Promoting equitable and inclusive healthcare informs the global communitys attempts to strengthen links between actual diversity and services. In research and program planning endeavors, maintaining other-oriented interpersonal stances and openness to cultural heterogeneity support universal access to health. Using type 2 diabetes (T2D) as an example, this paper examines the ideas of cultural humility, equitable care and research, inclusion, cultural bias, and community partnerships in health studies.
Health Equitys Role in the Global Distribution of T2D
Globally, the absence of ethnically, culturally, and economically dissimilar populations equal opportunity to attain their full health potential does not play a major role in T2Ds distribution. Contrary to other disorders with an inverse relationship between prevalence and the nations GDP, T2D is widespread in relatively wealthy countries, such as the United Kingdom, the U.S., Switzerland, the Netherlands, Sweden, and Taiwan (Khan et al., 2020). America ranks first in terms of both prevalence rates and the daily burden of suffering, whereas Africa has the lowest rates despite being the most economically disadvantaged region (Khan et al., 2020). Deficiencies in health equity are, therefore, more pronounced at the regional and national levels.
Cultural Humility, Inclusion, and Community-Based Participatory Research (CBPR)
Inclusion, humility, and CBPR are essential concepts in pursuing health equity. Inclusion and cultural humility, which is a three-tenet attitude to serving ethnically heterogeneous populations, are crucially important in health research as open-mindedness with regard to sample collection and recruitment produces truly generalizable findings to inform evidence-based practice. Such research creates the conditions for just resource planning and allocation decisions by ensuring the presence of complete data on inter-group differences and minority populations need profiles (Rajaram & Bockrath, 2014). Being an equitable approach to research based on community inputs and integrating community-specific knowledge into policy decisions, CBPR increases the recognition of local populations as stakeholders in research by including them in equitable partnerships (Ward et al., 2018). CBPR engages local populations in cyclical multi-stage processes, ranging from quality improvement projects to patient teaching campaigns. With that in mind, all three concepts are inextricably connected to addressing gaps in resource distribution.
T2D: Research Progress, Humility/Equity, and Communitys Role
T2D research has recently seen progress toward greater equity and culture-related humility, which is evident from ethnic and sexual minorities greater representation as research subjects. According to Tajkarimi (2018), the number of research reports focusing on T2Ds prevalence and characteristics in underserved minorities in the U.S., especially American Indians, Asian Americans, and African Americans, has increased since 2010, indicating the research communitys gradual adoption of humility and equitable research as priority areas. Recent advancements in promoting equitable T2D management are also seen in the increasing popularity of cultural humility-based patient teaching frameworks for LGBTQ+ populations diagnosed with T2D/prediabetes (Savin & Garnero, 2022). However, this progress does not eliminate disparities in the disorders prevalence.
The communitys role in promoting equity and humility also deserves attention. T2D-related CBPR interventions, including the methods of shared leadership and outreach, have become prevalent in the last decade and promote statistically significant post-intervention improvements in A1C levels, blood pressure, and lipid profiles (Campbell et al., 2020). In the U.S., recent community-based projects have focused on promoting these outcomes in diabetic and prediabetic minority populations, including African Americans, Marshallese people, American Indians, Bangladeshi people, and East Asian immigrants (Campbell et al., 2020). Thus, the communitys and the CBPR approachs contributions to equitable care and the practice of cultural humility with regard to T2D prevention and management have been tremendous, but the room for improvement still persists.
Inclusion/Equity Strategies for the U.S.
Two strategies can be proposed to increase equity and inclusion within the frame of the National Diabetes Prevention Program (NDPP) and the U.S. public health systems program for American Indians. The first strategy seeks to reduce the imbalance between urban and rural residents access to T2D prevention services by expanding the number of NDPP partnership sites in rural counties and establishing the institution of diabetes peer coaches in underserved rural areas (Ariel-Donges et al., 2020). Adapting the programs toolkits to rural Americans eating and self-management habits could also be instrumental in seeking cultural responsiveness and humility. The second strategy pertains to the Special Diabetes Program for Indians and involves reconsidering the approach to anti-T2D lifestyle interventions in neighborhoods with extremely high concentrations of American Indians (Jiang et al., 2018). This could be achieved by including such communities eating cultures and access to healthier food or places for physical activity in analytical efforts.
Cultural Biases in Global Health Research
Cultural biases can affect global health research by causing the most widespread groups inclination toward underestimating cultural minorities systematic struggles. The Equal Earth map projection method proposed by `avri
et al. (2019) seeks to represent the planets surface in a visually pleasing way while maintaining various continents true relative sizes. Similar to exploring global patterns in health research, preserving the planets features without any distortions is not possible, and those involved in decision-making will still have the chance to select the angle that makes their location fully visible while leaving the other areas distant from the center of attention. Therefore, the cultural affinity bias and the risk of producing oversimplified causal explanations that do not consider smaller groups internal heterogeneity and variability can be challenging to eliminate in health research.
Conclusion
Finally, cultural responsiveness and inclusive research and services should still be promoted when it comes to T2D. Culture-related humility and minority groups representation in T2D prevention and treatment endeavors feature some room for improvement, including disease prevention strategies that would address rural Americans and low-income ethnic minorities lifestyles. However, the existence of biases pertaining to culture might further strengthen ongoing barriers to health equity and inclusion.
Jiang, L., Chang, J., Beals, J., Bullock, A., & Manson, S. M. (2018). Neighborhood characteristics and lifestyle intervention outcomes: Results from the Special Diabetes Program for Indians. Preventive Medicine, 111, 216-224.
Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of type 2 diabetes: Global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1), 107-111.
Rajaram, S. S., & Bockrath, S. (2014). Cultural competence: New conceptual insights into its limits and potential for addressing health disparities. Journal of Health Disparities Research and Practice, 7(5), 82-89. Web.
`avri
, B., Patterson, T., & Jenny, B. (2019). The equal Earth map projection. International Journal of Geographical Information Science, 33(3), 454-465.
Tajkarimi, A. (2018). An overview of minority-based research on diabetes type II in the US between 20122017. The FASEB Journal, 32(1), S547.
Diabetes of type 1 usually develops due to autoimmune destruction of pancreatic beta cells in genetically predisposed individuals. The damage to beta cells occurs at a subclinical level for months or years in the form of insulitis. Patients with insulin deficiency cannot process glucose in peripheral muscle and fat tissues. This stimulates the secretion of antagonistic hormones such as glucagon, adrenaline, cortisol, and growth hormone (Lee et al., 2019). These antagonistic hormones, particularly glucagon, promote gluconeogenesis, glycogenolysis, and ketogenesis in the liver. Consequently, patients experience hyperglycemia and an anionic metabolic acidosis gap. Type 2 diabetes is the most frequently encountered pathology of the endocrine system organs. The core mechanism of disease development is insulin resistance (Lee et al., 2019). It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. Insulin resistance produces the inability of insulin-dependent tissues to absorb blood plasma glucose and disrupts glycogen synthesis in the hepatic.
Persons with diabetes should eat according to a structured regimen and receive their medications with meals. For type 1 diabetes, a recommended diet includes carbohydrates from fruits, vegetables, whole grains, legumes, and skim milk. Patients with type 2 diabetes, complex carbohydrates such as brown rice, whole wheat, fruits, vegetables, and beans should be included in the rations (Sinclair et al., 2019). At the same time, for both types of disease should be avoided, consumption of simple carbohydrates such as sugar, pasta, white bread, flour, cookies, pastries. During the first type of diabetes, insulin Degludec (Tresiba) is required together with the diet. It is suitable to confound hypoglycemia in patients over 18 years of age. In addition, Zynquista is an oral medication intended to be combined with insulin (Sinclair et al., 2019). Besides, individuals with type 2 diabetes may require insulin if their diet plan, weight loss, exercise, and anti-diabetic medications are not achieving their target blood glucose levels. In that case, Insulin Degludec may also be appropriate; the oral drug is Metformin.
References
Lee, P. A., Greenfield, G., & Pappas, Y. (2018). The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: A systematic review and meta-analysis of systematic reviews of randomised controlled trials. BMC health services research, 18(1), 1-10.
Sinclair, A. J., Abdelhafiz, A. H., Forbes, A., & Munshi, M. (2019). Evidencebased diabetes care for older people with type 2 diabetes:A critical review. Diabetic Medicine, 36(4), 399-413.
Maternal grandfather experienced high blood pressure, which was associated with diabetes and obesity. The mothers sister recently experienced high blood pressure linked to diabetes. However, the other two siblings, including my mother, have not suffered from any health condition despite being overweight. Paternal grandfather never had any health risks, but his two brothers had stress issues and tobacco use. The stress issue is evident in my father and his two brothers. The only difference is that the two brothers smoke, except my father. Although my sister and I have had no health issues, the sister has shown signs of being overweight. Therefore, diabetes is a possible health condition predominant in the family. The paper evaluates the prevalence of diabetes in our family history to inform lifestyle changes and prevention measures.
Signs, Symptoms, and Preventive Measures of Diabetes
Early signs of diabetes include frequent hunger and fatigue, dry mouth and itchy skin, blurred vision, peeing frequently, and becoming thirsty often (DArrigo). People with type 1 diabetes may experience unexpected weight loss, nausea, vomiting, or stomach pains (DArrigo). According to DArrigo, these symptoms develop within a few days or weeks and can be more severe. Although type diabetes is more prevalent in children, teenagers, or young adults, it can happen at any age.
Type 2 diabetes manifests observable signs after many years of development. It has ties to family history and is the most prevalent kind of diabetes (Mambiya et al. 1). Yeast infections between the fingers and toes, beneath the breast, and in or around the genital organs are the common symptoms of type 2 diabetes (DArrigo). It is also characterized by slow-healing cuts or sores, recent weight gain, and pain or numbness in the feet or legs(DArrigo). There is no cure for type 2 diabetes, but lifestyle changes can help manage the disease.
Lifestyle modification, such as losing weight, becoming physically active, and eating healthy plant foods, is essential for stopping the onset of type 2 diabetes. Study results have revealed healthy diet pattern coupled with physical activity in people with high genetic risk is effective in diabetes prevention (Rajput et al. 74). Meeting diabetic educators is also great for seeking support and guidance on a healthy lifestyle. For example, awareness of the need to cut sugar and refined carbohydrates, quitting smoking, eating fiber, and drinking plenty of water are good health tips for preventing diabetes.
The Way Forward
The family history of the maternal grandfather indicates high-risk factors for diabetes. Limiting refined carbohydrates and sugar will be the first step toward preventing the disease. Therefore, a small serving of food high in complex carbohydrates, such as whole grains, vegetables, and oatmeal, will be the regular meal. The meals will also contain plenty of fiber to prevent spikes in insulin levels and blood sugar.
My dietary goal is to lose weight and maintain a healthier weight. Therefore, I intend to intentionally remain active by walking, swimming, or lifting weights for 40 minutes four days a week. Other measures will include drinking water, which is essential in controlling blood sugar and insulin levels, instead of beverages. Besides, I will take precautionary measures like seeing a doctor whenever I notice any signs or symptoms of type 2 diabetes.
Conclusion
In summary, the stronger link between diabetes type 2 and family lineage indicates a higher risk of other family members becoming diabetic. Diabetes is generally characterized by hunger and fatigue, dry mouth and itchy skin, blurred vision, peeing frequently, and feeling thirsty often. The plan is to cut sugar and refined carbohydrates from my diet, eat plenty of fiber, and exercise regularly. Other measures will include taking water instead of beverages and seeking help from a doctor at the notice of any signs or symptoms of diabetes.
Mambiya, Michael, et al. The Play of Genes and Non-genetic Factors on Type 2 Diabetes. Font. Public Health, vol. 7, 2019, pp. 1-8.
Rajput, Sheeraz, et al. Diet and Management of Type II Diabetes Mellitus in the United Kingdom: A Narrative Review. Diabetology, vol. 3, no. 1, 2022, pp. 72-78.
It is a high metabolic disease that causes high blood sugar ( Diabetes Basics ).
Sugar also known as glucose is a bodys necessary fuel to sustain.
Insulin is a hormone that ensures the transfer of sugar from the blood and delivers it into the muscle, liver and fat tissues where sugar is used as energy source or stored for the body to use later.
If a person does not have enough insulin, sugar accumulates in his blood stream, causing diabetes.
Symptoms of Diabetes
The onset of symptoms may appear suddenly or gradually depending on each case.
Unexplained weight loss;
Excessive thirst or hunger;
Fatigue;
Frequent urination;
Blurred vision;
Nausea and/or vomiting ( Diabetes Basics ).
Once symptoms are notices, immediate medical care is needed.
Hypo and Hyperglycemia in the Context of Diabetes
Hypoglycemia is a condition where the level of sugar is lower than normal. People with diabetes who take insulin more than they need may end up with hypoglycemia. Symptoms of low sugar level if a person has diabetes are weakness, headaches, lightheadedness, and dizziness.
Hyperglycemia is otherwise a condition where the level of sugar is too high due to lack of insulin in a body. Associated with diabetes, hyperglycemia can lead to vomiting, excessive thirst, rapid heartbeat, hunger, vision problems and other symptoms. Neglecting hyperglycemia can lead to serious health problems.
Types of Diabetes
There are three main type of diabetes: Type 1, Type 2 and gestational diabetes ( Types of Diabetes ).
Type 1 diabetes is caused by autoimmune reaction that prevent realization of insulin in a body. Estimated 5-10% of people who have diabetes have type 1.
Type 2 diabetes is caused by a bodys disability to control normal blood sugar level. Most people with diabetes have type 1 diabetes.
Gestational diabetes develops in pregnant women who have never had diabetes. It leads to high risks of health problems for a baby. After birth, the diabetes stops, but mother has chances to develop type 2 diabetes.
Type 1 and Type 2
Similarities:
Type 1 and Type 2 diabetes both occur when the body cannot store and use glucose.
Both can lead to complications, such as cardiovascular disease, kidney disease, vision loss and other diseases.
Both types diagnose with A1C or glycated hemoglobin test.
Differences:
People with Type 1 do not produce insulin, while the ones with Type 2 do not respond to it or make not enough insulin.
The cause of Type 1 is the immunes system that attacks insulin-producing beta cells. Type 2 is caused by insulin resistance, the body unable to use insulin.
Type 2 is more common that Type 1 diabetes.
Type 1 cannot be prevented, while it is possible to lower risks of Type 2. ( Types of Diabetes ).
Risk Factors of Type 2
If a person:
is over overweight;
is 45 years or older;
has a family member with Type 2 diabetes;
is not physically active;
has ever had gestational diabetes;
is African American, Hispanic/Latino American, American Indian, or Alaska Native, Pacific Islander or Asian American.
He or she has higher risks of developing Type 2 diabetes ( Types of Diabetes ).
Carbohydrate Intake
Type 1:
People with Type 1 do not produce insulin, thereby they should intake insulin though injections or a pump. This will help to lower the blood sugar level.
People should count amount of carbs they eat each time.
There are twice-daily insulin and basal bolus insulin regime for Type 1 patients.
Type 2:
People with Type 2 should limit the carbs to control their blood sugar levels because high sugar can lead to complications.
Therefore, people usually go on low calorie diet.
Potential Complications with Type 2
People with diabetes must be very careful about their treatment and daily life with diabetes.
Potential complications and frequent cases include:
Heart and blood vessels disease. Stroke, high blood pressures and narrowing of vessels are severe outcomes associated with diabetes.
Neuropathy in limbs. High blood sugar levels may damage and destroy nerves causing numbness, burning, pain or eventual loss of feeling.
Kidney disease that may need dialysis of kidney.
Loss of vision or eye damage.
Skin problems, and other complications.
Stress, Exercise, and Alcohol in the Context of Diabetes
People with diabetes should change their lifestyle by including healthy eating and moderate exercises ( Diabetes ).
Increased stress level of people with diabetes may result in high blood pressure, rise of heart rate and sugar level. People may feel tried and even depressed. Therefore, people should learn how to manage their stress level to avoid any complications.
Drinking alcohol (one serving per day for females, up to two servings per day for males) does not significantly affect the blood sugar level. However, mixers like juices or cola can cause increased level of sugar.
Being physically active may help to lose weight, stabilize mood and control blood pressure, so positively influencing people with diabetes.
Controlling, Preventing and Reversing Type 2
People with Type 2 diabetes should have individual diet that is provided by professional. Usually, it is a low-calorie diet with less carbs ( What is Diabetes? ).
Physical activity is also an important part of controlling and preventing Type 2.
Quitting bad habits, such smoking and excessive drink of alcohol plays critical role in prevention of Type 2.
Regular self-monitoring of blood sugar level and controlling food intake should be a daily habit of people with Type 2 diabetes. These measures will help to control the disease.
By following all medical instructions and having healthy lifestyle, Type 2 diabetes can be reversed.
Controlling Type 1
Unlike Type 2, Type 1 diabetes cannot be prevented and reversed ( Diabetes Basics ).
However, there are ways of controlling Type 2 to have a normal life.
People with Type 1 should know their blood sugar goals for a day and how to count cabs. Medication doses are also crucial to know and count.
Insulin does, food and activity should be maintained every single day.
Careful listening to a bodys needs and response also critical strategy to avoid any complications. If a person wants to change something, one change at a time is the best option.
Works Cited
Diabetes Basics. Centers for Disease Control and Prevention. Web.
This study uses a population health method to assess the healthcare organization described in the Integrated Safety-Net Health Care System case study for its cultural competency. Care management is just one of the many services offered by Montefiore Care Management. Montefiore Treatment Management provides services to help people with chronic illnesses live better lives, get the best possible care, better grasp their illness, and spend less time in the hospital or emergency room. To complete the study on Montefiore Medical Centre and its relationship to the essential components, the study will be discussed (Interpreting Services Program, 2022). Improving cultural competency will be a major topic of discussion, along with patient engagement and communication, health promotion and illness prevention, financial incentives and quality improvement, and some suggestions for implementing these. Customer service and patient happiness are two areas that need standard operating procedures. Patients in the local area get priority at Montefiore Medical Centre, which prioritizes them by hiring only the most qualified doctors and nurses and providing them with patient education materials and language services.
Engagement and Communication
Translation Services
Patients and their loved ones who are deaf, hard of hearing, deafblind, or otherwise restricted in their English skills may take advantage of the translation and interpretation services provided by the Montefiore Medical Center in New York City. The medical facility and its affiliated locations provide the services of various interpreters at no cost. According to Interpreting Services Program (2022), by calling a toll-free number, customers may talk with a qualified translator fluent in any of more than 150 supported languages. There are no established procedures for dealing with the situation when a language is not supported. However, workers are encouraged to bring up queries or problems with translating services. As stated by the Interpreting Services Program (2022), if healthcare systems manage population health in various situations effectively, all stakeholders must play a part. The primary role of physicians, nurses, and other healthcare team members is to provide patients with medical treatment and coordinate that care while also working to keep costs down and expand access.
Educational Resources
Consistency in care and treatment may be improved via patient education. Care managers at CMO help members with complicated situations get the care they need and connect with the organizations that can provide it. Montefiore helps patients social and economic lives by providing them with cutting-edge community programs. Even after patients have finished seeing their doctors, Montefiore keeps in touch to strengthen their intervention plans and ensure they continue to live healthy, productive lives. According to the provided case study, Montefiore has created educational resources to communicate with the varied requirements of the people according to cultural, linguistic, and educational backgrounds. Interpreters for the deaf and hard of hearing, American Sign Language (ASL) interpreters, text telephone (TTY) services, amplified telephones, closed captioning for television, and other auxiliary aids are also available (Interpreting Services Program, 2022). They also provide transportable, dual-handset phones with splitters to further facilitate conversation.
Training
The team at Montefiore is always being trained on new methods to expand services to underserved communities and expand opportunities for those already there. Montefiore Medical Center offers many allied and other healthcare professional educational programs for clinical healthcare professions independent of dentists, nursing, and medicine. Given that some of these occupations are more specialized, they should comply with national education and training requirements criteria and their professional area of practice. They cannot provide top-notch service if they havent received enough training. Their employees are obligated by law to provide reasonable accommodations for their patients and offer the necessary resources to ensure all patients communication needs are satisfied. To treat patients with complex medical and social needs, MMC personnel must go beyond the box of conventional medicine (Chwastiak, 2017). Candidates for residency programs are evaluated on their clinical expertise and potential to employ social medicine methods to address patients underlying social problems (Interpreting Services Program, 2022).
Gaps or Deficiencies
Montefiore has achieved financial and organizational sustainability due to its dedication to providing care via patient participation and communication. Care management is effective in reducing hospital readmissions for patients with chronic conditions. Chwastiak et al. (2017) claim that in patients discharged from the hospital, nurse phone calls are directed at identifying gaps in care and providing patient education. New research suggests that the pediatric department altered its internal practices to have the asthma controller medicines, and not simply rescue medication, administered and prescribed upon discharge rather than waiting for a follow-up visit from the main care physician, which caused the delay in commencing maintenance therapy, (Moore, & Ewa Szumacher, 2018). The readmission rates at the Childrens Hospital at Montefiore have dropped because of this initiative and provider education (Moore, & Ewa Szumacher, 2018). The dropping in admission might have been attributed to various factors. Montefiore Medical Centres Attending Service Medicine Division is the nations oldest and largest department dedicated to physician assistant care. This could have been attributed to the dropping in admissions of patients.
Health Promotion and Disease Prevention and Management Strategies
Lee et al. (2021) found that around 12% of Bronx adults have diabetes. The Montefiore Diabetes Leadership Group is an organization that promotes diabetes awareness and provides community-based nutrition and education initiatives Belyeu et al., 2017). Workers in the field of public service have collaborated with the local parks department to provide free memberships to people with diabetes. They have created educational materials that cater to the requirements of a wide range of demographics. They have collaborated with local organizations to encourage the growth of green markets throughout the Bronx and have opened weekly farmers markets to provide fresh produce to the area.
When it comes to clinical healthcare careers that arent dentistry, nursing, or medicine, Montefiore Medical Center has you covered with a wide range of allied and other healthcare professional programs. Some of these occupations are more specialized than others. Thus, national qualifications and education criteria must be met, as well as limits on what professionals can do in these fields. The goal of Montefiores To ones Health! Associate Fitnesss initiative is to foster a work environment that prioritizes employees emotional and physical health and motivates them to adopt a healthier way of life to serve their patients needs.
Disease Prevention
Besides encouraging healthy habits, MMC has also done excellent work in illness prevention. An estimated 40% of Bronx children are overweight or obese (Gelfand et al., 2020). To aid in the battle against obesity, certain educational institutions have launched public health campaigns encouraging low-fat milk in school lunches rather than high-fat milk. Because of the increased likelihood of contact with others, the homeless population is also at a greater risk of contracting infectious illnesses (Chwastiak, 2017). Most people in these situations are so preoccupied with meeting basic needs like food and shelter that they dont give much thought to their health, which may lead to delayed medical care, worsened conditions, and even death (Interpreting Services Program, 2022). Montefiore has set up mobile clinics at Bronx homeless shelters to offer on-site medical care for those with certain types of illnesses.
Non-Programmatic Services
Efforts are being made to improve healthcare, government, and social services separately. The Family Health Center is committed to hiring and retaining a diverse workforce, particularly those of Hispanic and Vietnamese descent, to serve the communitys cultural competence needs better ((Defining Health Promotion and Disease Prevention, 2018). This electronic health record for outpatients facilitates data collection and sharing among healthcare professionals.
Montefiore Care Management is a CMO that offers programs to help people living with complex diseases live better lives, get the best possible care, have a better grasp of their illness, and use medical facilities like hospitals and emergency rooms less frequently. Managers at CMOs ensure that members with complex ailments have access to the required treatment. Members of CMOs health plans who enroll in Complex Care Management have access to an Accountable Care Manager who coordinates care between the patient, the patients primary care physician, and any specialists the patient sees.
Gaps or Deficiencies
Integrating outpatient data into a single electronic health record is still an open problem. For Montefiore, this has been a very slow procedure. To get the most out of the system, it is necessary to educate employees and modify certain processes to meet data input, access, and reporting demands (Chase 2010). Due to its size and, in part, its complicated patient group, the leadership has not been able to locate an EHR that satisfies the demands of its complex system. Dr.Kalkut, Integration is key, and you cant find a HIT system that can address asthma, transplants, and other conditions that move across the delivery system. We have to build what we need ourselves.
Financial Incentives & Quality Improvement
Policies
Montefiore has enhanced the quality of care and treatment it offers by adopting a strategy for using health information technology. Due to its potential to improve patient care and security, this data system has been adopted by pharmacies, laboratories, hospitals, radiology centers, outpatient clinics, and even their data warehouse and patient portal (Chwastiak, 2017). Clinicians, nurses, physicians, and IT experts work together to find new methods to improve their information systems, leading to better treatment and greater patient safety.
Montefiore Medical Center has developed a patient-centered care system tailored to the specific needs of its low-income, vulnerable population regarding access, delivery, and information systems. As the Bronx is home to a diverse population, MMC has successfully attracted and retained employees of all ethnicities.
Patient-centered Approach
Health care at Montefiore is a community-based and patient-centered approach. Referring doctors are highly respected at Montefiore, collaborate closely with them to provide comprehensive care for our patients. Through a dedication to patient-centered treatment and attention to the communitys social needs and access issues, they are working to alleviate suffering among the most marginalized members of society (Belyeu, 2017). Using two primary care clinics that prioritize medical, administrative, and social efforts, MMC hopes to develop patient-centered medical homes Chase,2010). Dr.Steven Safyer, MMCs president and CEO, attributes the institutions success to its emphasis on the well-being of each individual patient and innovation, efficiency, breadth of specialized services, and patient-centered care. According to him, the company would rather concentrate on the patients needs than on the insurance they may or may not have.
The focus of patient-centered care is on the individuals experience as a patient rather than on predetermined standards of care (Chwastiak et al.,2017). They form a collaborative relationship with their doctors who treat them holistically (in all senses of the word): physically, mentally, socially, emotionally, spiritually, and monetarily. A persons actions directly result from
Strategies
Several methods have been used at Montefiore Medical Centre to reduce expenses and raise standards of care. Access to primary care and ambulatory care is being expanded to more parts of the population with the goal of better managing chronic conditions (Interpreting Services Program, 2022). One method for ensuring patients get consistent treatment, Montefiore, ensures an increase in the proportion of their population who visit the same providers. This method helps hospitals make better use of their intensive care unit beds by bringing critical care services closer to patients bedsides in other medical and surgical units (Belyeu et al., 2017). Care management at MMC uses a telehealth program and quality improvement initiatives to keep tabs on patients with long-term illnesses. The overall improvements in quality of life, efficiency, chronic illness management, and healthcare costs are much appreciated as a result of this breakthrough.
Improvements in asthma, diabetes, and heart disease treatment have resulted through telemedicine, telehealth, and clinics in schools and homeless shelters. Moreover, they have taken the lead in expanding their efforts to the whole community by collaborating with other local hospitals to share data (Defining Health Promotion and Disease Prevention, 2018). Some initiatives include setting up primary care clinics in schools and encouraging local businesses to provide better food options. Montefiores new pediatrics chairman, Phillip Ozuah, altered the institutions policies so that patients are given asthma medication before leaving the hospital rather than having them follow up with their primary care doctors.
Gaps or Deficiencies
The hospital is strengthening its weak spots, adapting to the specific requirements of its patients and the community, and refocusing its efforts on performance improvement. With the safety measures taken by the hospital, there are some areas in which the hospital has not put much effort into bringing the well conversant experts in telehealth programs. With telemedicine, for instance, yearly expenses for illness management have dropped by 32% (RHI Hub, 2018). After just a year of participation in the CMO, home calls program, hospital admissions, ER visits, and overall expenses were decreased by one-third for participating patients (Interpreting Services Program, 2022). The 30-day readmission rate was reduced from 19.9 percent to 13.2 percent after a group of patients over the age of 70 who had been discharged from the hospital received nurse calls to identify gaps in care and provide patient education. This study was conducted in 2009 and lasted only a few weeks (Chase,2010). Every new initiative undertaken by Montefiore Medical Center has been designed for the well-being of patients and the local community.
Recommendations
Cultural Competence
The continued recruitment and retention of minority employees and the provision of training to develop cultural awareness are two strategies that might assist in boosting MMCs cultural competency with patient involvement and communication. Marketing and advertising may be tailored to a particular culture, and patients loved ones and community members can be included in their healthcare decisions. To provide care sensitive to the patients values and beliefs, cultural competence necessitates a cultural assessment as the first step in developing a treatment strategy (Belyeu et al., 2017). Staff members who take the time to learn about their patients cultural backgrounds are better equipped to provide individualized treatment and see favorable results.
Health status
The goal of health promotion and illness prevention initiatives is to maintain a healthy population. Health promotion initiatives aim to empower individuals and communities to adopt positive lifestyle changes that reduce the prevalence of preventable illnesses. Communication aimed at increasing public knowledge of the need to lead healthy lifestyles is one method for advancing health promotion and illness prevention (Defining Health Promotion and Disease Prevention, 2018). Promotional activities may include newsletters, media campaigns, and health fairs.
Approach
Improving public health will lead to fewer unnecessary trips to the emergency room and save money overall. Adding nutrition lessons to their culinary demonstrations will benefit the communitys health as a whole (Defining Health Promotion and Disease Prevention, 2018). With this, consumers can locate nutritious food selections and develop better eating habits, lowering their risk of diabetes and obesity (Belyeu et al., 2017). Introduction of the new technologies will be essential in decreasing patients as they avoid unnecessary doctors appointments, urgent care center visits, and hospital stays. The hospital should develop a new approach to training programs to integrate all the current and old-fashioned technologies. When the above measures are implemented, they will be very effective and help the hospital handle urgent and complicated issues.
References
Belyeu, B., Chwastiak, L., Russo, J., Kiefer, M., Mertens, K., Chew, L., & Jackson, S. L. (2017). Barriers to engagement in collaborative care treatment of uncontrolled diabetes in a safety-net clinic. The Diabetes Educator, 43(6), 621630.
Chwastiak, L. A., Jackson, S. L., Russo, J., DeKeyser, P., Kiefer, M., Belyeu, B., Mertens, K., Chew, L., & Lin, E. (2017). A collaborative care team to integrate behavioral health care and treatment of poorly-controlled type 2 diabetes in an urban safety net primary care clinic. General Hospital Psychiatry, 44, 1015.
The healthcare industry typically draws sufficient attention to patients education, especially when it comes to representatives of minority groups. That is why the article by McCurley et al. (2017) offers valuable information. The researchers demonstrate that Hispanic individuals deal with improved diabetes prevention when they participate in individual and group face-to-face sessions (McCurley et al., 2017). I believe that there is an apparent reason why such positive outcomes are achieved. It seems that face-to-face interventions are effective because patients have an opportunity to ask questions if they require explanations. Simultaneously, such educational sessions demonstrate that a patient is not unique with such a health issue. As a result, such interventions can improve peoples morale, which, in turn, will lead to increased motivation to take preventive measures and protect health.
This information allows for supposing that face-to-face interventions can be suitable to my practicum project that considers measures to improve access to care among African Americans with heart failure diseases. However, the focus on patients cultural backgrounds should not lead to ignoring a broader context. This statement refers to the findings by Cajiita et al. (2017), who stipulate that the use of mobile technology in healthcare (mHealth) can promote better knowledge. These scholars focused on 129 older adults, and almost 25% were African Americans, to analyze whether mHealth leads to improved care (Cajiita et al., 2017). The use of mobile technologies can be as effective as face-to-face interventions because modern people spend more time online. That is why it is reasonable to rely on mHealth opportunities to improve access to care among African Americans. Finally, it is possible to suggest that combining mobile technologies and face-to-face educational sessions can result in the best outcomes.
References
Cajiita, M. I., Hodgson, N. A., Budhathoki, C., & Han, H.-R. (2017). Intention to use mHealth in older adults with heart failure. Journal of Cardiovascular Nursing, 32(6), E1-E7. Web.
In recent decades, the problem of diabetes has become more common and affects different age groups, from children to the elderly. Trends in improved medical care and the development of technology and medicine are certainly contributing to the reduction of the problem. However, diabetes is still an extremely serious health problem that should be given more attention.
Diabetes is a chronic disease that greatly impacts many bodily functions. The advancement of medicine and medical technologies has improved the quality of life for patients with a diagnosis, but there is still a lack of focus on combating the problem itself. Diabetes has increased from 108 million in 1980 to 422 million today (Forouhi 22). Diabetes is one of the leading causes of blindness, kidney failure, heart attacks, strokes, and lower limb amputations (Saeedi). Diabetes mortality increased by 3% by age group between 2000 and 2019 (Cole 378). Diabetes and diabetes-related kidney disease killed approximately 2 million people in 2019 (Harding 4). This suggests that the measures taken to combat the diabetes problem are insufficient.
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or the body cannot effectively use the insulin produced. The rising diabetes death rate among people under 70 underscores the need to focus more on the issue. Diabetes affected 8.5% of adults aged 18 and up in 2014 (Pettus 912). Diabetes was the direct cause of 1.5 million deaths in 2019, with 48% occurring before age 70 (Pettus 912). It should also be noted that not all diabetes-related deaths are recorded, as elevated blood glucose is responsible for many cardiovascular deaths.
All of the above indicates the seriousness of the problem of diabetes and insufficient attention to it. Improvement requires increased advocacy and awareness of risk groups and prevention among people to become familiar with the causes and ways to prevent diabetes. Bringing more organizations to the attention of the problem can be decisive in its improvement.
Works Cited
Cole, Joanne B., and Jose C. Florez. Genetics of diabetes mellitus and diabetes complications. Nature reviews nephrology, vol. 16, no. 7, 2020, pp. 377-390.
Forouhi, Nita Gandhi, and Nicholas J. Wareham. Epidemiology of diabetes. Medicine, vol. 47, no. 1, 2019, pp. 22-27.
Harding, Jessica L., et al. Global trends in diabetes complications: a review of current evidence. Diabetologia, vol. 62, no. 1, 2019, pp. 3-16.
Pettus, Jeremy, and Neil Skolnik. Importance of diabetes management during the COVID-19 pandemic. Postgraduate Medicine, vol. 133, no. 8, 2021, pp. 912-919.
Saeedi, Pouya, et al. Mortality attributable to diabetes in 2079 years old adults, 2019 estimates: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice, vol. 162, 2020.
A healthy lifestyle is a vital point for people living with chronic diseases. Modifiable behaviors such as diet and physical activity can significantly improve the patients quality of life and help control and maintain chronic illnesses. This paper will focus on exploring the existing body of knowledge to define what measures could be taken in the case of a patient who has chronic diseases of diabetes and asthma.
First, considering other valuable information about the patient, in this case, one should address the fact that the patients BMI indicates obesity. Obesity and asthma are commonly associated, and many comorbidity cases signal a close connection between inflammatory and metabolic processes and regulation (Miethe et al., 2020). The data suggests that in such cases of comorbid asthma and obesity, 5% to 10% weight loss can improve lung function and asthma control (Miethe et al., 2020). Therefore, the combination of dietary intervention and introduction to daily physical exercises can significantly improve the patients condition.
Dietary and exercise interventions focused on developing a healthy lifestyle reduce risks for other chronic diseases besides asthma, such as cardiovascular disease and diabetes. According to Kuder and Nyenhuis (2020), weight loss of 5 to 10% leads to a reduced level of medication needed for diabetes. In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
Lastly, even though there is no extensive research on the influence of dietary moderations in asthma, diet is inevitably a vital factor. A poor high-fat and low-fiber diet is often associated with asthma, as high-fat consumption causes inflammatory processes (Kuder and Nyenhuis, 2020). The recommendations for dietary interventions provided by Stoodley et al. (2019) include reducing sodium and fat intake increasing the fruits and vegetables in the diet. The exercise recommendations include 20-60 min of physical activity three to five days a week (Stoodley et al. 2019). Therefore, a healthy lifestyle for this patients specific case will require changes in diet and the introduction of regular physical exercises.
Diabetes is a significant public health challenge that affects millions of individuals worldwide. As a chronic condition, it also leads to costly treatment and impacts the countries economies. Diabetes occurs and develops in people of all ages and requires self-management for maintaining relatively healthy conditions. Such groups as young children, adolescents, or incapacitated adults might experience issues and health worsening caused by the lack of self-control (Rankin et al., 2018). Diabetes management can be especially difficult for teenagers because of the hormonal changes they experience and their parents involvement. This period is critical because it influences how adolescents would control their diabetes in the future and how their systems would develop.
Numerous studies of different designs have already been conducted to explore how adolescents deal with diabetes, and the results provided a foundation for further research. For instance, the range of their parents involvement in the self-management practices can be a crucial factor in treatment and control (Eva et al., 2018). A teenager might be better at developing a correct set of regulations and prevent diabetes from worsening without any interventions (Eva et al., 2018). Consequently, a research question would be How does the parents intervention influence an adolescents self-management with diabetes?. This paper aims to discuss the epidemiologic study design appropriate for exploring the selected question and analyze the potential data sources strengths and limitations.
Based on the question How does the parents intervention influence an adolescents self-management with diabetes? the study can be conducted in the experimental randomized trial design to achieve objective results. Furthermore, that type of research allows to compare approaches used in a population and isolate the effects from other influential factors (Flannelly et al., 2018). Dividing the participants based on the decreased and increased parental involvement and performing specific measures would be a profound methodology appropriate for an experimental study design (Friis & Sellers, 2021). The application of experimental study design with randomized groups can also be supported by the assumption that diabetes self-management is better executed without parents intervention.
Data sources for studying the question about the role of parents intervention in adolescents self-management include the previous qualitative and quantitative researches, interviews with participants, and diabetes control practices exploring. Moreover, information that provides insights about the selected population from a behavioral and psychological perspective would be helpful to develop the trial strategy before randomizing (Flannelly et al., 2018). Self-management approaches for diabetes include monitoring conditions, performing blood sugar tests, and controlling systems responses and tractions on foods or other external triggers (Rankin et al., 2018). The way adolescents and their parents deal with these practices is a data source for the experimental study that is crucial for considering limitations (Friis & Sellers, 2021). The strength of the recourses is that they have solid evidence behind them because of the numerous epidemiologic studies about diabetes conducted. The limitations are the subjective assumptions of participants and biases about the population that might influence the study results.
Diabetes requires continuous control and self-management, which can be challenging for adolescents. Their parents might severely influence the development of health controlling habits, and research can help support or deny that statement. The experimental randomized trial study design is the most appropriate because it provides a foundation to test a question and achieve objective results. Data sources for exploring diabetes are broad, and the limitations are related to biases about adolescents as a population.
Diabetes mellitus is a health complication involving an increase in the concentration in the concentration of blood sugar either due to a failure by cells to effectively respond to the production of insulin in the body, or as a result of no insulin production. Additionally, diabetes is related to irregular metabolism of food components such as carbohydrates, proteins, and fats (Wylie-Rosett 1998, p. 143). The high blood sugar levels are associated with several health complications such as polyuria, polyphagia, and polydipsia, which are recurrent. Therefore, Diabetes mellitus being a chronic disorder, there is the need to start disease management interventions to relieve the patients of unnecessary suffering (Beisswenger 2000, p. 95).
Diabetes management entails proper management of diet, physical exercising, and proper use of medications such as insulin among other counseling interventions. The process of managing diabetic patients may be hindered by other factors such as stress, co-morbidity complications and illnesses, which are unique to specific life stages. For instance, elderly individuals encounter numerous problems such as lowered appetites; poor and diminishing dentition; loss of weight; poor nutritional in-takes among other bodily disabilities, which may influence the deleterious complications of diabetes (Chau & Edelman 2001, p. 172). Beside, studies show that over 300 Million elderly persons will be diabetic by the year 2025. Most of these patients will be in the developing countries whereby they represent a 170% increase in incidence rates compared to about a 42% increment in most developed nations. In the elderly populations, diabetes affects individuals aged 45-64 years in most developing countries while in developed nations, those affected are aged 65 years and above. At this age brackets, many studies show that most individuals lead solitary lives characterized by poverty and poor nutritional care (Klein et al. 2001, p. 733; King, Aubert & Herman, 1998).
Furthermore, studies show that the first step in the management of diabetes entails controlling the blood sugar levels. Therefore, dietary intakes, which are composed of carbohydrates, proteins, and fats, form an integral part in diabetes management (Meneilly & Tessier 2001, p. 56). Assessment of the dietary content of diabetic patients is important because carbohydrates influence the levels of blood sugar and fats play a role in development of obesity and cardiovascular diseases, which are co-morbidity complications in diabetics. On the other hand, proteins are the major contributors of energy in diabetics relative to carbohydrates (Meneilly 1999, p. 239).
This essay presents an elaborate discussion on the health complications associated with uncontrolled and poor management of diabetes among older adults in addition to the potential implications of these complications on the daily activities of the patients. Additionally, most studies indicate that regulation of carbohydrate, fat, and protein diets play a significant role in diabetes management. In this essay, an extensive literature review is given relative to the efficacy of these dietary components in the management of the health complications and improvement of the quality of life among the diabetics.
Health Complications
When the blood sugar levels in the body are quite high, the ensuing condition is often referred to as hyperglycemia. This condition leads to a variety of health complications when it is prevalent in the body for a long period of time. These complications are attributed to the deleterious damages on the nerves, retina, kidney, and blood vessels. Therefore, at old age, the major health complications associated with diabetes include Diabetic retinopathy, Diabetic nephropathy, Diabetic neuropathy, Gastroparesis, Atherosclerosis, High blood pressure, Hypoglycemia, Diabetic Ketoacidosis, and Hyperosmolar hyperglycemic non-ketotic syndrome (Glasgow & Anderson, 1999, p. 2090).
The role of Diabetes and Dietary Components in the Etiology of the Health Complications
Diabetic Retinopathy (DR)
This is a health complication in which the tiny capillaries of the retina of the eye are damaged due to an increase in the concentration of blood sugar. This can lead to blindness. Besides, DR is the major cause of poor vision in the elderly persons aged 65 years and above. Over a long period of time, the high sugar levels can affect the eyes leading to swollen lenses and poor vision. In addition, diabetes enhances the development of cataracts and glaucoma, which are major risk factors that lead to blindness. Due to uncontrolled blood sugar levels in the elderly persons, severe cases of retinopathy occur in the persons aged 65 years and above (Coyne et al. 2004, p. 447).
Diabetic Neuropathy
This involves a neuropathic disorder associated with diabetes in which the micro-vascular blood vessels supplying blood to the nerves are affected. Additionally, the macro-vascular blood vessels can be affected leading to development of severe cases of the disorder. The disorder is characterized by numbness at the extremities, loss of sensation, and muscles weaknesses among other symptoms. As a result, four factors are cited in the pathogenesis of diabetic neuropathy. They include protein kinase C, micro-vascular disorder as well as the end products of advanced glycerate (Etzwiler 1997, p. 563).
However, the major pre-disposing factor in diabetic neuropathies is the micro-vascular disease. Here, some uncontrolled diabetic factors such as hyperglycemia and hyperlipidemia can change the microvasculature of blood vessels leading to vasoconstriction (Diabetes control and complication trial group 1993, p. 977). As vasoconstriction progresses, other neuronal dysfunctions and vascular disorders occur leading to thickening of the basement membranes, hypoxia, and neuronal ischemia. Finally, these pre-disposing structural and functional changes on the nerves and the blood vessels lead to the severity of diabetic neuropathy and neuronal damages.
Diabetic nephropathy
This is a diabetic complication affecting the kidneys leading to presence of proteins in urine. High and uncontrolled blood sugar levels are the major factors associated with development of diabetic nephropathy (Wylie-Rosett, 1998, p. 148). This condition occurs parallel to the prevalence of high blood pressure in a diabetic patient. As a result, the uncontrolled sugar levels cause the nephrons and the glomerulus to thicken and sometimes porous. Subsequently, other renal blood vessels are affected and severely destroyed leading to appearance of proteins in urine.
Atherosclerosis
In this disorder, the arteries are affected by the deposition of the fatty tissue on the inner walls of these blood vessels. Subsequently, the fatty matter solidifies, thickens, and finally narrows or completely blocks the blood vessels. Moreover, both the micro- and the macro-vascular blood vessels are affected by this condition (American Diabetes Association 2004, p. 15). However, if the coronary arteries are affected, the rate of blood flow to the heart is severely compromised leading to heart attacks, chest pains, high blood pressure, and stroke. The major predisposing factors in atherosclerosis include diabetes, obesity, and diets high in fats (Kahn & Porte 1997, p. 487).
The impact of the above-mentioned health complications on the daily activities of Diabetic patients
Diabetic retinopathy is a diabetic complication affecting the blood vessels of the eyes. Therefore, patients affected by this disorder have an increased probability of experiencing minor or advanced blindness. In addition, studies show that about 50-80% of diabetic patients are potentially predisposed to visual dysfunction and blindness (Madsen et al. 2002, p. 750). In a study conducted to explore the symptoms experienced by patients and the potential impact on the daily activities in patients suffering from diabetic retinopathy, it is shown that the disorder affects both the individual and social activities of the patients (Madsen et al. 2002, p. 751).
Additionally, the researchers note that the major symptoms experienced by diabetic retinopathy patients include difficulties in reading, inability to drive at night, and inability to participate in active sports and exercises. However, these symptoms vary relative to the level of severity in the patients (Campbell 1992, p. 414). Consequently, most diabetic patients at old age experience severe diabetic retinopathies, which are attributable to the heightened inabilities to carry out most diabetic management activities such as assessing nutritional information, exercising, preparing insulin injections, and the home-based glucose assessment and others (Testa & Simonson 1998, p. 1490). In addition, most patients experiencing low visual acuity are unable to accomplish various social responsibilities. Therefore, most elderly diabetic patients are social dependants and they hardly engage themselves in active physical activities such as walking around, sports and exercising.
Management of Diabetes in elderly patients
Most elderly persons are experiencing increased prevalence rates of diabetes mellitus. Besides, managing diabetes in these populations pose a variety of difficulties to physicians because most elderly diabetic patients suffer from complex health complications associated with advanced diabetic symptoms (Kahn & Porte 1997, p. 512). Additionally, elderly diabetic patients experience functional inabilities in terms of their individual and social activities. Therefore, dietary interventions and nutritional restrictions present the most appropriate intervention approaches in the management of diabetes mellitus (Musey et al. 1995, p. 483). In the elderly populations, the major dietary and lifestyle components considered in the management of diabetes include dietary fats, carbohydrates, and proteins.
The role of Dietary Carbohydrates in the Management of Diabetes
Most studies show that diabetes is a complication associated with impaired carbohydrate metabolism particularly due to its ability to alter the blood sugar levels directly. In addition, carbohydrates influence the rate of glucose absorption and clearance from the blood (DeFronzo & Ferrannini 1998, p. 683). This is called the post-prandial blood sugar response. Therefore, the source and variety of the ingested carbohydrates can affect the blood glucose concentration in many aspects. However, according to other studies, the impact of the type and origin of carbohydrates on the concentration of post-prandial blood sugar is a debatable issue (Sheard, Clark, Brand-Miller & Franz 2004, p. 2266). As a result, management of diabetes relative to the origin and variety of carbohydrates entails maintaining the concentration of blood sugar at a level comparable to the normal or near-normal concentrations.
Additionally, to categorize carbohydrate diets relative to their ability to increase or decrease the post-prandial blood sugar levels, most studies recommend that the glycemic indices and glycemic loads for different diets should be considered. The glycemic index shows the extent to which the blood sugar concentration changes after consumption of a carbohydrate meal. On the other hand, the glycemic load equals to the glycemic index of a carbohydrate meal multiplied by the total carbohydrates consumed per meal (Collier & ODea 2008, p. 944). Therefore, carbohydrate meals can be grouped into fast-releasing foods and slow-releasing foods. Furthermore, studies show that there is a direct correlation between increased glycemic indices and glycemic loads and the prevalence of diabetes mellitus type II. However, most other studies have failed to show this correlation.
Therefore, management of diabetes relative to the in-take of carbohydrate meals should consider the potential of the food component in terms of influencing the concentration of the post-prandial blood sugar levels. Thus, effective management of diabetes relative to carbohydrate diets does not entail restricted or decreased in-take of carbohydrates. This is because; carbohydrates are the major contributors of a huge portion of the energy required in the body. Besides, most researchers recommend that the daily carbohydrate in-take in diabetic patients should be 45-65% of the total caloric in-take to avoid a burst in the glycemic response and hyperglycemia, which is a risk factor in most metabolic and health complications associated with diabetes.
The role of proteins in the management of diabetes
To accurately determine the daily allowance for dietary proteins in the management of diabetes, most studies note that the potential benefits of proteins in the body, the role of proteins in controlling diabetes, and the diabetic health complications associated with proteins should be considered (Wylie-Rosett 1998, p. 143). Therefore, the main objective in recommending proteins for diabetes management entails determination of dietary levels of proteins that achieves the control, prevention, and delay of diabetic health complications associated with dietary components such as fats, carbohydrates, and proteins.
On the other hand, it is notable that the main function of dietary proteins in the human body is to maintain normal growth of tissues. However, proteins are also essential in regulating the blood sugar levels besides playing a major role in the development of diabetic health complications. Moreover, studies show that almost 50% of the dietary proteins are availed in blood as glucose (Wylie-Rosett 1998, p. 145). In addition, dietary proteins can influence the rate of insulin secretion and other counter-regulatory hormones such as epinephrine and glucagon.
It is also imperative to note that one-third of diabetic patients suffering from type II diabetes mellitus and an additional one-fifth of individuals suffering from type I diabetes mellitus are greatly susceptible to diabetic nephropathy within the first 15 years after their first diagnosis. However, clinical studies note that restriction of protein in-take can help to slow down the rate of progression of the kidney disorder (Wylie-Rosett 1998, p. 148). Despite of the high statistical significance in these findings, additional studies are required to determine the predisposing risk factors in diabetic nephropathy relative to protein diets. In addition, the findings fail to show how protein restriction can influence the course of the kidney disease.
However, increased protein and carbohydrate diets are implicated in the Kidney disease because their presence impairs the functions of the kidneys. Additionally, it is notable that most elderly diabetic patients suffer from severe organ dysfunctions associated with diabetes. Therefore, to effectively manage diabetes and improve the quality of life in the elderly populations, researchers note that dietary proteins should provide 12-20% of the total calories required by the body. This infers that for elderly persons, the daily recommended dietary protein allowances contain 0.8g/kg of body weight (Wylie-Rosett 1998, p. 151).
The role of dietary fats in diabetes management
The main problem associated with recommending dietary fatty acids in the management of diabetes is that the appropriate dietary fat allowances for diabetic patients cannot be extrapolated from those recommended for normal individuals. Besides, the incidence rates of diabetes are directly related to the concentration of n-6 fatty acids relative to that of the n-3 fatty acids (Berry 1997, p. 991). Therefore, the significance of fatty acids in the management of diabetes entails regulating the levels of n-3 and n-6 fatty acids in the patients diet. This approach is important because most studies note that n-3 fatty acids can lower the levels of triacylglycerol and high blood pressure thereby improving the health and metabolic complications associated with insulin resistance (Mollard, Gillam, Wood, Taylor & Weiler 2005, p. 499). On the other hand, n-6 fatty acids greatly affect the control of glycemic responses in some patients suffering from type II diabetes mellitus. Moreover, n-6 fatty acids can lower cholesterol levels in the body while increasing the rate of lipoprotein oxidation (Segal-Isaacson, Carello & Wylie-Rosett 2001, p. 161).
Additionally, studies show that in the presence of transition metals such as Iron and Copper, glucose generates free radicals that play a major role in the destruction of the pancreas and hinders the process of glycosylation that influences the NO-mediated relaxation of the smooth muscles (Collier & ODea 2008, p. 941). The effect of glucose on smooth muscles can be controlled through consuming fish oil, which contains high levels of mono-unsaturated fatty acids (MUFA). In addition, the same studies note that diets high in carbohydrates and low fats can increase the progress of hypertriglyceridemia, a condition that partially leads to atherosclerosis (Haffner 1998, p. 160). Therefore, diets rich in MUFAs can influence the level of lipids in the body and increase the antioxidant properties of most dietary components that aid in regulating lipoprotein oxidation. However, these studies fail to show the impact of high MUFA in the progress of obesity, which is a risk factor in diabetes (Madsen et al. 2002, p. 742).
Overall, to achieve effective diabetes management and improvement of the quality of life in diabetic patients relative to dietary allocations, it is advisable to individualize the dietary carbohydrate and fat allowances so that the control of glucose and fat concentrations match with other diabetes management interventions such as maintenance of appropriate lifestyles, limiting smoking, exercising, and regulating blood pressure. In addition, modification of fatty acids in the body can be encouraged through allocation of balanced diets containing different types of poly-unsaturated fatty acids (PUFA) and antioxidants among other food components.
Conclusion
The essay elaborates on the various health complications associated with diabetes and the poor control of diabetic factors in the elderly diabetic patients. From the discussions above, most diabetic patients are bound to suffer from various health complications such as diabetic neuropathies and diabetic nephropathies among other metabolic complications. In addition, these complications can have adverse effects on the daily activities of most patients. For instance, diabetic retinopathy leads to blindness, poor reading abilities, inadequate exercising, and poor nutrition.
Subsequently, the essay notes that most elderly individuals suffer from various functional disabilities that hinder effective management of diabetes such as preparation of insulin injections and assessing nutritional instructions. Therefore, nutritional interventions form an integral part in the management of diabetes in the elderly persons. This entails regulation of the carbohydrate, protein, and the fatty acid composition of the daily recommended dietary allowances for diabetic patients. This approach is imperative because the three dietary components play a major role in aggravating or controlling the health implications associated with uncontrolled diabetes.
Reference List
American Diabetes Association 2004, Standards of medical care for patients with diabetes mellitus, Diabetes care, vol. 27, no. 1, pp. 15-35.
Beisswenger, PJ 2000, Type 1 diabetes. In Medical Management of Diabetes Mellitus, Marcel Dekker Publishers, New York.
Berry, EM 1997, Dietary fatty acids in the management of diabetes mellitus, The American Journal of Clinical Nutrition, vol. 66, pp. 991-997.
Campbell, S 1992, Diabetes: recognizing symptoms, preventing complications, Am Pharm., vol. 32, pp. 414-18.
Chau, D, Edelman, SV 2001, Clinical management of diabetes in the elderly, Clinical Diabetes, vol. 19, no. 4, pp. 172-175.
Collier G & ODea K 2008, The effect of congestion of fat on the glucose, insulin, and gastric inhibitory polypeptide responses to carbohydrate and protein, Am J Clin Nutr vol. 37, pp. 941944.
Coyne, KS, Margolis, MK, Kennedy-Martin, T, Baker, TM, Klein, R, Paul, MD & Revicki, DA 2004, The impact of diabetic retinopathy: perspectives from patient focus groups, Family Practice, vol. 21, no. 4, pp. 447-453.
DeFronzo, RA & Ferrannini E 1998, Influence of plasma glucose and insulin concentration on plasma glucose clearance in man, Diabetes, vol. 31, pp. 683688.
Diabetes control and complication trial group 1993, The effect of intensive treatment of diabetes on the development and progression of long- term complications in insulin- dependent diabetes mellitus, N Engl J Med, vol. 329, pp. 977- 86.
Etzwiler, DD 1997, Chronic care: a need in search of a system, Diabetes Educ., vol. 23, 569- 73.
Glasgow, RE, Anderson, RM 1999, Diabetes care: moving from compliance to adherence is not enough: something entirely different is needed, Diabetes care, vol. 23, pp. 2090-7.
Haffner, SM 1998, Management of dyslipidemia in adults with diabetes, Diabetes Care, vol. 21, pp. 160178.
Kahn, SE & Porte, D Jr. 1997, The Pathophysiology of type II (non- insulin dependent) diabetes mellitus: Implications for treatment, Diabetes Care, vol. 2, no.1, pp. 487- 512.
King, H, Aubert, RE, Herman, WH 1998, Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections, Diabetes care, vol. 21, pp. 414- 31.
Klein, R, Moss, SE, Klein, BEK, Guiterrez, P & Mangione, CM 2001, The NEI-VFQ-25 in people with long term type 1 diabetes mellitus: the Wisconsin Epidemiologic Study of Diabetic Retinopathy, Arch Ophthalmol, vol. 199, pp. 733740.
Madsen, L, Guerre-Millo, M, Flindt, EN, Berge, K, Tronstad, KJ, Bergene, E, Sebokova, E, Rustan, AC, Jensen, J, & Mandrup, S et al, 2002, Tetradecylthioacetic acid prevents high fat diet induced adiposity and insulin resistance, J. Lipid Res., vol. 43, no. 5, pp. 742 750.
Meneilly, GS 1999, Pathophysiology of type 2 diabetes in the elderly, Clin Geriatr Med, vol. 15, pp. 239253.
Meneilly, GS and Tessier, D 2001, Diabetes in elderly adults, J Gerontol Med Sci, vol. 5, no. 13, pp. 56-65.
Mollard, RC, Gillam, ME, Wood, MT, Taylor, CG, & Weiler, HA 2005, Fatty Acids (n-3) reduce the release of prostaglandin E-2 from bone but do hot affect bone mass in obesity, J. Nutr., vol. 135, no. 3, pp. 499 504.
Musey, VC, Lee, JK & Crawford, R et al. 1995, Diabetes in urban African- Americans. Cessation of insulin therapy is the major precipitation cause of diabetic ketoacidosis, Diabetes Care, vol. 18, pp. 483-9.
Segal-Isaacson, CJ, Carello, E & Wylie-Rosett, J 2001, Dietary fats and diabetes mellitus: is there a good fat? Current Diabetes Reports, vol. 1, no. 2, pp. 161-169.
Sheard, NF, Clark, NG, Brand-Miller, JC & Franz, MJ 2004, Dietary carbohydrate (Amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association, Diabetes Care, vol. 27, no. 9, pp. 2266-2271.
Testa, MA & Simonson, DC 1998. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus, JAMA, vol. 280, pp. 1490- 96.
Wylie-Rosett, J 1998, Evaluation of protein in dietary management of diabetes mellitus, Diabetes Care, vol. 11, no. 2, pp.143-148.
