Category: Diabetes

Introduction

In the United States of America, diabetes is a major health issue that affects many people. According to CDC s’ statistics, more than 25.8 million Americans had diabetes in 2010 (Centres for Disease Control and Prevention, 2014). This number represented 8.3% of the country’s population (Centres for Disease Control and Prevention, 2014). The prevalence and health effects of diabetes are different for various age groups. The state governments are addressing the situation because of its negative economic effects. In 2007, the government estimated that the economic cost of diabetes was approximately $174 billion (Centres for Disease Control and Prevention, 2014). $116 billion of this amount accounted for medical costs while $58 billion accounted for indirect costs related to effects of diabetes such as absence from work (Centres for Disease Control and Prevention, 2014). Several approaches are applied in the reduction, diagnosis, and treatment of diabetes. Treatment of diabetes in primary care is based on patient-focused approaches and personalized care. Individuals are encouraged to participate in physical exercise and reduce their intake of high-calorie foods.

Diabetes among adults (people above 20 years of age)

According to statistics from the Centers for Disease Control and Prevention (CDC), the rate of diabetes prevalence is higher among people above the age of 20 years than among people below 20 years. According to statistics, more than 25.6 million Americans have diabetes. This number accounts for 11.3% of the population (Centres for Disease Control and Prevention, 2014). Among older people (adults over the age of 65 years), prevalence is higher. More than 10.9 million people have diabetes. This accounts for 10.9% of the population. Diabetes leads to the development of illnesses that affect the vigor and day-to-day activities of patients (Centres for Disease Control and Prevention, 2014). Complications associated with diabetes in adults include heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system disease, and amputation. In 2007, statistics revealed that diabetes caused 71,382 deaths (Centres for Disease Control and Prevention, 2014).

Literature review

Diabetes management measures and approaches include controlled diets, patient education, awareness to influence patients’ perceptions, and participation in physical activities as well as self-management. According to Barnard, Katcher, Jenkins, Cohen, & Turner-McGrievy (2009), vegan and vegetarian diets are effective in the management of type 2 diabetes. These diets control the amount of plasma glucose concentration in the body because they contain high fiber content, zero cholesterol, and small amounts of saturated fat. The Chronic Care Model (CCM) has been effectively used in the management of diabetes. According to Stelfson, Dipnarine, & Stopka (2013), CCM has two main goals. It aims to equip patients with self-management skills and monitor their progress in order to ensure steady progress toward the improvement of health outcomes. Factors that affect effective management of diabetes include patients’ perceptions, financial constraints, lack of awareness regarding management approaches, and physical limitations that prevent patients from engaging in physical activities. According to Fukunaga, Uehara, & Tom (2011), it is important for patients to develop positive perceptions in order to benefit from diabetes management approaches. Treating complications that emanate from diabetes is also important. According to Kitabchi, Umpierrez, Miles, & Fisher (2009), two major metabolic complications experienced among diabetic patients include a hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA). Treating these complications aids in the management of diabetes. Teaching patients about diabetes is important for effective management (Tidy, 2014). Patients need to know about the importance of physical exercise, lifestyle changes, and regular monitoring of blood pressure well as glucose levels. Moreover, nurses should teach patients about the importance of the cessation of habits such as smoking.

Management measures

Vegan and vegetarian diets in glycemic control

Diet regulation is one of the most effective measures used to manage diabetes. According to Barnard et. al (2009), vegetarian and vegan diets are effective in the management of diabetes particularly type 2 diabetes. According to a study on the effect of vegan diets on diabetes management, the prevalence of type 2 diabetes is lower among individuals who followed vegetarian diets than among individuals who did not follow vegetarian diets. On the other hand, the study revealed that low-fat vegan diets are more effective than conventional diabetes diets in glycemic control among diabetic individuals (Barnard et. al, 2009). Vegan and vegetarian diets manage diabetes by controlling the amount of plasma glucose concentration in the body. High concentration of plasma glucose results in microvascular complications like neuropathy and nephropathy (Barnard et. al, 2009). Vegan and vegetarian diets have high fiber content, zero cholesterol, and low quantities of saturated fat.

Fiber makes individuals feel full and thus helps them to reduce the amount of food they consume. Intake of vegan foods with high fiber content helps in lowering the level of blood glucose (Barnard et. al, 2009). Patients with type 2 diabetes usually succumb to death because of macrovascular complications. Timely management of diabetes prevents the development of complications that worsen the health of patients and in some cases cause death. Consumption of diets with low quantities of saturated fat, high amounts of vegetable protein, low amounts of iron, and concentrated intramyocellular lipids aids in glycemic control (Barnard et. al, 2009). Glycemic control lowers the risk of developing vascular complications (Barnard et.al, 2009). Common metabolic complications experienced among diabetic patients include a hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) (Kitabchi et. al, 2009). The main signs of DKA include metabolic acidosis and uncontrolled glycemia. On the other hand, HHS’s symptoms include uncontrolled glycemia and dehydration. DKA and HHS are treated by body hydration, maintenance of electrolyte balance, and patient monitoring (Kitabchi et. al, 2009). Other treatment remedies include fluid therapy, insulin therapy, bicarbonate therapy, phosphate as well as potassium replacement.

Chronic Care Model

One of the approaches applied in the management of diabetes is the Chronic Care Model (CCM). It is applied in primary care settings. The model promotes evidence-based changes in the health care system in order to cater to the needs of diabetics. The main aim of the model is to facilitate the availability of health information through community-based initiatives. CCM has two main goals. First, to equip patients with self-management skills, and second, to monitor the progress of patients to enhance the attainment of positive health outcomes (Dipnarine et. al, 2013). This is achieved by restructuring medical care and giving patients the freedom to develop personal plans for diabetes management. CCM comprises six major components. They include patient empowerment through learning, organization of health care, professional support, coordination of care processes, monitoring patient progress, and improvement and application of community resources as well as policies (Dipnarine et. al, 2013). According to the model, self-management education (DSME) is effective in improving the psychosocial and clinical outcomes of diabetic individuals.

Nurses teach individuals about important topics like compliance to medication plans, foot care, setting goals, and ways of interpreting laboratory results (Dipnarine et. al, 2013). In self-management support, clinicians make follow-up calls in order to determine whether patients progress in achieving their goals. Self-management practices include personal care, physical exercise, and regulation of metabolic process through measurement of blood pressure and levels of glucose in the body (Dipnarine et. al, 2013). One of the most important aspects of self-management support is effective communication. Effective communication between patients and nurses gives assurance that medical help is readily available when needed. The CCM approach integrates personal management practices and professional care. It gives patients the freedom to develop and implement personal plans of management with the help of nurses and medical professionals. In the CCM approach, the role of the nurse is to facilitate patient learning and empowerment, provide guidance to patients with regard to effective ways of implementing evidence-based care, track patients’ progress, and coordinate care processes to guarantee the attainment of desired health outcomes (Dipnarine et. al, 2013). In addition, nurses provide support services such as foot and medical examinations for patients who are at risk of developing complications due to errors in the implementation of the personal management program.

Perception and barriers to diabetes management

A factor that affects effective management of diabetes is the patient’s perception, which can be either positive or negative. The perception of diabetes among adults determines the effectiveness of self-management approaches and community-based initiatives. For instance, a study conducted on 198 Hawaiian adults revealed that many of them felt that diabetes was a hindrance to productive lives because of its negative effects on their lives. The study involved assignment of participants to treatment and focus groups. Each focus group comprised an average of 1 to 7 participants between the ages of 18 and 65. According to participants, the burden of controlling diet, maintaining recommended blood sugar levels and changing certain eating habits affected the quality of their lives. These were the negative effects of diabetes. On the other hand, other adults argued that diabetes had positive impacts on their lives because it made them make healthy food choices and implement lifestyle changes (Fukunaga et. al, 2011). Participants perceived diabetes as a dangerous disease that mainly led to complications such as blindness and amputations.

These perceptions were mainly based on the experiences of family members. Many participants talked about their fear of such complications. However, they did not participate in diabetes management activities. Insufficient understanding of diabetes, as well as negative emotional effects and psychological barriers, are major causes of poor management of diabetes among adults (Fukunaga et. al, 2011). The study also found out that another barrier to effective management of diabetes is health-related factors. For instance, some patients had physical conditions that prevented them from taking part in physical exercise. In addition, side effects of medication and related complications were hindrances to the physical activities of patients (Fukunaga et. al, 2011). Other hindrances to effective management of diabetes include financial challenges, psychological barriers, and time limitations. In order to improve the management of diabetes, it is important to educate patients on effective management practices. The role of nurses is to provide psychological care to patients, social and emotional support, and promote public awareness and education (Fukunaga et. al, 2011). Nurses should provide the support that caters to the physical, emotional, and social needs of patients. The study revealed that many patients were unaware of available methods with regard to diabetes management. Nurses should educate patients and emphasize the efficacy of active prevention methods (Fukunaga et. al, 2011).

Patient education

Patient education is an important aspect of improving diabetes management. According to Tidy (2014), teaching patients about diabetes is imperative for effective management. In the United Kingdom, the government developed two programs namely X-PERT and Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) in order to teach patients how to make lifestyle changes and develop healthy habits (Tidy, 2014). According to studies, many education and self-management programs are not effective. They only help patients to change their beliefs about diabetes. Patient education involves offering dietary advice to patients, encouraging them to engage in physical exercise, teaching them about the benefits of lifestyle changes as well as the importance of early diagnosis (Tidy, 2014). Initial assessment and monitoring of patients are very important. The role of nurses in patient education is to guide patients with regard to healthy lifestyle behaviors and teach them about various complications related to diabetes and ways of avoiding them. In addition, they aid patients in making important decisions that affect their health. Blood pressure management, regulation of blood lipids, eye screening, and monitoring for kidney damage are examples of activities that nurses carry out on patients in order to enhance the management of diabetes (Tidy, 2014). Other aspects of diabetes management include timely illness assessment, referrals, and dietary advice.

Conclusion

Diabetes is a serious illness in the United States. Its prevalence among adults is very high. Statistics reveal that in 2010, more than 25.8 million Americans had diabetes. This number represented 8.3% of the country’s population. Among older people (people over the age of 65 years), the prevalence of diabetes is higher. In this age group, more than 10.9 million people were diagnosed with diabetes in 2010. This number accounted for 10.9% of the population. Effective measures of diabetes management include dietary control, patient education, and physical exercise. Vegan diets have high fiber content, zero cholesterol, and low quantities of saturated fat. Fiber makes individuals feel full and thus helps them reduce the amount of food they consume. Patient education involves offering dietary advice to patients, encouraging them to engage in physical exercise, and teaching them about the benefits of lifestyle changes as well as early diagnosis. Insufficient understanding of diabetes, as well as negative emotional effects and psychological barriers, are major causes of poor management of diabetes among adults.

References

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.

Centres for Disease Control and Prevention: Diabetes Research and Statistics (2014). Web.

Dipnarine, K., & Stopka, C., & Stellefson, M. (2013). The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review. Web.

Fukunaga, L., Uehara, D., & Tom, T. (2011, February 15). Perceptions of Diabetes, Barriers to Disease Management and Service Needs: A Focus Group Study of Working Adults with Diabetes in Hawaii. Preventing Chronic Disease, 8(2), 32-46.

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.

Tidy, D. C. (2013). Management of Type 2 Diabetes.Web.

Nursing Process

The quality of inpatient care for diabetes type II remains one of the major obstacles facing caregivers and nurses. Healthcare facilities “readmit many patients with diabetes a few days after they are discharged” (Pandya & Nathanson, 2009, p. 4). This has become a common challenge for individuals with diabetes type II. This situation has worsened because society gives little attention to the needs of diabetic persons (Healy, Black, Harris, Lorenz, & Dungan, 2013). Patients with “poorly controlled diabetes should be readmitted in hospitals and healthcare facilities” (Pandya & Nathanson, 2009, p. 3). According to Purdy (2010), readmission increases the costs incurred to provide quality health services. Society should support education, awareness, and home health nursing to help people manage diabetes.

Intervention, Implementation, and Evaluation

Readmission is a major challenge facing different socio-cultural groups in the United States. Re-hospitalization is also common among the elderly. The practice is also common in every disadvantaged neighborhood (Stone & Hoffman, 2010). Community workers and caregivers should address these social inequalities in order to address the needs of every group (Hines, Yu, & Randall, 2010). The workers should also focus on the health needs of re-hospitalized patients. Nurses should educate their patients about the best practices towards managing diabetes type II.

Healthcare institutions and medical homes should provide the best education to diabetic patients. The use of education and awareness can help individuals suffering from diabetes type II (Silow-Carroll, Edwards & Lasjbrook, 2011). The use of continued awareness and educational programs is sustainable. The practice will equip more patients with the best ideas and initiatives to deal with diabetes. Different societies have embraced the importance of educational programs and awareness campaigns for patients with diabetes. According to Martin and Lipman (2013), education and awareness can help diabetic patients manage their health conditions without readmission. Inpatient diabetes control and management programs should use the best concepts in order to empower every patient. According to Stone and Hoffman (2010), nursing education can result in better health outcomes among the targeted patients. The practice will reduce the number of re-hospitalized patients.

Homecare nursing can also offer appropriate solutions to patients with diabetes type II. The involvement of various medical practitioners and specialists can significantly reduce the chances of re-hospitalization. Homecare nursing helps diabetic patients receive the best medical support. Kirkman et al. (2012) observed that continued homecare nursing empowers and motivates every patient. The practice helps the patient embrace the best health practices. The individuals receive the best incentives and support in order to manage their conditions. Many scholars and researchers encourage every patient to be part of these practices (Aalaa et al., 2012). This situation explains why the number of home care nursing centers is on the rise in the United States and across the globe.

Study Approach

This study seeks to examine how nursing homes and outpatient organizations can address the problem of re-hospitalization for diabetic patients. The study will identify how continuous education and awareness can address the problems associated with diabetes. The study will present the best evaluation plan to ascertain whether these practices can help people with diabetes type II. I will use Martha Rogers’ nursing theory because it offers the best solutions for diabetic patients. According to Rogers, health does not necessarily mean the absence of diseases in the body (Benbow, 2009). The theory treats every human being as an essential part of the universe (Martin & Lipman, 2013). Nursing should examine the relationship between human beings and their surrounding environments. Martha Rogers’ theory can help nurses and caregivers provide the best ideas to individuals with diabetes. According to Martha’s nursing theory, nursing is both an art and science. Benbow (2009) explains how every patient can benefit from disease self-management practices. The practice will reduce the rate of readmission. Increased education opportunities for patients with diabetes type II will significantly minimize the risk of readmission. The completed study will provide the best practices and evidence-based ideas to help patients with diabetes type II.

Annotated Bibliography

Aalaa, M., Malazy, T., Sanjari, M., Peimani, M. & Mohajeri-Tehrani, M. (2012). Nurses’ role in diabetic foot prevention and care; review. Journal of Diabetes & Metabolic Disorders, 11(24), 2-6.

According to the authors, diabetes is one of the diseases receiving much attention within the wider healthcare system. Diabetes type II is common in every society. The article explains why disease management should start as early as possible. Nurses should be ready to detect the disease at its earliest stage. The approach will make it easier to provide the best education to the targeted patients. This practice will improve the health outcomes of the targeted patients and reduce the rate of re-hospitalization.

Benbow, D. (2009). Heart Failure: Educating Your Patient Can Help Prevent Readmission. Nursing Management, 40(9), 5-7.

The article supports patient education because it is the best tool to reduce the rate of readmission. Nurses and caregivers should deliver evidence-based, reliable, and timely care for diabetic patients. The first approach towards achieving this goal is by using the best nurse educators and caregivers. The practice can help many patients with various diseases. The approach will also decrease the level of hospital readmission. Nurses should educate their patients before discharging them. The practice will equip them with the best skills and ideas to manage their conditions and eventually reduce the rate of re-hospitalization.

Healy, S., Black, D., Harris, C., Lorenz, A., & Dungan, K. (2013). Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control. Diabetes Care, 1(1), 1-8.

The authors conducted this study to analyze the relationship between hospital readmissions and inpatient diabetes education (IDE). Formal IDE plays a significant role in managing diabetes type II. The practice was also associated with reduced frequency of all hospital re-hospitalization within one month. Some of the basic skills include injection of insulin and proper dietary practices. The authors support education and awareness as the best tools to equip patients (and their guardians) with the best ideas to manage diabetes type II. The practice will also reduce the chances of re-hospitalization.

Hines, P., Yu, K., & Randall, M. (2010). Preventing Heart Failure Readmissions: Is Your Organization Prepared? Nursing Economics, 28(2), 74-85.

The article explains why many organizations and hospitals are working hard to improve inpatient outcomes and performance in cardiovascular support. The authors support the implementation of new programs in order to manage different complications such as heart failure and diabetes. The current rate of readmission is associated with increased costs and the provision of poor healthcare support. The article explains why every hospital and healthcare organization should execute appropriate strategies and education programs in order to reduce the number of readmitted patients. The practice will make it easier for individuals suffering from certain terminal diseases and diabetes to manage their conditions successfully.

Kirkman, S., Briscoe, V., Clark, N., Florez, H., Haas, L., Halter, J., Huang, E., Korytkowski, M., Munshi, M., Odegard, P., Pratley, R., & Swift, C. (2012). Diabetes in Older Adults: A Consensus Report. Journal of the American Geriatrics Society, 10(1), 1-15.

The authors examine the importance of evidence-based research and practice to treat diabetes in senior citizens. The article supports the use of continued awareness and individualized treatment regimes for the elderly. Such recommendations are applicable in homecare centers and hospitals. This practice is relevant because many people in the country are suffering from different chronic diseases. This explains why caregivers should focus on the health needs of the group. Such recommendations are critical towards dealing with diabetes type II.

Martin, A., & Lipman, R. (2013). The Future of Diabetes Education: Expanded Opportunities and Roles for Diabetes Educators. The Diabetes Educator, 39(1), 436-446.

The article explores the opportunities and challenges associated with diabetes awareness and education. The authors wanted to understand the need for more diabetes educators. The practice will increase their roles in the management of different diseases such as diabetes. The authors encourage nurses to address every obstacle limiting continued diabetes education in order to support the targeted population. The authors also encourage diabetes educators to use evidence-based practices in order to acquire the best competencies and skills.

Pandya, N., & Nathanson, E. (2009). Managing Diabetes in Long-Term Care Facilities: Benefits of Switching from Human Insulin to Insulin Analogs. American Medical Directors Association, 10(1), 1-8.

Long-term care (LTC) facilities for patients with diabetes should focus on the health conditions of every person. The main requirement is to ensure the individuals receive individualized care. This explains why nurses and caregivers in LTC facilities should avoid not using the established medical guidelines because they target the general population. Every caregiver should promote the concept of insulin analogs in order to improve the health conditions of his or her patients. The use of awareness programs and homecare practices will reduce the costs associated with re-hospitalization.

Purdy, S. (2010). Avoiding Hospital Admissions: What does the research evidence say? The Kings Fund, 1(1), 1-28.

Purdy believes every emergency admission (and readmission) is preventable. This has become a major concern for every hospital and healthcare organization. The author goes further to explain how the best practices will help patients get the best medical support. The article offers some of the best practices such as the provision of proper care, continued patient education, and focus on individuals from marginalized societies and communities. The study findings also support diabetes self-management because it reduces the complications associated with diabetes. This will also reduce the rate of re-hospitalization.

Silow-Carroll, S., Edwards, J., & Lasjbrook, A. (2011). Reducing Hospital Readmissions: Lessons from Top-Performing Hospitals. The Commonwealth Fund, 5(1), 1-19.

This article gives a new dimension to the issue of hospital readmission and diabetes education. The authors begin the article by explaining why hospitals should be on the frontline to reduce the rate of re-hospitalization for patients with diabetes and other chronic diseases. Every healthcare organization should invest in patient education and quality improvement practices. It is appropriate for every hospital to use modern practices and evidence-based nursing strategies to manage diabetes. This practice will empower more patients and eventually reduce the rate of readmission.

Stone, J., & Hoffman, G. (2010). Medicare Hospital Readmissions: Issues, Policy Options, and PPACA. Congressional Research Service, 7(1), 1-37.

The government can reduce Medicare spending by minimizing hospital readmissions in the United States. As well, the practice will ensure patients get quality services from disease educators and community workers. Nurses and caregivers can improve the current situation by providing adequate information to patients, post-acute caregivers, and disease educators. The practice will ensure every diabetic patient complies with the best disease management practices. The approach will improve the patient’s health conditions and reduce the rate of readmission.

Introduction

Written by Andrew Long and Tina Gambling, the article Enhancing Health Literacy and Behavioral change within a Tele-care Education and Support Intervention for People with Type 2 Diabetes is a must-read research that strategically presents the best ways of enhancing health literacy and behavioral change within a tele-care education. It investigates the supportive interventions that are done for people diagnosed with type 2 diabetes. The study’s main goal is to find out the level of confidence of people with “type 2 diabetes, as well as the in depth changes in diabetes related knowledge” (Long & Tina, 2011, p. 261). Two professionals, Andrew Long, a professor in the school of heath care in the University of Leeds, and Tina Gambling, senior lecturer in the school of health care studies from the University of Cardiff, conducted the research, which was published in March 2011 after meeting the accepted quality and standards of a research paper. The research findings have assisted in great depth to enlighten various peoples on the issues pertaining to chronic diseases, specifically diabetes type 2.

Methodology used for research

Methodology refers to the steps of actions that the researcher undertook to gather data for analysis and interpretation. Methodology that is selected depends on the nature of the study and the required information. Various researchers employ different methodologies in their studies to ensure that they achieve their goals. In this research, the researcher adopted a two-year prospective observational study design. In this method, the researcher used questionnaires to collect information from a sampled audience. Data was collected in two phases. At the initial stage of conducting the research, and after duration of two years. Furthermore, in-depth interviews were used with a subsample. In the questionnaires, the questions were centered on the acceptability of various aspects of the proactive call centers’ treatment support. They consisted of 20 statements where every statement was scored on a five-point scale. Two questions were open-ended questions and they asked about any changes they experienced after they were exposed to advice and support services. It further asked on how they perceived about the controls measures in place. In the next phase of data collection, questions were modified. They contained four open-ended questions that covered three most important issues including treatment support centre, feelings of control, and whether PACCTS could be recommended to others and lastly on the relationship that existed between them and the tele-carers. These questionnaires further included eighteen diabetes empowered scale and two other confidential statements that were all scored on a five-scale point. The questionnaires also included background information about the age, level of glycaemic control, and gender among other important information. In-depth interviews were also used in collection of information that helped in analyzing and determining the findings. A sample of 25 patients was taken from interviewees. They were categorized into four groups based on the pre and post randomized control trial HbA1c results. Some patients control was either good or poor or had deteriorated. The number of women and men included in the interview was the same. Therefore, there was gender balance. The same patients were re-interviewed in the second interview after two years. It sort to know or identify what the participants had learnt on decision making concerning self-care and on the elements of interventions that were most appropriate and helpful besides the ones that they would wish to change. The researcher administered the interviews at the university. Some were carried out in the patient’s home. The expenses incurred in traveling to meet these patients were cleared by the university. Some of the information was tape-recorded though with the permission from the interviewee. In general, these two designs were appropriate since they suited the type of the research. The research was descriptive. Therefore, enough information was gathered for the target audience.

Summary of Findings

In any research, findings form an essential component that makes the research a success or a failure. They are important to both the researcher and the target audience and even to other stakeholders. In this case, findings are important to the two researchers because they will help them to widen their scope of knowledge in the area besides helping the patients who were interviewed to adapt good behaviors in order to enhance their health. Stakeholders such as health practitioners and the government are also important and crucial components because they will be affected by the information in one way or another. In this study, it was revealed that approximately 90 percent of the patients or interviewees had confidence in their inputs of keeping their blood sugar controlled. They had recorded high levels of perceived empowerment. Furthermore, most of the respondents recorded improved levels of competence in translation of knowledge into practice. Furthermore, there were some “changes in the depth of diabetes knowledge and confidence from one specific area to general knowledge” (Long & Tina, 2011, p. 269). Participants in this research had a median age of 67 years. They had experienced or suffered from diabetes for a median of six and a half years. Among the total respondents, two fifth were women. Suffering from diabetes among the participants did not depend on differences in gender, age or length of time.

On sustainability, knowledge, confidence, and empowerment issues, most of the participants said that they undertook the advice they were given by tele-carers. Therefore, they felt knowledgeable about diabetes in general and how it affected them. For instance, 99 percent had gained knowledge, 97 percent felt that they were knowledgeable about issues to do with diabetes, and 96 percent consented that they were in total control of their diabetes (Long & Tina, 2011, p. 271). Most of the respondents were keen on their blood sugar in their body. Therefore, they vowed to ensure that the level was maintained to the required levels to allow them live well and enjoy their different lifestyles. There were high scores on the participants’ self-perceptions on empowerment. They felt that the training made them know themselves better. Therefore, they were empowered thus looking upon themselves as conquerors and not losers. When it comes to relationship with the tele-carers, most respondents were satisfied with the kind of treatments they were provided. The relationship was mutual. Friendliness was evidenced through their conversations and interactions. The respondents were contended with the way they were treated. They were engaged in decision making and support, which made them feel appreciated and valued. For instance, the conversations were based on respect as the carers respected the time of their patients thus adjusting appropriately to their programs. They also listened keenly besides allowing them an opportunity to ask questions and or seek clarification on various aspects that they did not understand better.

The findings on the changes on the nature of behavioral and health literacy revealed that most of the patients changed their attitude and behavior when they were spoken to by the tele-carers. They were very much elevated after having been equipped with skills and knowledge that made their lives better. They learned various issues concerning health. This knowledge uplifted their life more. Most of the respondents had changed their specific self-behaviors across some of their lifestyles. They took upon their own initiatives in ensuring that they remained in good health standards by always checking their blood glucose levels, doing exercises, seeking mediation, and self-managing their diets. They therefore understood their illness and knew how to take good care of themselves. Self agency also increased among the participant as they were motivated and more confident about measures to control their illness, as well as how to prevent any complications from happening besides knowing where to get immediate health care when in need.

Conclusion and Personal Reflection

It is imperative that researchers addressing possible knowledge deficits to tailor their context-driven advice by making it relevant to the socio-economic status of the participants. In this study, even though participants were selected based on the level of blood sugar control, they had different levels of knowledge about diabetes. However, after the training, they learned and appreciated new skills and knowledge, which made them change their attitude and behaviors. The training enabled them develop personal skills that made them have self-agency and self-control hence undertaking upon themselves the responsibility of maintaining their health. Therefore, patients are very crucial in managing the translation of knowledge. They should be willing to change their behaviors. Therefore, there is still need for more research to be conducted on youths and younger generations to find out how they would respond to such trainings. This group of audience may also suffer from type 2 diabetes. Therefore, salient measures should be done to find out the prevalent, the behavior change, and the literacy level for amicable solution. The research has successfully managed to elicit various findings that are very important in the future researchers. Therefore, such information and findings can be relied upon in the future by other researchers interested in the areas of study.

Reference

Long, A., & Tina, G. (2011). Enhancing health literacy and behavioral change within a tele-care education and support intervention for people with type 2 diabetes. London: Blackwell Publishing Ltd Health Expectations.

Research Performed

This article describes a meta-analysis of three clinical trials that were performed over 30-weeks and controlled using a placebo (Bond, 2006). This study reviews the outcomes of using exenatide as an adjunct to first-line medication including sulfonylurea and/or metformin, for treatment of type II diabetes mellitus in adults.

Metmorfin vs. Exenatide

The first study evaluated the effects of using exenatide as an adjunct to metformin (DeFronzo, Ratner, Han, Kim, Fineman, & Baron, 2005). The study, which adopted a triple-blind design, used four treatment arms. These treatment arms included two placebo arms of metformin monotherapy, metformin combined with a 5 mcg dose of exenatide bid; and metformin with a 10 mcg dose of exenatide bid (5 mcg dose increased to 10 mcg dose subsequent to the first 4-weeks of the study). The subjects did not all maintain to the end as several withdrew from the study. The researchers used hemoglobin A_1c as a variable for measuring glycemic control and safety associated with the use of the new intervention (Bond, 2006).

The finding of the study was positive for the two arms that applied exenatide as an adjunct to metformin. The arms that used a 10 mcg dose of exenatide indicated a greater reduction in glycemic activity and body weight of the subjects than that which used a 5 mcg dose (Bond, 2006).

Sulfonylurea vs. Exenatide

The second study evaluated the outcome of using sulfonylurea monotherapy and sulfonylurea with exenatide as an adjunct (Buse, Henry, Han, Kim, Fineman, & Baron, 2004). This study adopted a triple-blind design in which the effects of the adjunct were controlled using a placebo. The researchers standardized therapy by putting all patients into a placebo lead-in over a period of four weeks. The subjects were on different kinds of drugs of the sulfonylurea group.

Similar to the study by DeFronzo et al. (2005), the authors studied four arms of treatment, including sulfonylurea uncombined (two arms), sulfonylurea with the adjunct 5 mcg dose bid, and sulfonylurea with the adjunct 10 mcg dose bid (5 mcg dose increased to 10 mcg dose at the start of the fifth study-week). At the end of the 30-week study period, fewer subjects completed the study than there were at the initiation of the study; however, the withdrawal rates did not have significant effects on the outcome.

The two exenatide arms indicated a reduction in HbA_1c at P < 0.001. However, the percentage reduction in glycemic activity differed. The 10 mcg dose arm indicated a greater reduction of HbA_1c and weight than the 5 mcg dose arm (Buse et al., 2004).

Metformin Combined with Sulfonylurea vs. Exenatide

Bond (2006) performed a systematic review of a study by Kendall et al. (2005). Kendal et al. (2005) analyzed the effects of exenatide as an adjunct to a combination of metformin and sulfonylurea against the combination of the same drugs without the adjunct (exenatide). The study adopted a randomized, double-blind design that was controlled using a placebo. Like the mentioned two studies, this study used glycemic control represented by HbA_1c and safety as dependent variables for the outcomes of the new intervention.

The authors studied four arms of the treatment. One arm included a combination of metformin and sulfonylurea with placebo (two arms). A third arm involved metformin, sulfonylurea and the adjunct at 5 mcg dose bid. A fourth arm involved metformin, sulfonylurea and the adjunct 10 mcg dose bid (5 mcg dose was increased to 10 mcg dose in the subsequent weeks after the first 4 weeks). Like the mentioned two studies, some subjects withdrew from the study as of the end of the 30-weeks of study; although, the effects of the withdrawal were not statistically significant in all of the arms.

The authors observed reductions in HbA_1c and weight for the two exenatide arms, although the difference in the reductions of HbA_1c between the two arms was smaller than when metformin and sulfonylurea were used separately. In fact, the two arms indicated the same change in weight of –1.6 ±0.2 kg relative to the arm with a placebo of –0.9 ±0.2 kg, after the 30-week period.

Clinical Findings and Significance to Nursing Practice

Contraindications and Adverse Effects

Exenatide has numerous events for which it is contraindicated. This situation means that nurses must have full knowledge of the contraindications to ensure the safety of type II diabetic Mellitus patients. In the same line, they must ensure that they have full knowledge of every patient’s medical history with which they get involved. In addition, they must maintain and pass an accurate medical history of their diabetic patients between shifts to ensure patient safety.

Exenatide application was associated with mild or moderate side effects, with nausea as the most common of all the effects. Nevertheless, the severity of nausea was reduced with progressive administration and was dependent on dose. In this vein, nurses should be equipped with interventions for managing side effects of exenatide to correct nausea, vomiting and diarrhea in diabetic patients using exenatide in adjunct treatment of type 2 diabetes mellitus. Because exenatide does not cause hypoglycemia when used in the treatment of type II diabetes mellitus (Bond, 2006), nurses should use it as a choice drug in preference over insulin.

Dosing, Administration and Drug Interaction

The proposed initial dose for the use of adjunct in the treatment of diabetes mellitus type II is 5 mcg for every dose given subcutaneously bid, an hour prior to breakfast and dinner. However, a nurse may increase the dose to 10 mcg bid after one month if the effect of the first dose is insignificant. The sites of administration include the upper arm, thigh, and abdomen (Bond, 2006). Depending on the first-line agents used, the nurses must know when the dose adjustment of the adjunct is appropriate and when it is not.

Exenatide influences the bioavailability of oral medications by reducing the rate of gastric emptying. Therefore, nurses must be cautious to administer oral drugs whose bioavailability depends on gastric emptying at least an hour following administration of exenatide (Bond, 2006).

References

Bond, A. (2006). Exenatide (Bettal) As a Novel Treatment Option for Type 2 Diabetes Mellitus. Proc (Bayl Univ Med Cent) , 19, 281-284.

Buse, J. B., Henry, R. R., Han, J., Kim, D. D., Fineman, M. S., & Baron, A. D. (2004). Exenatide-113 Clinical Study Group. Effects of Exenatide (Exendin-4) on Glycemic Control Over 30 Weeks in Sulfonylurea-treated Patients with Type 2 Diabetes. Diabetes Care, 27 (11), 2628-2635.

DeFronzo, R. A., Ratner, R. E., Han, J., Kim, D. D., Fineman, M. S., & Baron, A. D. (2005). Effects of Exenatide (Exendin-4) on Glycemic Control and Weight Over 30 Weeks in Metformin-treated Patients with Type 2 Diabetes. Diabetes Care, 28 (5), 1092-1100.

Kendall, D. M., Riddle, M. C., Rosenstock, J., Zhuang, D., Kim, D. D., Fineman, M. S., et al. (2005). Effects of Exenatide (Exendin-4) on Glycemic Control Over 30 Weeks in Patients with Type 2 Diabetes. Diabetes Care, 28 (5), 1083-1091.

Gestational diabetes is a disease found among women only when they are pregnant; where it has an effect on the way the body utilizes sugar (glucose) which is the main source of energy. It should be noted that, gestational diabetes can lead to ‘high blood sugar levels’ among pregnant women; which are improbable to cause harms and which affect the wellbeing of the unborn baby. In this case, gestational diabetes denotes any quantity of glucose intolerance with the beginning or initial acknowledgment during pregnancy. Further it can be argued that, gestational diabetes is caused when the varying hormones and mass gain make makes it difficult for the pregnant woman’s body to carry on with its need for insulin. In this case, the body lacks the vigor required from the food eaten (Davidson, 1998).

It can be argued that, gestational diabetes has a small number of signs among pregnant women and it is in most cases detected through screening. In this case, analytic tests sense unsuitably high degrees of glucose in blood samples. According to studies and researches done on gestational diabetes; depending on population studied, gestational diabetes affects 3-10% of pregnancies with 135,000cases detected each year (American Diabetes Association, 2001).

Client risk factors

It can be argued that, babies born to mothers with gestational diabetes are at higher risks of troubles including being big for gestational time, which might result to deliverance difficulties; low blood glucose and jaundice. On the other hand, the new born may be prone to mounting babyhood fatness where it may have type 2 diabetes in its later life. In addition, babies born of a mother with gestational diabetes are at the risk of perinatal mortality, birth trauma and or neonatal hypoglycemia (Martin, 2004).

Further, mothers suffering from gestational diabetes are at an increased risk of type 2 diabetes or latent autoimmune diabetes later in her life. On the other hand, mothers risks of developing complications when delivering and also preeclampsia or type 2 diabetes increases. It is of importance to note that, someone who comes from a family which has been known to have diabetes; will be at a higher risk of getting gestational diabetes than one who has no historical diabetes within the family. Additionally, a mother who has siblings who she socializes with and has diabetes is at a risk (American Diabetes Association, 2005).

Dynamics of the disease process in relation to cellular disruption and effect upon major body system

It can be argued that, increased serum triacylglycerol (TAG) and NEFA degrees are connected with the increase in weight and type 2 diabetes; adding up to lipid accretion in many nonadipose tissues. In this case, this unsuitable accretion of surplus lipid results to cellular dysfunction and decease of cells. A good example here is the verifications from rodent representations; powerfully implicating cardiac accretion of lipid which is the onset of heart failure in diabetes (Davidson, 1998).

Pertinent assessment data including diagnostic studies

It should be noted that, gestational diabetes is noticed through a glucose tolerance test conducted from week 24 all through week 28 of the pregnancy. In this case, this test is all about drinking a glucose solution after which the blood is removed and glucose level measured. It is of importance to note that, the diagnosis of gestational diabetes includes the consumption of a cautiously considered diet; having a lot of exercises, upholding a vigorous pregnancy weight, observing glucose levels and dairy insulin vaccinations. In addition, the diagnosis and succeeding management of gestational diabetes after given birth has significant inferences for the deterrence of type 2 diabetes. Based on this, diagnosis suggestions for gestational diabetes are based basically on facts from early tests signifying that insulin diagnosis can decrease the occurrence of macrosomia (Martin, 2004).

Further it can be argued that, gestational diabetes involves the placenta’s hormones which help in the baby’s growth. In this case, a mother is deprived of the vaccinated insulin needed when these hormones are blocked. Additionally, there are two types of diabetes which include type 1 and type 2 diabetes. In this case, women suffering from gestational diabetes are at an increased risk of type 2 diabetes in their later life (American Diabetes Association, 2005).

In order to treat a woman of gestational diabetes, it is further important to note her past medical history. In this case, a woman who had been treated of diabetes; stands a higher chance of type 2 diabetes in her later life. On the other hand, it is important to note the diagnostic information about a patient, like whether she had ever been treated of high blood pressure. In this case, a patient who had high blood pressure earlier on; is more likely than not to suffer from type 2 diabetes. It can also argued that from the pertinent data on the diagnosis of gestational diabetes; there are positive and negative implications. In this case, the positive implications include the assurance of a proper care-diet modification, exercise and medication are initiated. On the other hand, the negative implications of gestational diabetes diagnosis especially testing are the experiences of nausea during testing. On the other hand, a woman to be screened must have no low risk; that is must be younger than 25 years of age with no individual cultural or family risk factors (Jovanovic, 2009).

Medical Management

It can be argued that, gestational diabetes should be carefully treated to avoid the further complications associated with it. Thus it is of importance to note that, the testing for gestational diabetes should be done during or before pregnancy. In addition, the best management for gestational diabetes is designing a reasonable diet plan. Based on this, this diet plan should address the gestational diabetes problems and at the same time provide the unborn with sufficient nutrients and calories. On the other hand, a patient is supposed to have a reasonable level of exercises; which help the body utilize insulin more effectively and as a result controlling its blood sugar levels (American Diabetes Association, 2001).

It is of importance to note that, the diagnosis for gestational diabetes engages in making choices. In this case, most women who make changes in their eating habits and modes of exercising are usually capable of maintaining their blood sugar level within a target range. Based on this, the control of blood sugar is the main factor in preventing complications during pregnancy or delivery; where it should be noted that as these changes are made concerning eating habits and mode of exercising; a woman will be in a position to learn how her body reacts to the food and practice engagements. By doing this, a woman will have no problems when delivering and also will have more energy (Martin, 2004).

On the other hand, in the case that a patient is not improving; she should consult her medical adviser for advices on diet change. In this case, a patient would have a regular checking of blood sugar at home; in order to know whether she is improving or not. Importantly, all diagnostic plans should stress on a decrease in the cardiovascular risk; putting much consideration chiefly on hypertension control and smoking termination of dyslipidemia. Further, the present advancement to control of drug treatment in patients with type 2 diabetes is to start insulin therapy; in the case a mixture of two oral means is unable to offer adequate glycentric control (Davidson, 1998).

Pharmacological therapy

It is of importance to note that, because insulin arrangements tried currently have been determined not to cross the placenta or to cross plainly; insulin has been the therapy of preference in most parts worldwide for patients with gestational diabetes. In this case, even though developments have been made in developing insulin levels that may be managed by substitute routes; insulin is naturally vaccinated subcutaneously. From earlier researches and studies it can be argued that, the use of glyburide during pregnancy is supported. On the other hand, there is inadequate evidence to support or refute the use of metformin. In this case, metformin is an agent that has been shown to cross the placenta; thus could be helpful or harmful to the developing unborn baby (Jovanovic, 2009).

Medical and/or surgical intervention

In this case, therapy in general for gestational diabetes can overturn the high glucose levels within the blood and hence reduce or completely eliminate likely problems. Based on this, therapy contains a well incorporated arrangement that comprises of normal physical exams and trying of glucose levels by a health care practitioner (American Diabetes Association, 2005).

It should also be noted that, even though a cautiously impartial diet and an insulin vaccination have been used to control gestational diabetes; there is a new proof that high insulin levels can be harmful. In this case, there are no proofs that it leads to death but the long term consequences on the child are not clear. Further, It should be noted that from studies and researches carried out concerning gestational diabetes; patients have been known to respond to treatments. On the other hand, in the case a patient does not respond to the treatments; the patient’s medical advisor should give directions on changes in diet and exercises (American Diabetes Association, 2001).

Study

It is of importance to note that, the treatments given to gestational diabetes patients are appropriate and useful. Based on a personal perspective, other forms of therapies like pure bitter melon and morpheme pure herbs could be applied. In this case, these remedies for gestational diabetes are readily available at homes and are less expensive. On the other hand, there are other natural herbs used in the cure of gestational diabetes which include grape fruits and leaves of a mango tree. It can also be argued that, diet is very crucial as far as the treating of gestational diabetes is concerned since it has no side effect like it could be with drugs. From this, it would be advisable for a patient to supplement cereals with gram in trying to lower the blood sugar within the body. It should further be noted that, gestational diabetes is ranked fifth among the leading death causing diseases in America; hence its consideration should be prioritized. Based on this, it would be appropriate to take a whole fruit rather than fruit juices in the control of gestational diabetes. It is of importance to note that, when natural remedies are used in the treatment of gestational diabetes; they relief a patient and the stresses of using drugs always (American Diabetes Association, 2005).

Reference lists

American diabetes Association. (2001). Gestational diabetes: what to Expect, 4^th edition. Virginia: American diabetes Association Publishers

American Diabetes Association. (2005). Gestational Diabetes: what to Expect. Virginia: American Diabetes Association Publishers

American diabetes Association. (2005). Diabetes 4-1-1: Facts, figures and Statistics at a Glance, 1^st edition. Virginia: American diabetes Association Publishers

Davidson, M. (1998). Diabetes Mellitus: Diagnosis and Treatment, 4^th edition. Philadelphia: W.B. Saunders Publishers

Jovanovic, L. (2009). Medical Management of Pregnancy complicated by Diabetes, 4^th edition. Virginia: American Diabetes Association Publishers

Martin, P. (2004). The Everything Diabetes Book, 1^st edition. Ohio: F+W Media Publishers

Introduction

According to the 2012 population estimates, Cook County had a population of 5,194, 675 people. This figure makes it the most populous county in the state of Illinois, which has a population of 12,880,580 (Public Health, 2012). Among the health challenges that the population faces, Diabetes is a major disease in this county. It is indeed one of the major causes of death. To gain a better understanding of health problems that a specific population faces, epidemiological studies offer crucial insights that relate to the health problems. Such insights assist policymakers and stakeholders of population health to establish the correct measures to address the problem. In this paper, the focus is on the evaluation of diabetes in Cook County in the State of Illinois.

Background and Significance of the Disease

Diabetes can be defined as a chronic and progressive condition, which indicates the lack of or deficiency of insulin or reduced ability of the body to digest insulin (Estrada, Danielson, Drum, & Lipton, 2009). In case of diabetes is not controlled, glucose and fats (lipids), which the body fails to absorb, remain in the bloodstream. These substances not only damage vital body organs but also lead to heart disease, vision loss, stroke, nerve damage, and kidney disease. Diabetes appears in three categories, which include type-1, type-2, and -gestational diabetes. Type-1 diabetes, which is also referred to as insulin reliant, infantile inception diabetes, or immune-mediated diabetes, is responsible for 10% of all diabetes cases in Cook County. In this diabetes category, the immunity system attacks and kills the pancreas’ beta cells that are responsible for producing insulin, which cuts down or eradicates the production of insulin in the body (Saudek et al., 2013). While individuals of any age can suffer from type 1 diabetes, the ailment is common in teenagers and kids. For survival, patients must receive a daily injection of insulin to control their blood sugar (glucose). On the other hand, type-2 diabetes is the most widespread category that is responsible for up to 93% of all instances that are reported in any population. This type of diabetes is also referred to as non-insulin-reliant diabetes or adult-onset diabetes. It is common in people who are above 40 years, although it can also occur earlier. In this diabetes, the main characteristics include insulin confrontation and comparative insulin insufficiency. The last type of diabetes is gestational diabetes, which is also referred to as gestational diabetes mellitus (GDM). It primarily occurs during pregnancy (Public Health, 2012). It is a transitory condition of heightened blood levels in a mother during late pregnancy. However, it usually disappears after pregnancy. If unmanaged, GDM can lead to negative consequences for the mother and the child. The situation increases the likelihood of developing diabetes later in life. It can also affect a baby to the extent of leading to a condition that is referred to as macrosomia, which is the big-baby disorder. Approximately, 50% of women who have gestational diabetes develop type-2 diabetes within 5 to 10 years after delivery (Khare et al., 2012). The indicators of diabetes include frequent releasing of urine, particularly during the night, tremendous weariness, deep and recurrent dehydration, speedy and inexplicable mass loss, genital burning and thrush, protracted curing of cuts and injuries, and distorted visualization.

Based on the report by the Illinois Performance Threat Factor Inspection System findings, cases of individuals who have suffered from the ailment diabetes in Illinois have increased dramatically in the last two decades. Approximately 800,000 people had been diagnosed as of 2012 while more than 500,000 people were unaware that they had the disease (Public Health, 2012). In Cook County alone, more than 278,000 have been diagnosed with the disease. In the United States, diabetes is a significant health concern. The disease is the seventh-leading cause of death in the nation. Further, according to the Center for Disease Control and Prevention (CDC), approximately 25.8 million people or 8.3% of the US population have the disease while a further 7 million people are not aware that they have the condition (Estrada et al., 2009). This situation puts them at a very high risk of developing other health complications because of unmanaged diabetes (Estrada et al., 2009). The table below shows the prevalence rate of diabetes in Cook County as compared to Illinois and the US between 1998 and 2012.

The following is a graph representing the diabetes trends in the Cook County as compared to Illinois and USA:

Diabetes is among the primary roots of fatality in Cook County, as well as Illinois State. For instance, in 2009, the mortality rate from diabetes in Cook County was 21 per 100,000 as compared to Illinois whose rate was 20.5 per 100,000. The national rate was 20.9 per 100,000. As of 2012, the mortality rate in Cook County from diabetes was 22.7 per 100,000 as compared to 22.5 per 100,000 deaths that were recorded for the Illinois State (Khare et al., 2012). The death rate from diabetes increases with age. For instance, in Illinois, the death rate for individuals who are beyond the age of 87 whose death results from the disease is approximately 300 per 100,000 and 200 per 100,000 for 70 to 90-year-old persons.

Current Surveillance Methods

The first check-up technique is the Behavioral Threat Factor Inspection Structure, which is a universally nationally sponsored structure that examines health threats (Public Health, 2012). For Cook County, the BRSS surveillance method is applied through the Illinois BRFSS, which covers all counties in the region. Through the system, the state can gather information on behaviors and conditions that relate to primary causes of death in the whole state. In this surveillance method, random telephone numbers are picked for handset interviews concerning diseases and health behaviors. The information that is collected annually is used as a reflection of the identified conditions concerning the whole population.

The second method of surveillance is the use of Hospital Discharge Data. In Cook County, hospice emancipation is used to denote all inpatient individuals who are released from non-governmental or sensitive care health facilities in the county. Mortality data is a very crucial surveillance method for diabetes in Cook County. It shows the causes of death of individuals. Cook County obtains such facts from the National Center for Health Statistics (Public Health, 2012). The last surveillance method is the Adverse Pregnancy Outcomes Reporting System (APORS). Through APORS, registry records indicate infants who are born with defects from mothers who had gestational diabetes. The APORS is the most inclusive foundation of facts concerning delivery imperfections in the entire Illinois region.

Epidemiological Analysis of Diabetes

The first risk factor is prediabetes. In this case, individuals who have impaired fasting glucose (IFG) or Impaired Glucose Tolerance (IGT) are referred to as prediabetics. They have an elevated risk of developing diabetes. Prediabetics have high levels of glucose compared to normal levels. However, their levels are not enough to show diabetes (Saudek et al., 2013). The primary category of diabetes that these people are likely to develop is type-2 diabetes. They are also more likely to develop stroke and heart diseases. Approximately 79 million Americans aged 20 years and above had prediabetes as of 2010 (Public Health, 2012). In Illinois, about 10% of people above 65 years are prediabetic. The risk of developing prediabetes also varies based on race. Non-Whites have a higher risk at 6.4% compared to Whites at 4.9% (Saudek et al., 2013). Gender is also a major risk factor where females are more likely to develop prediabetes at 5.8% as compared to males at 4.7% and/or non-Hispanics/Latinos at 5.4% as compared to Hispanics/Latinos at 3.6% (Public Health, 2012).

The use of tobacco and alcohol is also a risk factor for developing diabetes. In Illinois, 13% comprises current smokers who have diabetes while 38% comprises former smokers (Khare et al., 2012). On the other hand, chronic use of alcohol leads to unremitting inflammation of the pancreas. The irritation, which affects the ability of the pancreas to secrete insulin, results in diabetes (Saudek et al., 2013). Diabetes is very costly not only to the individual but also to the county, state, and national economies. For instance, victims of diabetes incur 2.3 times higher medical expenditures compared to those who do not have the ailment (Saudek et al., 2013). In Illinois, the cost of diabetes was USD$7.3 billion in 2006. The figure included USD$ 4.8 billion in excess costs of care and USD$ 2.5 billion in lost productivity (Public Health, 2012).

Screening and Diagnosis

Various methods of screening and diagnosis are used for the purpose of diabetes. The table below highlights the various screening and diagnosis approaches in addition to the related sensitivities and costs for the tests. The universal testing methods in Cook County are the Random Blood Glucose Level and A1C Levels (Public Health, 2012).

Plan for Action

Diabetes is very costly to an individual, as well as the economy of a society. In this case, it is very vital to take initiatives at both individual and societal levels to fight against the disease. One of the best approaches for action is the creation of awareness in the population concerning risk factors for the disease and the recommended actions for reducing the risks. In this case, I plan to be actively engaged in awareness activities in the county concerning this chronic disease. The second approach that I will adopt is the campaign for early diagnosis and treatment of the disease. Early diagnosis allows the medication to begin early. Hence, it guarantees an individual a better and prolonged normal living with the disease. The last strategy is the involvement of the community in health awareness-related activities. For instance, at an individual level, I will be at the forefront in suggesting the best approaches to ensuring community participation in awareness initiatives.

Conclusion

Diabetes is a chronic disease, which accounts for a high number of deaths in Cook County and in the whole of the USA. Although the disease affects people of all ages, it is common among older people above 40 years. The paper has revealed the three types of diabetes, which include type-1, type-2, and gestational diabetes. Type-2 diabetes is the most widespread in Cook County where it accounts for up to 90% of all cases. The disease costs the state of Illinois USD$7.3 billion, including USD$ 4.8 billion in extra costs and USD$ 2.5 billion in lost productivity. The most regular screening and testing methods are the Random Blood Glucose Level and A1C Levels. Consequently, there is a need to have initiatives that will help in reducing the prevalence of this disease in Cook County.

Reference List

Estrada, C., Danielson, K., Drum, M., & Lipton, R. (2009). Hospitalization is subsequent to diagnosis in young patients with diabetes in Chicago, Illinois. Pediatrics, 124(3), 926-934.

Khare, M., Carpenter, R., Huber, R., Bates, J., Cursio, F., Balmer, W., & Loo, K. (2012). Lifestyle intervention and cardiovascular risk reduction in the Illinois WISEWOMAN Program. Journal of Women’s Health, 21(3), 294-301.

Public Health. (2012). The Burden of Diabetes in Illinois: Prevalence, Mortality, and Risk Factors. Illinois: Illinois Department of Public Health.

Saudek, D., Herman, H., Sacks, B., Bergenstal, M., Edelman, D., & Davidson, B. (2013). A New Look at Screening and Diagnosing Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism, 18(2), 24-36.

The results of the research show that the key risk factors for developing type II diabetes depend on several variables. Even though weight and diet are generally considered the key factors that increase or reduce the possibility of having diabetes, the research shows that there are still many other variables to take into account. Splitting the key factors into three major sections, namely, demographics, clinical and dietary factors, one can see a more detailed picture. Speaking of such demographic factors as race, the white population suffers from it in the majority of cases (635, or 94.4%), unlike the rest of the races (38, or 5.4%), the remaining 0.2% belonging to the white population in the control group. As far as the family history goes, one must admit that type II diabetes is a hereditary disease since 46.3% of the tested had diabetes running in their families (323 people). Weirdly enough, smoking, the habit that is ranked as one of the most harmful ones, seems to have little to do with diabetes (99 people, or 14.2% of the total number). In addition, diabetes, type II seems to manifest itself in the women who are in the postmenstrual phase (65.8%, or 495 people). Finally, age seems to be the defining factor, since there are only 6.9% of young people (57) in the studied group. It is noteworthy, however, that the p-value for the given data is very high (.63 to.83 in 5 cases out of 6), which means that the given data is rather relative. However, clinical factors also seem to play a great role in creating the premises for diabetes development. In contrast to the demographic ones, the clinical data, reasonably enough, have a very low p-value rate (<0.01), which means that the given data is credible enough. Of all the factors, the crucial ones are the amount of ferritin and the ratio of transferrin receptors to ferritin (79.7 % (105 participants) and 41.8% (102 participants) respectively). As one might have expected, the subjects with lower transferrin concentration had more risks of developing diabetes. The above-mentioned seems rather predictable since soluble transferrin receptor levels are considered the early indicators of iron deficiency and, therefore, a threat of type II diabetes (de Block et al. 1384). Finally, the dietary issues also seem to matter, especially the percentage of magnesium (293 (55.3%)). It is also necessary to mention that the study has shown a clear link between alcohol consumption and diabetes. According to the research results, the increase in alcohol consumption by 5 g/d raises the ferritin concentration.

Analyzing the above-mentioned research data, one must mention that the research had its limitations. To start with, it could not embrace the entire variety of possible victims of diabetes; though people of a different races, age groups, and gender were involved, the precision of the results is still somewhere in the middle. As for the research outcomes, it is necessary to mention that some of the most widespread myths, like the link between smoking and diabetes, have been proven wrong. In addition, the relation between transferring rates and the risks of diabetes has been discovered. Once the key factors that cause diabetes are defined, it is possible to come up with solutions for avoiding type II diabetes development in children and adults.

Reference

De Block, Christophe E. M. et al. “Soluble Transferrin Perception Level.” Diabetes Care 23.9 (2000): 1384–1388. Print.

Pan et al. (2011) researched the consumption of red meat in relation to type 2 diabetes (T2D). The research aimed at identifying the likelihood of contracting diabetes as a result of consuming red meat. The researchers followed a cohort of about four million people in order to document the cases of T2D that were discovered. The population included dentists, pharmacists, and physicians among other professionals. The target population was varied across age and gender in order to allow reliability. Results showed that eleven percent of the people suffering from T2D acquire the disease through obesity and physical inactivity. In addition, the researchers found that the consumption of processed and unprocessed red meat had a weak correlation to the acquisition of type 2 diabetes. The strength of this research is based on the effort of determining the effect of eating behavior on health. It forms a base of warning people against the consumption of diets that can lead to poor health. However, the research exhibits some weaknesses that limit its scope. For example, the research has only focused on the relationship between red meat and T2D. This shows disregard for other types of diabetes.

In light of reporting the findings of this research, the Times Healthland gave a detailed report on the various aspects of this research. First, the report focused on similar research that has been carried out previously. Secondly, the report presents Pan’s research as the latest research that has been carried out. The presenters articulate the most important aspects of their research including the population statistics, ways of collecting data, and the results among others (Sifferlin, 2013). Importantly, the media presentation has reported on the disadvantages of eating red meat clearly including the increment of body weight. Essentially, the report has reported on parallel research on the life of vegetarians. In my perspective, the report is satisfactory because it is categorical. First, it touches on the previous research that was carried out before the actual research was presented. Secondly, the presentation focuses on the current research and reports on the condition of vegetarians. This implies that the report forms a satisfactory ground for comparison of various fields of research. This comparison enables readers to make the right choices that concern their feeding habits. However, the report fails to give an advisory opinion to the general public. In a suggestive manner, its report almost dismisses the consumption of red meat. This implies that the general public will make divergent decisions regarding their diets. However, the availability of a direct advisory opinion that either supports or dismisses the consumption of red meat would be much helpful to the people.

Apparently, the report indicates that the consumption of red meat contributes to poor health in many ways. Many patients would interpret the report as being against the consumption of red meat. Therefore, many patients would opt to reduce or dismiss the consumption of red meat in their diets.

Essentially, all professionals should integrate this research in their subsequent research studies. In this light, it will act as prerequisite knowledge that forms the basis of research. In fact, it should be the starting point for any other research that concerns diabetes. In future research studies, researchers should try to establish the relationship between red meat and other types of diabetes. Also, it should determine the other health effects related to the consumption of red meat.

References

Pan, A., Sun, Q., Bernstein, A. M., Schulze, M. B., Manson, J. E., Willett, W. C. (2011). Red Meat Consumption And Risk Of Type 2 Diabetes: 3 Cohorts Of US Adults and an Updated Meta-analysis. American Journal of Clinical Nutrition, 94(4), 1088-1096.

Sifferlin, A. (2013). Eating More Red Meat Linked to Higher Risk of Type 2 Diabetes: Study | TIME.com. Health & Family | A healthy balance of the mind, body and spirit | TIME.com. Web.

Introduction

For centuries, medical scientists have been developing various interventions in a bid to treat and manage diabetes among the population. Nutrition and lifestyle interventions are part of interventions that have proved to be effective in the treatment and management of diabetes. According to Delahanty (2010), nutrition and lifestyle interventions are current therapies for diabetes because they “have been a critical component in three of the four largest clinical trials that focused on diabetes in the past two decades” (p. 360).

The three major clinical trials involving diabetes are Diabetes Control and Complications Trial 1983-1993 (DCCT), Diabetes Prevention Program 1996-2001 (DPP), and Action for Health in Diabetes 2001-2012 (Look AHEAD Trial). These clinical trials confirmed that nutrition and lifestyle interventions play a central role in the treatment and management of diabetes; type I and type II diabetes mellitus. Therefore, this essay examines the findings of the three clinical trials that are relevant in the treatment and management of diabetes, as nursing practice.

Diabetes Control and Complication Trial

The DCCT trial entailed diabetic patients with type I diabetes who volunteered for the study. The clinical trial randomly assigned participants who volunteered for the study to conventional and intensive therapies. Conventional therapy is aimed at helping diabetic patients to measure their glucose levels in blood and urine while attending their clinics after every three months. Comparatively, the intensive therapy required the diabetic patients to measure their glucose levels in the blood and urine regularly while attending their clinics monthly. Both patients under conventional and intensive therapies received similar dietary counseling.

When planning a diet for diabetic patients, “insulin doses were first matched with a consistent diet, and the dieticians taught participants how to adjust insulin for variations in food intake and activity level” (Delahanty, 2010, p. 362). During the progress of the clinical trial, it was evident that intensive therapy with nutrition has a significant impact on the treatment and management of diabetes.

The findings of the DCCT show that there is a marked difference between conventional and intensive therapy. Delahanty (2010) states that “intensive therapy achieved a stable HbA1c by approximately 7.2% versus 9.1% with conventional treatment” (p. 362). Such reduction in HbA1c has significant benefits because it reduced the risk of developing retinopathy by 76% and progression of diabetes by 54%. Moreover, the reduction in HbA1c decreased the risk of developing microalbuminuria by about 30-60%. In this view, the DCCT proved that medical nutrition therapy is important in maintaining blood glucose levels, achieving HbA1c targets, and minimizing weight gain.

Diabetes Prevention Program

DPP intervention focused on patients with diabetes type II. The clinical trial aimed at determining whether 150 minutes of physical activity would help diabetic patients reduce their weights by 7%, and thus prevent or delay the occurrence of type II diabetes (Delahanty, 2010). To achieve this, DPP randomly assigned 3000 patients to three groups, namely, metformin, placebo, and lifestyle intervention groups.

Patients in the three groups underwent regular assessment after every three months, where they received their respective counseling about treatments. As case managers, the dietitians “scheduled quarterly outcome assessment visits within the appropriate time windows, reported and documented adverse events, reviewed their participants’ progress with lifestyle goals at weekly team meetings” (Delahanty, 2010, p.366). Throughout the clinical trial, dietitians assessed the impact of physical activity on the prevention, treatment, and management of diabetes type II.

The findings of DPP intervention indicate that modification of diet and physical activity are critical in preventing the development of type II diabetes among the predisposed population, or in delaying its progression among the diabetic population. According to Delahanty (2010), “the lifestyle intervention decreased the development of diabetes by 58% compared to placebo,” while metformin decreased its development by 31% (p. 366).

Moreover, the findings indicate that lifestyle intervention is very effective among older patients and the ones with low body mass index when compared to metformin intervention. Overall, lifestyle intervention of physical activity led to weight reduction, which ultimately reduced the risk of diabetes by 71% among older patients.

Look AHEAD Trial

Look AHEAD trial focused on the impact of intensive lifestyle intervention on patients with diabetes type II. The objective of the Look AHEAD was to “determine the long-term effects of a lifestyle intervention compared to conventional ‘diabetes support and education’ treatment” (Delahanty, 2010, p. 367). The Look AHEAD intervention entailed modification of diet and incorporation of physical exercise in the management of diabetes among patients.

The evidence obtained indicates that the Look AHEAD intervention is the most effective intervention when compared to the DCCT and DPP interventions. The Look AHEAD intervention has a two-fold effect in the treatment and management of diabetes because it reduced HbA1c levels and enhances weight loss. The findings of the study are relevant in nursing, because, nurses can utilize them in aiding diabetic patients to make informed decisions regarding the nature of the diet and physical activity, which are appropriate in the management of diabetes.

Conclusion

The DCCT, the DPP, and the Look AHEAD are three interventions, which have proved that nutrition and physical activity are central in the treatment and management of diabetes among the population. The DCCT intervention aims at aiding a diabetic patient to understand how to manage body weight and blood glucose levels. Moreover, the aim of DPP and Look AHEAD interventions is to help a diabetic patient manage own body weight and maintain normal glucose levels in the blood. Overall, the three interventions show that dietitians have a noble role in offering lifestyle and nutritional interventions, which prevent the development and progression of diabetes in the population.

Reference

Delahanty, L. M. (2010). Research charting a course for evidence-based clinical diabetic practice in diabetes. Journal of Human Nutrition and Dietetics, 23(4), 360-370.

Abstract

Diabetes has become a major health problem in the United States and other parts of the world in recent times owing to the changing trends in the predisposing factors. Taking into account that the disease is chronic makes it a major public health problem since its impact to healthcare and the patient increases with age. Patients suffering from diabetes and their families suffer the highest burden from the disease through complications that lowers the life expectancy while diminishing the quality of life for the patients. The largest impact of diabetes has been felt in the health systems where large portion of resources are continually allocated to cover for medication and nursing personnel. The burden caused to the health institutions and providers is enormous considering the amount of productivity and personnel who are consistently in charge of emanating the disorder. There is need for concerted efforts in terms of prevention and treatment programs to help lower the negative impacts of the disease on the patients, society and national economies.

Introduction

Diabetes has become a major health problem in the United States and other parts of the world in recent times owing to the changing trends in the predisposing factors. According to McDowell et al (2007, p. 2), diabetes usually refers to a medical condition that ensures the body has persistently high amounts of blood sugar occasioned by the inability of the body to produce or utilise it. Although there are many forms of diabetes, the commonest include type 1 and type 2 diabetes that are responsible for causing massive suffering to patients. Taking into account that the disease is chronic makes it a major public health problem since its impact to healthcare and the patient increases with age. Significant improvements on the treatment methods have been achieved in the last few decades. Over reliance on high dosages of insulin has been replaced with innovative drug and preventive therapies that are informed by evidence based practice (McDowell et al, 2007, p. 2). Further improvements have been achieved in treating the complications which are the major causes of fatalities and disabilities in patients. This research paper will describe diabetes while taking closer interest on its impact on healthcare in the world.

Effects to patients and family set-up

Diabetes has persistently offered major challenges to public health with negative impacts to the patient, society, healthcare and the economic situation of many countries (Colwell, 2003, p. 6). An alarming increase of the prevalence of diabetes in the developed countries has continually worried the health authorities. More importantly, the increase in the number of obese persons coupled with the sedentary lifestyle that is fuelled by the improvements in technology has brought forward the need for intensive preventive programs targeting lifestyle changes in the society. The World Health Organisation estimates about 170 million people suffer from the chronic disorder in the globe, which represents about 2.79 % of the population (American Diabetes Association, 2003, p. 920). With the prevalence expected to double in the next years and rapid increases in the incidences, several measures and policy changes have to be implemented in order to curtail the alarming trend.

Patients suffering from diabetes and their families suffer the highest burden from the disease. Not only does the disease have major complications on the body functions but also lowers the life expectancy while diminishing the quality of life for the patients. Moreover, the family is overly overwhelmed economically owing to the demanding and persistence of the condition. According to Theodore and Varavikova (2008, p. 34), the expenses accrued due to diabetes has been shown to escalate in recent years. Furthermore, medical expenses due to diabetes have proved to be a major drain particularly for low and middle income families who lack basic health insurance policies (Theodore and Varavikova, 2008, p. 34). Considering most of the drugs are bought through out of pocket payments makes the families to continually suffer while the patient undergoes further agony due to irregularities in accessing drugs.

Impact to health systems

The largest impact of diabetes has been felt in the health systems where large portion of resources are continually allocated to cover for medication and nursing personnel. Since majority of the health systems in the developed world are public funded, the governments have not been spared with much of the health budgets going into buying medications for diabetes and other chronic disorders. Moreover, the utilisation of a sizeable proportion of the trained health workforce on diabetes management has exposed the society to other health problems while diminishing the quality of quality care in the hospitals. According to Dubois and Bankauskaite (2005, p. 21), several countries had established national programs targeting diabetes management with mixed rates of success. In the developing world, management of the diabetes programs has remained a challenge, despite the fact that only a small proportion of the population is affected. Majority of the developing countries suspended the programs due to the lack of adequate funding particularly after donors pulled out of the funding arrangement.

The management of diabetes particularly for people aged between 20 and 80 years is estimated to cost about 280 billion US dollars yearly in direct healthcare costs alone. This amount constitutes a heavy burden considering that the disease can be prevented by innovative and cost effective strategies (Cronin, 2010, p. 32). The situation is no different in the United States where about 130 billion dollars are spent on directly and indirectly related health expenditure in health management (American Diabetes Association, 2003, p. 920). The excessive costs in health costs is due to skyrocketing prices and extensive consumption of drugs and high numbers of hospitalisation days that are coupled with expensive treatment procedures for outpatients and the high costs of running the nursing homes (Clement et al, 2004, p. 554). With more than 50% of the cost going directly into management of chronic and general medical conditions, there is need to increase screening and diagnostic techniques to enhance the early detection of the condition thereby lowering the expenditure. While the prevalence of diabetes stands at 4 % in the United States, expenditure estimates has shown that one out of every five dollars spent is directed to diabetes management. The situation is made even dull by the fact that the major component of the US population is progressing towards old age which is a predisposing factor for the disease and complications.

Impact to health institutions

People suffering from diabetes have a three-fold propensity of undergoing hospitalisation when compared to those without it. Moreover, the risks of getting admitted to a hospital are always increased in diabetes regardless of the immediate reason for seeking medical attention. The risk is greatly increased by factors such as age and the length of suffering combined with the number of complications experienced due to the chronic disorder. Silink (2006, p. 86), noted that about 15 to 20% of all hospitalised cases are due to diabetes. The burden caused to the health institutions and providers is enormous considering the amount of productivity and personnel who are consistently in charge of providing patient care. More importantly, the hospitalised cases take longer durations in the facilities that other patients owing to the fact that admission is mainly due to co-morbid conditions such as cardiovascular and other related complications (Piwernetz, 11993, p. 372). Diabetes care and management is a common challenge that the nursing homes and elderly homes face on a regular basis (Vijan, Hayward & Langa, 2004, p. 6). Large numbers of the nursing workforce continually offer their services in these homes taking into consideration the inability of the inhabitants to care for them due to old age coupled by the complications which may results in physical disability (Newson, Patel & Shah, 2006, p. 43).

Conclusion

Diabetes is a major health problem has continually caused much suffering to patients and families while causing a major strain on the health systems of many countries. More importantly, the negative economic impact of the disease has served to diminish the productivity in the health sector thereby leading to poor quality patient care. There is need for concerted efforts in terms of prevention and treatment programs to help lower the negative impacts of the disease on the patients, society and national economies.

Reference List

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Colwell, J. (2003). Diabetes – Hot Topics. London: Churchill Livingstone.

Cronin, K. (2010). Diabetes Cost to Healthcare: Type II Diabetes Putting Pressure on the Economy. Web.

Dubois, H. & Bankauskaite, V. (2005). Type 2 diabetes programmes in Europe. Euro Observer 7 (2): 5–6. Web.

McDowell, J., Brown, F. & Matthews, D. (2007). Diabetes: A Handbook for the Primary Healthcare Team. London: Churchill Livingstone.

Newson, L., Patel, A. & Shah, R. (2006). Hot Topics for MRCGP and General Practitioners. New York: PasTest.

Piwernetz, K., Home, P., Snorgaard, O., Antsiferov, M., Staehr-Johansen, K. & Krans, M. (1993). Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee. Diabetic Medicine, 10(4): 371–7.

Silink, M. (2006). The Impact of Diabetes on healthcare And Hospitalization. Clinical care focus: diabetes. Web.

Theodore, H. & Varavikova, T. (2008). The New Public Health, Second Edition. New York: Academic Press.

Vijan, S., Hayward, R. & Langa, K. (2004). The impact of diabetes on workforce participation: results from a national household sample. Health Services Research, 12, 1-12. Web.

Winter, W. & Signorino, M. (2002). Diabetes Mellitus: Pathophysiology, Etiologies, Complications, Management, and Laboratory Evaluation: Special Topics in Diagnostic Testing. New York: AACC Press.