of a research (Neumann, 2007). This research by application of the random sampling will have a sample size of 500 hospitals.

Data Collection and Instrumentation

The study questions and the hypothesis to be tested will be used to guide the research. As a result, the study will apply a type of data collection method that will ensure gathering of comprehensive data. Denzin and Lincoln (2008), point out that the choice of any method of data collection is usually depended on the research strategies, the point of collection, and the person to carry out the research.

Archival Records

This source of data will include diabetes information gathered since the discovery of diabetes. Other records will also be collected to help in comparison.

Interviews

In order to collect in-depth information, the study will contact interviews. According to Denzin and Lincoln (2008) interviews are good research instruments that can be applied in data collection since they focus on the respondents’ attitudes and perceptions along with the exploration of personal differences, experiences, and outcomes.

Data Analysis

After data is collected, the study will apply different methods of data analysis. The statistical package for social sciences (Foster and Yarvosky, 2006) will be used to analyze the data, i.e. to compute the average mean, modes and standard deviation from the collected data. Correlation will be calculated by use of regression analysis. This will help in establishing the level of diabetes awareness among people under study. In addition, cross-sectional time series analysis will be utilized in the analysis. Such will assist the researcher in studying the statistics of diabetes since its discovery. The causal relationship here will entail the respondents’ perspectives and the respective hospital details.

In addition, data from BRFSS will be used in analyzing the level of diabetes’ awareness in US (Cdc.gov, 2015). As such, the use of BRFSS will allow the use of more variables in relation to respondents’ demographic information. Such variables will include sex, age, level of education, ethnicity, level of income, weight, as well as marital status. In order to answer the question of diabetes awareness and its preventive measures, the study will analyze the number of patients under diabetic pills, length of insulin intake and frequency of blood test.

Summary

From the above, it suffices that a number of factors are responsible for causing diabetes. Shaw, Sicree and Zimmet (2010), point out that the causes of diabetes are classified depending on the type of diabetes. However, some causes are common in both cases. Often, Type 1 diabetes affects children and young adults. Genetic susceptibility is the primary cause where the genes inherited by children make them prone to suffer from diabetes type 1.

From the analysis of the data collected during the study, it is evident that diabetes is preventable. In addition, the study found out that few hospitals out of the sample had adopted measures of preventing diabetes. However, according to most of the respondents, the preventive measures put forward were not sufficient and that more diabetes awareness was necessary.

References List

Cdc.gov. (2015). NHANES 2009 – 2010: Diabetes Data Documentation, Codebook, and Frequencies. Web.

Denzin, N. and Lincoln, Y.S. (2008). Colllecting and interpreting qualitative materials. Malden, MA: Blackwell.

Foster, J. and Yavorsky, C. (2006). Understanding and Using advanced statistics. Thousand Oaks, CA: Sage.

Mitchell, M. and Jolly, J. (2010). Research design explained. Belmont, CA: Wadsworth.

Neumann, W. L. (2007). Social Research Methods: Qualitative and Quantitative Approaches. London: Allyn & Bacon, pp.35-44.

Shaw, J. E., Sicree, R. A., & Zimmet, P. Z. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes research and clinical practice, 87(1), 4-14.

Introduction

The scientific method is a process of finding out why and how things occur based on quantifiable evidence. Dependence on facts distinguishes the scientific method from other inquest methods (Ritchie, 2001, p.6). The scientific method uses hypotheses to elucidate and create tests for experiments through the forecast. Scientific methods aim at showing the practicability of science and eliminating biases and problems in showing the truth (Ritchie, 2001, p.13). In general, the scientific method involves making observations, carrying out research, hypothesizing, making predictions, testing, and drawing conclusions (Ritchie, 2001, p.27). However, all of these steps may not necessarily be taken in every other scientific experiment.

Solving problems using the scientific method

Solving problems using the scientific method involves stating the problem and making observations first. The test to be carried out is then explained and a literature review developed (Gauch, 2002, p.10). Using the observations, a hypothesis that should give factors to be tested is developed. The hypothesis of the experiment ought to be straightforward and understandable. An experiment is then designed with resolute steps to verify the hypothesis. It is imperative to ensure that all the necessary materials for the experiment are scheduled. The control group and the experiment group for the test are then identified (Gauch, 2002, p.16). The control group should be the experiment’s reference point and its variables should remain unchanged.

Once the experiment setup is complete, a series of tests are carried out. The test can be conducted as many times as possible while recording measurements. For verification purposes, it is important to change at least one variable in every test with other groups. After carrying out all tests and recording accurate data successfully, conclusions can be drawn. In the conclusion, results regarding your observations and the hypothesis should be stated. Also stating what needs further research and possible recommendations are key components of the conclusion (Gauch, 2002, p.21). However, in problem-solving using the scientific method, ignoring information that does not compliment the outcome or taking the hypothesis for the answer without testing should be avoided (Gauch, 2002, p.29).

The experiment

Concerning a report published on Science Daily on June 10, 2010, the hypothesis of the experiment can be said to be: the role of caffeine in reducing the risk of diabetes. The question the researchers were trying to answer with this experiment was whether caffeine, a component found in coffee, can help reduce the risk of diabetes.

This experiment had both a control group and a treatment group. The control group for this experiment was human beings (Science Daily, 2010, par.2). In this experiment, humans are not exposed to any conditions of the experiment. Humans are separated from exposure to the experiment and they can not influence the results on the condition being tested. The treatment group for this experiment was mice. The treatment group can also be referred to as the experimental group. The mice were exposed to all the conditions of the experiment for the variable being tested (Science Daily, 2010, par.2). For validation of the hypothesis, the observations on the treatment group were recorded.

The researchers in this experiment followed the scientific method in their experimental design. This experiment involved making observations, developing a hypothesis, research, and testing. All these are key steps in the scientific method experimental designs. This experiment may not have any bias, though it may have a few problems. Some of the possible problems with this experiment could be ignoring data that does not compliment the result and taking the hypothesis for an answer.

Conclusion

The hypothesis was supported as evident from the data collected in the experiment. The data indicated the effects of caffeine on blood sugar levels and insulin sensitivity, all of which are related to diabetes (Science Daily, 2010, par.3). Drinking coffee can reduce the risk of diabetes in humans. This should be recommended for the millions of American population that are at risk of type 2 diabetes.

References

Gauch, H. (2002). Scientific Method in Practice. London: Cambridge University Press.

Ritchie, A. (2001). Scientific Method. London: Routledge.

Science Daily: New Evidence that Drinking Coffee May Reduce the Risk of Diabetes. (2010). Web.

Introduction

Diabetes type II was previously referred to as noninsulin-dependent diabetes mellitus as well as adult-onset diabetes. Diabetes type II is a metabolic disorder that influences the glucose metabolism process by the body. The body resisting the impact of insulin as well as producing less insulin to maintain normal glucose levels characterizes the condition (Goldstein and Mueller-Wieland 5). In other words, the metabolic disorder is exemplified by high blood glucose due to insulin resistance as well as comparative insulin deficit.

Of all the cases of diabetes, diabetes type II accounts for 0.9 of the cases. Further, obesity in individuals that are genetically subjected to the condition is the main source of diabetes type II. The development of diabetes type II is also caused by anxiety and a poor diet characterized by excess consumption of sugar-sweetened foods. Individuals suffering from the condition often experience recurrent urination, increased thirst, polyphagia, and loss in weight. The conditional can result in cardiovascular diseases, limb amputations as well as kidney failure (Goldstein and Mueller-Wieland 33). Regular workouts and an appropriate diet are significant in the prevention of diabetes type II.

Hormonal mechanism

The reduced capability of the body cells to respond to the activities of insulin is regulated by intracellular and trans-membrane protein receptors. The types of receptors in the activities of insulin include ion channel-linked receptors including calcium ions and enzyme-linked receptors such as tyrosine kinase receptors. Alpha and beta subunits make up the insulin receptor. Disulfide bonds join the subunits of insulin receptors together. The former subunits are extracellular and house insulin-combining realms whereas the latter subunits infiltrate through the plasma membrane. The pancreas plays the role of producing insulin. Additionally, the pancreas moves the hormone from the bloodstream into the body cells to be utilized for energy. In diabetes type II, the resistance to insulin is a critical aspect. In essence, the glucose that builds up in the bloodstream and the body cells is unable to operate efficiently (Goldstein and Mueller-Wieland 15). During the regulation of glucose metabolism, multifaceted signaling interfaces between fat, liver, and muscle tissues as well as brain tissues occur.

When there is high glucose sugar, the insulin combines with the receptor tyrosine kinase on the cell surface. The receptor transports phosphate groups from ATP to tyrosine deposits on intracellular target proteins. The receptor then undergoes endocytosis. The islets of Langerhans release excess insulin to achieve homeostatic levels in the blood. The increase in blood insulin causes the receptor to diminish the number of insulin receptors thereby increasing the hormone resistance through the decrease of insulin sensitivity leading to diabetes type II.

Essentially, the binding of receptor kinase decreases the activity of the insulin receptor complex. As such, the combination of the signaling effectors to the insulin is reduced because of condensed phosphorylation sites on the insulin receptor as well as inhibition of response on the signaling molecules (Goldstein and Mueller-Wieland 56). Feedback inhibition on the signaling molecule thwarts joining to insulin receptor thereby leading to malfunctioning downstream activation of kinase flow and second messenger indicating passageway. Consequently, decreased glucose transporter fusion to the cell membrane and less transported glucose in the body cells occur.

The activation of second messengers including Ca²⁺ ions, phosphoinositides, and diacylglycerol is also a common mechanism of multi-protein signal transduction. The messengers move freely through the cytoplasm as well as the membrane. When the second messengers are released, signal intensification, as well as augmented speed in signal transduction, is achieved due to simultaneous interactions with numerous targets in the cells. The receptor makes active a pair of second messenger pathways by breaking phosphoinositide into diacylglycerol and calcium ions (Goldstein and Mueller-Wieland 37). For instance, the Ca²⁺ ions from the endoplasmic reticulum diffuse through the cell activating other signaling molecules thereby initiating cellular feedback.

Intracellular effects of insulin

Insulin plays a critical role in regulating the delivery of glucose in the body cells to provide energy. As such, in the case of diabetes type II, the cells are unable to absorb glucose and amino acids. The deficiency in the quotient of insulin and glucagon slows down glycolysis. The inhibition of glycolysis reduces energy production (Roper 114). In other words, insulin holds back the discharge of glucagon thereby halting the utilization of fats as a source of energy. Additionally, insulin leads to the control of glucose levels in the blood at a stable ratio.

Actually, insulin is significant in endocrine metabolism. The hormone has diverse cellular effects on the regulation of glucose levels in the blood. Specifically, insulin is invaluable in enhancing the progress of glucose admission into a muscle as well as adipose tissues. Most importantly, hexose transporters make easy the mechanisms through which cells absorb glucose. In particular, the action of insulin is essential for availing GLUT4, the transporters utilized in the uptake of glucose in the plasma membrane (Roper 112). Further, insulin facilitates the process through which amino acids are absorbed for energy and balance in blood sugar at different levels of the hormone.

In circumstances where the concentrations of insulin are stumpy, the GLUT4 transporters play a worthless role in transporting glucose in the cytoplasm vesicles. In fact, the joining of insulin to receptors initiates the fusion of vesicles together with the plasma membrane as well as the incorporation of the GLUT4 transporters. Consequently, the blood cells are capable of taking up glucose effectively.

Another significant cellular impact of insulin is that the hormone facilitates the storage of glucose as glycogen. In essence, insulin triggers hexokinase that traps glucose through phosphorylation. Essentially, insulin hampers the action of glucose-6-phosphatase while activating the activities of phosphofructokinase and glycogen synthase enzymes that are significant in the synthesis of glycogen (Roper 82).

Generally, the effect of insulin entails the lessening of glucose concentration in the blood cells. In other words, the take-up of glucose by body cells for energy depends on the availability of insulin. Additionally, insulin hampers the crashing of adipose tissue by slowing intercellular activities. When the breakdown of fat in adipose tissue is inhibited, hydrolysis of triglycerides to release fatty acids is thwarted.

How diabetes type II affects glucose regulation mechanism

Diabetes type II significantly influences how the body cells normalize blood glucose levels. For instance, in diabetes type II patients, the body is incapable of standardizing the blood glucose levels since there is ineffective functioning between insulin and glucagon. In other words, the body resists insulin, which leads to higher glucose levels in the body and comparative insulin deficit. As a result, excessive insulin is released by the insulin-secreting tumor called insulinoma in the pancreas (Roper 77). The excess release of insulin can be hazardous life since there is a rapid drop in glucose blood levels leading to insulin shock in the brain due to starvation of energy. Additionally, high glucose in the blood cells has adverse effects on glucose metabolism ranging from hardening of arteries to hyperosmolar nonketotic diabetic coma.

Works Cited

Goldstein, Barry J. and Dirk Mueller-Wieland. Type 2 Diabetes: Principles and Practice. Boca Raton, FL: CRC Press, 2013. Print.

Roper, Marcia Ruth. Type 2 Diabetes: The Adrenal Gland Disease. Bloomington, IN: AuthorHouse, 2005. Print.

This paper aims at analyzing family genetic history of a family, evaluating the impact of the family history on an adult participant’s health and planning a future wellness change to promote the wellness of the family’s health both now and in the future.

Family genetic history form

The form below represents an analysis of a family diabetes mellitus type 2 genetic history.

Evaluation of family genetic history

Diabetes mellitus type 2 can be acquired genetically and can be explained through the study of family histories. The table above indicates a situation whereby both paternal grandparents had a health history of diabetes mellitus type 2 and hypertension and the maternal grandfather had diabetes mellitus type 2. When both parents have diabetes mellitus type 2, chances of children inheriting the disease are quite. This explains why the participant’s father and one of his brothers were diagnosed with diabetes mellitus 2 and hypertension. A family that is characterized by grandparents and parents having diabetes mellitus type 2 and hypertension has higher chances of passing it to the next generations.

Family cases that involve both parents having diabetes mellitus type 2, expose the children to a 50 percent risk of inheriting the disease. This case represents itself in the case of the participant’s father who inherited the disease from his parents who had the disease. The age of the onset of the disease parents also matters. In the cases where one of the parents become sick on or before the age of 50, off springs face a high risk of inheriting the condition. The participant is therefore at a high risk of inheriting diabetes mellitus type 2 from his father who became sick before the age of 50.

The environment of the family is also an influencing factor to the disease. This explains why obesity has been replicated in various generations. The family eating environment is characterized by dietary foods that make some members obese hence explaining why the participant has obesity health related issues that have been passed even to the participant’s children.

Planning for future wellness

To promote the wellness of the family now and in the future, diabetes mellitus type 2 is preventable through both natural and medical strategies. Natural methods can be acquired through a change of lifestyle that would encourage the maintenance of age-appropriate body weight through engaging in physical activity. This drives away the obesity condition. The observation of a nutritious diet characterized by low fats, regulated fats and more intakes of water, fluids and fruits is also a natural way of regulating the level of insulin and fat in the body. Medical strategies that include genetic tests at early ages to enable people to learn of their individual vulnerability so as to take necessary precautions can be employed by the participant. This should include the testing of children at early stages of life to know their vulnerability. Lastly, medication at early stages can prevent deaths caused by cardiovascular related disorders. The participant therefore needs to begin medication at an early stage to avoid death related cases as observed in the family history.

Abstract

Currently the increasing cases of diabetes in the US have become a major health issue. The essay below illustrates ways of managing the disease. This essay focuses on the approaches of reducing, diagnosing, and treating diabetes. The essay explores confirmed practice guidelines, clinical approaches, and algorithms that reveal the tasks of the diabetes care physicians in the primary care setting. In the primary care context, the management of the disease relies upon patient focused approaches and personalized care. To address the prevalence of diabetes, the government, members of the public, and the physicians must work together to find and implement appropriate measures to end the consequences of the diseases. Researchers assert that to achieve this, all stakeholders must look for ways that will ensure that we increase our physical activities and reduce the intake of high- energy foods.

Annotated Bibliography

Barnard, N. D., Katcher, H. I., Jenkins, D. J., Cohen, J., & Turner-McGrievy, G. (2009). Vegetarian and Vegan Diets In Type 2 Diabetes Management. Nutrition Reviews, 67(5), 255-263.

This article was published in Nutrition Reviews Journals in the year 2009. The article offers crucial benefits for controlling diabetes with the use of vegetarian and vegan diets (Barnard, Katcher, Jenkins, Cohen, & Turner-McGrievy, 2009). Based on the current findings, persons on vegetarian diets are less likely to be victims of diabetes weighed against non-vegetarians. Medical trials on type 2 diabetes have indicated that food with less-fat vegan diets augment glycemic management extensively compared with the usual diabetes diets. Despite the fact that this consequence is chiefly linked with bigger weight loss, experiments indicate that the reduction in consumption of saturated fats can be attained by consuming high-glycemic-index diets. Similarly, enhanced consumption of fiber and vegetable Protein, concentrated intramyocellular lipids, and reduced iron food arbitrates the impacts of plant-based foods on glycemia.

In the article, the accounted adequacy of vegetarian and vegan foods is analogous to other therapeutic treatments (Barnard e tal, 2009). The existing texts show that vegetarian and vegan diets offer possible benefits for the control of type 2 diabetes. Present dietary advances in the control of type 2 diabetes naturally advocates for a reduction of carbohydrate consumption, reduction in the consumption of fatty foods, and reduction of energy intake among obese persons. As suggested in the other references, these instructions are personalized in accordance with medical situations, ways of life, and food preferences. On the other hand, proofs from observational and medical analysis indicate that plant-based foods give precise advantages. In general, all stakeholders must look for ways that will ensure that we increase our physical activities and reduce the intake of high- energy foods.

The only limitation with this article is that it overemphasizes only on the use of vegetarian diets as a means of managing diabetes. I believe that the disease can be appropriately managed through a combination of therapies.

Dipnarine, K., & Stopka, C. (2013). Centers for Disease Control and Prevention. Web.

Centers for Disease Control and Prevention is an advanced article meant for clinical medics, students, and the people with diabetes. In the primary care context, the management of the disease is based upon patient focused approaches and personalized care. In the article, the author discusses about ADA and IDF screening algorithms used in enhancing faster determinations, the most recent therapies available in the market, patients’ queries, and an analysis on the connection between overweight, sleep disorder, and the disease.

The article highlights on ways of managing diabetes based on proofed approaches. In the introductory part of the article, the author focuses on the disease definition and its causes. As the article progresses, the author highlights on all feature of outpatient care for grownups and teenagers with the disease. Through this, the author illustrates the current curative, behavioral, and surgical alternatives to effective management of patients with the disease in the primary care setting.

One of the articles’ limitations is that the author provided a general knowledge on how to manage diabetes. Dipnarine covers all topics related to diabetes. He does not only focus on the cultural diversity, but also the adjustment of insulin in patients under chemotherapy. In every paragraph, readers are provided with the general means of patient centered care. I believe that it would have been appropriate if the author could have comprehensively covered on a particular approach of managing the disease. This implies that the article cannot be relied on in totality by the medics. As such, professionals should be consulted before administering any therapy approach mentioned in the article. Despite these limitations, I believe that the article is still one of the most inclusive reviews of diabetes. However, the article would not be helpful until readers understand the concepts highlighted in the article. I believe that by studying this article, readers will be able to slow down the explosive progression of diabetes.

Fukunaga, L., Uehara, D., & Tom, T. (2011). Abstract. National Center for Biotechnology Information. Web.

This article focuses on the support requirements and difficulties to effective disease management among working grownups in Hawaii. The study was undertaken with the help of 74 participants. Over the years, researches have been conducted on the quality diabetes care. The results indicate that the existing measures aimed at managing diabetes such as neurological examinations, blood pressure management, smoking cessation, and patient education have not yielded impressive results to suggest that the diabetes care has improved. To determine the factors that have slowed down the development towards improved care among the working class, the author of this article examines the perceptions of a number of working adults in Hawaii.

The article tackles barriers related to disease management with respect to The International Diabetes Center Program. The program champions for the management of the disease as indicated in its mission statement. This methodical treatment agenda comprises of realistic resolutions to the diagnostic and treatment of the disease. Similarly, the program comprises the disease impediments and metabolic syndrome in adults. This is achieved by use of evidence-based medicine.

The article later identified a number of barriers to disease management. These barriers included added health issues, social bigotry, and absence of social support. This implies that the public need to be informed on the issues related with the disease. Through this, the article offers evidence-based approach for medical decision-making, reliable scientifically based practice, ideal criteria for initiating altering therapy, and fostered a patient approach used in the management of the disease.

Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic Crises in Adult Patients with Diabetes. Diabetes Care, 32(7), 1335-1343.

This advanced article was published on Diabetes Care Journal. The article investigates clinical presentation of severe diabetic crises among adults. These emergencies include the ketoacidosis, hyperosmolar coma, and chronic hyperactive and hypoglycemia. Medics usually encounter these emergencies on their regular practice. The article analyses the top ways of managing these situations and overseeing follow-up guidance and treatment. Numerous researches have been conducted on diabetes mellitus. The article asserts that researchers have found that diabetic management might not be effective if the disease is not appropriately managed during the pre-operative, peri-operative, and post-operative period. The same results indicate that acute decompensation of diabetic control can a times result in fatal attacks if not well managed. In this regard, this article was produced to benefit the doctors, nurses, and other medics because it was realized that all physicians have an obligation to understand ways of diagnosing and addressing such situations.

The article supports my thesis in that it focuses on diabetes management. Through this, it illustrates that the management of the disease should be boosted by enhancing its understanding among the medics. All through the article, the authors emphasizes on description of emergency, epidemiology, possible causes, diagnosis, and medical management.

In the article, the authors substantiate their findings with a number of website content. Based on the fact the numerous sources are unreliable, I feel that the authors’ findings should be applied with caution. In this regard, it is advisable for readers to consult with medical professionals before administering any findings highlighted in the article.

Tidy, D. C. (2013). Patient.co.uk – Trusted medical information and support. Web.

The United Kingdom physicians using the findings from European Guidelines’ researchers produced this article. The article is meant for health professionals and people with diabetes. In the article, the authors assert that all treatments should be focused on lessening signs and reducing the threats of long-term complications. The author asserts that to control the disease the most favorable management of glucose and other cardiovascular risk factors should be affected. These factors include controlling smoking, inactive lifestyle, high blood pressure, dyslipidaemia, and corpulence. The author asserts that to control of type two- diabetes should be customized to meet every patient’s needs and conditions. As such, the usefulness of strict glucose control should be evaluated against any possible difficulties like the recurring hypoglycemia.

For effective diabetes management, the author highlighted on patient education, initial illness assessment, dietary advice, and referral. With respect to patient education, the patients should be able to access planned information about the disease. Equally, the authors assert that through initial assessment and monitoring, the patients, height, weights, waist circumference, smoking status, and glucose control should be assessed. Concerning dietary advice, the author suggests that the patients should be provided with personalized and continuing nutritional counsel from a health care expert with exact knowledge and experience in nutrition.

Unlike the other references, this article is very simple and concise. In this regard, I believe the article can be of more useful to a larger audience than the other articles. Similarly, based on its brevity, it can be argued that most readers will appreciate the article. However, it should be noted that the information provided in the article are in their summary form. Therefore, readers should consult other professionals for their clarification.