Category: Diabetes

Introduction

The health of any population depends on various factors, such as genetics, environment, economy, psychosocial aspects, and overall lifestyle tendencies. Consequently, epidemiological research about diseases must view the issue from several perspectives simultaneously to achieve considerable results. Diabetes, as one of the most significant modern health challenges, is the case where observational studies consider different conditions, their correlations, and consequences. Moreover, disease development and prevention vary for individuals with specific genetic, socioeconomic, and environmental circumstances; therefore, evidence-based research requires narrowing the topic to a particular population (Chow et al., 2018). For instance, diabetes management is commonly performed under parental surveillance, overuse of which can lead to a lack of self-control in adolescence, worsening the chronic conditions (Eva et al., 2018). This paper aims to discuss how epidemiological research can be applied to study how the parents’ intervention influences an adolescent’s self-management with diabetes.

The Problem

Diabetes is a widespread disease in many countries and populations, including the United States, and it severely influences national mortality rates. As the condition is chronic, has a genetic predisposition, and can be triggered by numerous environmental factors, individuals can develop it early on (Chow et al., 2018). Furthermore, diabetes requires continuous control, and adults are involved in supporting their child’s well-being. In a home environment where parental intervention is considerable, a young individual with diabetes might maintain comfortable blood sugar levels, timely receive medication, and stay safe from environmental agents. However, as adolescence begins, parents’ authority decreases, and the aspiration to be independent can reveal that a teenager lacks self-management skills and control over their diabetes (Rankin et al., 2018). The issue appears due to the intense parents’ intervention during childhood and the risk-absent home environment.

Person

Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents rate emphasizes the severity of the population’s health problem. Today people can easily access numerous variations of unhealthy foods, have a sedentary lifestyle, and delay medical checkups due to the costs of healthcare services. Consequently, a modern person lives at a high risk of diabetes, and individuals who already have this chronic illness are in danger of worsening their health. Genetic predisposition contributes to approximately 60% of susceptibility by affecting insulin processing and chromosomes, and the deviation is hereditary (Gamboa et al., 2017). Moreover, diabetes development is tied to environmental agents such as air pollution, low-quality water, unhealthy diet, frequent stress, vitamin deficiency, and decreased physical activity (Gamboa et al., 2017). Most individuals have at least two of these external triggers in their lifestyle, increasing the risk of illness occurrence.

Diabetes requires self-management, and adolescents are the population with the most challenging situation around controlling their conditions. Indeed, hormonal changes, desire to socialize and difficulties in relationships with adults can have severe outcomes (Rankin et al., 2018). However, controlling skills taught by the parents during childhood and providing children with sufficient independence to learn self-management can considerably help adolescents deal with diabetes. As the selected age is transformative for a person, the outcomes of poor self-support traits might lead to severe consequences in the future.

Place

Diabetes is a national healthcare challenge in the United States due to its economic cost and influence on mortality rates. Indeed, 10% of the US population have diabetes, and 34% have pre-disease conditions (Centers for Disease Control and Prevention [CDC], 2020). Different cultures, ethnicities, and racial groups live in the United States, and this circumstance complicates disease treatment and prevention. A diverse population does not have a unified set of genetic predispositions, people live in dissimilar environments, and although the place is the same country, the external agents and risks vary (Gamboa et al., 2017). Adolescents who live in households with low socioeconomic conditions or have an unhealthy atmosphere in their families can lack the ability to properly self-manage their diabetes.

Time

Modern prevention and treatment technologies continuously improve; however, diabetes remains a significant challenge for healthcare services nationwide. Moreover, the COVID-19 pandemic complicates chronic disease management and limits resources by forcing facilities to prioritize the infection spread (Cardona‐Hernandez et al., 2021). Adolescents, among other diabetics, must improve their self-management approaches and integrate them with the COVID-19 prevention regulations. The recent times’ circumstances are also challenging to address by the parents whose worries increase and can cause more intense control over their children with diabetes.

The Problem’s Magnitude

Millions of citizens of diverse cultural and racial backgrounds have diabetes or have risks increasing lifestyle and environment. CDC (2020) states that “210,000 children and adolescents younger than age 20 years—or 25 per 10,000 US youths— had diagnosed diabetes” (para. 4). Moreover, the trend of growing incidence in the selected age group exists, specifically among Hispanic and African American populations (CDC, 2020). Considering that adolescents are the country’s future, and the rates of diabetes tend to grow, the magnitude of the problem is immense. Teenagers’ ability to maintain optimal conditions through self-management is crucial for making the next generations healthier.

Research Question

Most health-related habits and conditions maintenance attitudes are developed during childhood, yet the parents of children with diabetes might severely influence the process. Adolescence is the period when self-management is the most challenging due to hormonal and psychological changes; therefore, teenagers without solid disease control habits might worsen their conditions (Rankin et al., 2018). Based on the data research and the problem’s identification, the research question can be “How does the parents’ intervention influence an adolescent’s self-management with diabetes?”

Research Methods

Epidemiologic Study Design

Self-management of adolescent diabetics and their parents’ control can be explored via an epidemiologic study. The observational design would provide a significant scope of data to assess from various perspectives and make a foundation to develop approaches for addressing the selected population’s health problem. Epidemiologic studies are commonly separated on cohort, cross-sectional, and case-control, and the appropriate format must be identified based on the type of data necessary for achieving results answering the initial question (Friis & Sellers, 2021). The third type of research design is the most appropriate for assessing self-management challenges among teenagers with diabetes. Case-control studies require dividing a population into groups, doing experiments, and driving conclusions based on the outcomes of implementations (Friis & Sellers, 2021). Indeed, separating the adolescents according to their parent’s involvement range in controlling diabetes is beneficial to admit or deny the research question.

Adolescents’ ability to properly manage their diabetic conditions is the outcome of past activities of their parents. The case-control epidemiologic study design is suitable for conclusions based on retrospective information (Friis & Sellers, 2021). Experiments on the groups are necessary to admit the parental intervention’s influence on how teenagers deal with self-management. Besides, the observational study design is beneficial for identifying certain distinctions between attitudes of diabetics, and further studies would use the data for developing the most effective diabetes control strategies for adolescents.

Assessment Strategies

The assessment strategy is crucial for pointing out the study direction, selection of tools, and data collection approaches; therefore, it must comply with the research design and question. Families with identified low levels of past parental intervention in diabetes management for the case-control structure can be selected as a control group. Furthermore, to exclude other factors such as genetic predisposition to specific conditions of the disease, adolescent changes, and cultural backgrounds, no representatives of specific ethnic populations or ages must dominate any group (Belbasis & Bellou, 2018). Tools such as surveys and questionnaires would be used for the selection to help researchers gather sufficient information to divide the participants (Belbasis & Bellou, 2018). Methods where communication with participants is included, are convenient for the case-control study because they allow the data collection process and retrieve crucial details that might influence the entire research.

A case-control study of the interdependence between parental control and adolescents’ diabetes self-management would benefit from including experiments. For instance, the same strategies for communication can be offered to the parents to influence their relationships with children. On the other hand, teenagers can be offered to learn a new self-management approach to dealing with diabetes. Participants who obtain the novel strategy faster and more effectively would be considered more capable of controlling their conditions (Gamboa et al., 2017). The experimental section of the study would require surveying before and after the activity and observation of the tasks’ performance (Friis & Sellers, 2021). The range and diverse basis of tools might become inconvenient for researchers because such a program is time-consuming. However, the scope of data obtained from communicating with participants and observing them during the experiment is significant for the results verification.

Data Collection Activities

Data collection for the case-control study must be performed on different research studies. The initial segmentation, basic information, and identification of parents’ intervention assessment require surveys and interviews. The former can be performed remotely and is necessary to identify participants’ backgrounds and exclude the specific conditions of the children’s diabetes (Parast & Paknahad, 2017). Interviews would benefit from being conducted in an in-person format and would help evaluate the level of parents’ involvement in the disease management and understand how adolescents perceive the control approaches of their families. After the experiment part of the research, the questionnaires about the experience can be distributed among participants to reveal the patterns in the reactions and make conclusions (Belbasis & Bellou, 2018). Researchers might require implementing tagging, categorizing, or coding the collected information to optimize further analysis and notice tendencies or changes during the study.

Conclusion

Diabetes is a chronic disease that demands daily control and self-management, which cannot be successfully performed without proper habits development. Most conditions maintenance attitudes are developed during childhood, yet the affected children’s parents might severely influence the process, and epidemiologic research can support or deny that statement. Adolescence is the period when self-management is the most challenging due to hormonal and psychological changes; therefore, teenagers without solid diabetes control habits might worsen their conditions. The case-control study design is the most appropriate because it provides a foundation to test a question and achieve objective results. Participants would be surveyed, divided into two groups, and the experiments related to the parents’ communication approaches and adolescents’ learning capabilities would be performed. Data collection tools would include interviews, questionnaires, surveys, and observations during the experimental activities part of the study. The research results would offer evidence for identifying how the parents’ intervention influences an adolescent’s self-management with diabetes.

The Intervention

The intervention strategies to address the problem of parents’ influence on diabetes self-management among adolescents depend on the selected epidemiological study design. The observational framework is beneficial because it results in a considerable scope of data crucial to set a foundation for developing population health problem addressing approaches. A case-control format of an epidemiological study is applicable for assessing self-management challenges among teenagers with diabetes (Friis & Sellers, 2021). Adolescents’ ability to properly manage their diabetic conditions is the outcome of past activities of their parents.

The results of a case-control study about the parent’s influence on adolescents’ self-management with diabetes suggest that both involved sides need to be affected to make a significant change. Consequently, the interference must address the parental control attitudes and the children’s perception of their conditions. The common public health interventions based on the descriptive case-control studies are related to screening, vaccination recommendations, nutritional pattern updates, or behavioral changes (Friis & Sellers, 2021). The latter is appropriate for influencing adolescents’ self-management because the activities requiring revision are habitual. Besides, parents’ attitudes towards controlling and assisting their children with diabetes are also tied to routine actions they developed.

Behavioral public health intervention contains promotional and educational programs created to influence individuals’ attitudes toward preventing disease outbreaks or decreasing mortality. For instance, the diabetes-related media campaigns address the scientifically-approved connection between habitual consumption of sugary products and the risk of getting ill by promoting healthier ways of acting (Eva et al., 2018). The selected health challenge is based on a specific and reachable audience – adolescents and their parents- so the educational intervention is more appropriate than the promotional. The set of consultations, helpful guidelines, and access to professional diabetes-related practitioners would be included in the influential strategy (Eva et al., 2018). The most appropriate intervention, based on the results of the case-control study suggesting that parents’ influence on their children’s self-management attitudes is significant, is to create an educational program. The intervention’s outline must contain methods for evaluating the problem’s significance in a certain family, types and descriptions of activities, their influence on parents and adolescents, and the minimal results to achieve.

The Intervention Outline

Problem Assessment Methods

Families have diverse relationships and values, and the case-control study’s results revealed that how parents interact with their children significantly influences diabetes self-management attitudes. Consequently, assessing how difficult communication is and how strong the supervision of adolescents is necessary for selecting the proper interventional strategy. The methods must contain the benchmarks to identify if there are severe interaction issues that require psychologists’ interference and understand who primarily needs the intervention – a child or parents (Friis & Sellers, 2021). The first method is reviewing the diabetes history in a family to retrieve the patterns and register when the crisis conditions occurred. The second strategy is to interview the participants separately to reveal if the adolescent has severe self-management issues and if the parents have developed harmful controlling attitudes (Carpenter, DiChiacchio, & Barker, 2019). The last approach is to ask the participants to describe how diabetes management is performed to understand if they are aware of the proper practices.

Interventional Activities

Behavioral public health intervention, when performed through educational programs, can contain multiple activities performed separately or simultaneously. The most influential approach is to develop lectures for parents who have pre-adolescent children with diabetes and include them in the required treatment strategy (Felix et al., 2020). For instance, educational meetings can be conducted at local healthcare facilities, and attending them must be necessary. Interventional activities for adolescents should contain educational handouts about self-management standards to follow for maintaining stable conditions. The children need to receive a consultation with a psychologist who would describe to them when personal boundaries can be established and how to improve communication with the parents (Felix et al., 2020). Furthermore, educational intervention requires specialists to develop and distribute materials about the importance of proper diabetes management.

Influence on Parents

How the public health intervention would influence, all the individuals involved is included to an outline to help the responsible specialists timely revise and improve the quality of the program. The educational campaign must help the parents develop the correct attitude towards controlling their pre-adolescent and adolescent children (Eva et al., 2018). Consequently, the intervention needs to include several checking activities, such as consultation for parents (Carpenter et al., 2019). Besides, the program can contain brochures developed based on the most frequent questions and crisis situation descriptions to help the parents deal with difficulties.

Influence on Adolescents

Adolescents who have already developed severe habits for their diabetes self-management might protest against one’s intervention in their life. Showing the example through role models or tailoring the message about the harmful consequences of self-mistreatment to them are crucial (Eva et al., 2018). Also, adolescents might experience difficulties at school or be abused, thus, consultations with trustworthy specialists are required for the program (Eva et al., 2018). For instance, local administration can assign psychologists to each pediatric clinic’s diabetes department to selected address the population’s health problem.

Minimal Expected Results

The intervention’s expected results must be included in the outline to define and adjust the educational program’s efficiency. Indeed, the minimal outcomes can be divided into three groups: adolescents’ self-management quality, changes in parents’ behaviors, and overall family situation (Carpenter et al., 2019). The first can be considered achieved if a child controls their diabetes without additional stress or parental interference. The changes in parents’ attitudes can be positively evaluated if their lack of influence on self-management does not lead to diabetes conditions. Lastly, the family situation evaluation can reveal the positive impact if the disease of a child does not influence the relationships. To retrieve and analyze the minimal expected results, a descriptive case-control study is necessary to be conducted, and the intervention is then revised based on the new results.

Literature Review

The interventions that have already been developed to improve self-management suggest that life with diabetes can become comfortable if individuals learn to control their conditions properly. Indeed, one study reviewed the family-based interventions targeting improvements in health and family outcomes and revealed the positive impact on children’s conditions and management attitudes (Feldman et al., 2018). The research was primarily based on glycemic control-related procedures, and the outcomes of educating the people about proper practices were family-centered (Feldman et al., 2018). Awareness of all members about diabetes management improved the relationships between them and made an affected adolescent feel more confident and comfortable.

Another study explored how the educational intervention targeted to the parents of adolescents with diabetes impacts the latter’s conditions. Felix et al. (2020) claim that “diabetes self-management education (DSME) programs that engage the families of patients with diabetes have shown to be effective in improving diabetes-related outcomes of the patients” (p. 121). The study’s results also revealed that the parents tend to have low attendance in the program’s sections dedicated to their own health and well-being (Felix et al., 2020). Lastly, the interventions aimed to educate the adolescents about proper diabetes self-management were studied based on the patients’ self-care attitudes (Eva et al., 2018). The studies suggested that young people’s habits can be influenced to receive better health outcomes and improve their lifestyle.

The Impact

The way parents comply with their pre-adolescent children’s diabetes control significantly influences the attitudes which will be asserted during adolescence. Chronic disease self-management is crucial for each individual because it impacts their quality of life, thus, the correct habits must be developed (Felix et al., 2020). The outcomes of the intervention start from the improvement of one’s life and expand to the entire society, where families learn how to deal with diabetes, and the affected adolescents do not experience severe issues.

Health Outcomes

The health outcome of the behavioral intervention based on educational programs for adolescents and their parents is if the former would become independent in their diabetes control. Furthermore, the proper self-management strategies obtained and applied to the daily practice by the affected individuals would be a significant improvement (Carpenter et al., 2019). Lastly, family relationship improvement and the ability of adolescents to set boundaries is an important mental health outcomes expected from the intervention.

Social Impact

The social impact of the intervention, which addresses the problem of parental influence on diabetes self-management among adolescents, can be viewed from three perspectives. Firstly, the quality of relationships in a family is critical for the overall situation in society, and improvements in this aspect are beneficial for populations’ well-being (Felix et al., 2020). Secondly, support and proper education is given to adolescents can help raise a mentally and physically healthier generation and profoundly influence the future of a nation (Friis & Sellers, 2021). Lastly, the increased attention to chronic diseases such as diabetes impacts society as it forces the government and healthcare providers to enhance the prevention measures.

Conclusion

Diabetes-related intervention to address the population health problem of parents’ influence on adolescents’ self-management must impact the behaviors and habits of the involved individuals. The most appropriate method is the education with integration of programs, lectures, brochures, and consultations. Addressing the diabetes control problem is impactful for personal health and society. Indeed, the knowledge about proper self-management of a chronic condition improves one’s quality of life, and the changes in family relationships are crucial for making a population healthier mentally and physically.

References

Belbasis, L., & Bellou, V. (2018). Introduction to epidemiological studies. Genetic Epidemiology, 1-6. Web.

Cardona‐Hernandez, R., Cherubini, V., Iafusco, D., Schiaffini, R., Luo, X., & Maahs, D. M. (2021). Children and youth with diabetes are not at increased risk for hospitalization due to COVID‐19. Pediatric Diabetes, 22(2), 202-206. Web.

Carpenter, R., DiChiacchio, T., & Barker, K. (2019). Interventions for self-management of type 2 diabetes: An integrative review. International Journal of Nursing Sciences, 6(1), 70-91. Web.

Centers for Disease Control and Prevention. National diabetes statistics report, 2020. Web.

Chow, C. K., Ramasundarahettige, C., Hu, W., AlHabib, K. F., Avezum Jr, A., Cheng, X., & Yusuf, S. (2018). Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study. The Lancet Diabetes & Endocrinology, 6(10), 798-808. Web.

Eva, J. J., Kassab, Y. W., Neoh, C. F., Ming, L. C., Wong, Y. Y., Abdul Hameed, M., Hong, Y. H., & Sarker, M. M. R. (2018). Self-care and self-management among adolescent T2DM patients: a review. Frontiers in Endocrinology, 9, 489. Web.

Feldman, M. A., Anderson, L. M., Shapiro, J. B., Jedraszko, A. M., Evans, M., Weil, L. E., Garza, K. P., & Weissberg-Benchell, J. (2018). Family-based interventions are targeting improvements in health and family outcomes of children and adolescents with type 1 diabetes: A systematic review. Current Diabetes Reports, 18(3), 1-12. Web.

Felix, H. C., Narcisse, M. R., Long, C. R., & McElfish, P. A. (2020). Effects of a family diabetes self-management education intervention on the patients’ supporters. Families, Systems, & Health, 38(2), 121. Web.

Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6^th ed.). Jones & Bartlett.

Gamboa, C. M., Colantonio, L. D., Brown, T. M., Carson, A. P., & Safford, M. M. (2017). Race‐sex differences in statin use and low‐density lipoprotein cholesterol control among people with diabetes mellitus in the reasons for geographic and racial differences in stroke study.Journal of the American Heart Association, 6(5), e004264. Web.

Parast, V. M., & Paknahad, Z. (2017). Antioxidant status and risk of gestational diabetes mellitus: a case-control study. Clinical Nutrition Research, 6(2), 81-88. Web.

Rankin, D., Harden, J., Barnard, K., Barth, L., Noyes, K., Stephen, J., & Lawton, J. (2018). Barriers and facilitators to taking on diabetes self-management tasks in pre-adolescent children with type 1 diabetes: a qualitative study. BMC Endocrine Disorders, 18(1), 1-9. Web.

Advocacy Tool

Diabetes is a significant health issue that is facing most American adults in the United States. Disability among seniors is also a significant concern for improved healthcare (Trewin et al., 2019). Older adults in the US find it difficult to live with this condition as it involves daily medication. This document discusses advocacy tools to deal with this challenge, showing procedures taken to develop and implement the proposed actions.

Advocacy tool refers to the channel used in reaching the target, who was the United States president. Two tools were used, including sending out a letter and creating a call centre script. Writing a letter included pointing out the significant benefits of passing the bill and highlighting some policies which needed change. I selected this tool since it targets the primary person responsible for implementing and enforcing the accounts that have been passed. He can therefore look into the existing gaps and make necessary changes for the benefit of most people.

A call center script gives ethical guidance to be followed when communicating with important government officials. This tool is effective to avoid conflicts that may occur during the interactions. It reduces errors while speaking, and they provide the officials with answers to guide the citizens efficiently and accurately. Respect is seen, and the official’s morale and efforts to serve the citizens improve.

Steps Taken to Develop and Implement the Action

To communicate with the US president on issues concerning the diabetes bill, I followed the following steps. The first and most crucial procedure was to identify me as a constituent. This is because politicians and other government officials prefer to reply to such emails. I wrote my significant points and tried to summarize them to avoid ambiguity. My position in the health care facility was stated for easy understanding of the considerable concern being addressed. I used polite language to reduce the chances of sounding rude. Facts were used in handling the presidents to avoid exaggerations and lies. The message sent was timely and strict to the content for quicker response. To ensure the implementation and consideration of my plea, I sent a copy of the letter to the government officials so it could reach the president.

Tool-Related Materials Used to Communicate With the President

Online channels like the White House websites checked letters to pass information to the presidents. I used the phone numbers provided online to write my comments and concerns on the bill amendment. Messages were also written to the congresspersons who were addressing the president. They are responsible for passing this information to the president since they represent him. I used testimonials in public gatherings where the president was invited as the primary guest of honor. Lastly, I used the petition approach, which involved sharing my ideas with other members of the public. The white house officials were contacted to comply with my opinions and inform the president.

Advocacy Letter

Dear President,

As one of the social workers in a health facility, I am writing to request your support of Bill S. 3665, passed on 03/31/2022 on the Affordable Insulin Now Act. The bill aims at limiting the cost-sharing of insulin between the Medicare prescription drug benefit and private health insurance (Warnock 2022). This bill will support many residents, especially the ageing, who find it hard to control this condition (Knox, 2020). Since creating awareness is essential in curbing diabetes, this bill will facilitate the education of the aging on diabetes preventive measures. The bill advocates for a monthly supply of insulin-covered products at a 25% negotiated price, even for the private sector. It will also help the local community improve hospital care services.

From my perspective, I feel that some of the policy changes can be beneficial if accompanied by the bill. The guidelines should consider both the uninsured and the insured patients since affording them is difficult due to poverty (Ebbinghaus, 2021). The policy of insulin products should be regulated to limit pharmaceutical companies from looting prices for their benefit. Insulin equipment like syringes, strips and pumps should be affordable. Most importantly, I would request that the proposed price be lowered from $35 to $25. The aging diabetes patients will benefit significantly if the above amendments are made. I strongly persuade you to pass Bill S.3665 to help many patients fight diabetes.

Script for Phone Calls

Contacting state house officials needs a specific procedure to make the communication a success. The first step taken is to search for the contact representative. The position of the office should be chosen if they are the House of Representatives, governor, senator, or mayor. A brief introduction is made and the state of residence. A detailed and straightforward explanation of the reason why the call is made follows. One should air issues of concern to the target person. Finally, a person should end the call respectively and thank the respondent for their time (Woydack & Lockwood, 2020). By following the above procedure, effective communication will be enhanced between the citizens and the congress members of the office.

Diabetes ageing patients in the US face many challenges in dealing with this condition. Some of the problems faced by older adults with diabetes include the higher cost of insulin and Voracity. The government should also ensure equal distribution of resources to old and disabled diabetic patients (Heslop et al., 2019). To help them, the government advocated for the affordable insulin now act, which would include 3% of the population uninsured.

References

Ebbinghaus, B. (2021). Inequalities and poverty risks in old age across Europe: The double‐edged income effect of pension systems. Social Policy & Administration, 55(3), 440-455. Web.

Heslop, P., Turner, S., Read, S., Tucker, J., Seaton, S., & Evans, B. (2019). Implementing reasonable adjustments for -disabled people in healthcare services.Nursing Standard, 34(8), 29-34. Web.

Knox, R. (2020). Insulin insulated: barriers to competition and affordability in the United States insulin market. Journal Of Law And The Biosciences, 7(1). Web.

Trewin, S., Basson, S., Muller, M., Branham, S., Treviranus, J., Gruen, D., Hebert, D., Lyckowski, N. & Manser, E. (2019). Considerations for AI fairness for people with disabilities.AI Matters, 5(3), 40-63. Web.

Warnock, R. (n.d.). H.R.6833 – 117th Congress (2021-2022): Affordable insulin… Congress. GOV. Web.

Woydack, J., & Lockwood, J. (2020). Affordances for language learning in a call center.English For Specific Purposes, 60, 159-178. Web.

Diabetes mellitus is a condition whereby cells cannot utilize glucose at an elevated serum glucose level. Insulin hormone prevents hyperglycemic levels by regulating the glucose concentration in the blood (Petersmann et al., 2019). The hormone is produced by the β cells of the islets of Langerhans found in the pancreas. Autoantibodies production against the β cells causes the diminished production of the regulatory hormone. The condition results from a decrease in insulin production by the cells or a decreased insulin sensitivity by the body cells. Type I diabetes mellitus is associated with reduced production of insulin hormone, while type II diabetes mellitus is correlated with the reduced insulin sensitivity by the cells. A sedentary lifestyle and obesity are commonly linked to type II diabetes. Lifestyle adjustment, public education, and regular screening in the population help prevent diabetes in society.

The prevalence of diabetes varies according to age, lifestyle practices, and even geographical areas. Type I diabetes mellitus is more common in children, while type II is more prevalent in the middle commonplace in older persons. The disease affects more people in developed countries than third-world countries (Saeedi et al., 2019). The individuals in the urban centers are more affected than those in the rural areas. It is attributed to the variation in the lifestyle of these individuals in these two geographical zones. The worldwide prevalence of impaired glucose tolerance is expected to rise if society does not modify its lifestyle practices. Even in developing countries, more people currently afford a sedentary lifestyle, and thus the cases of diabetes are on the rise in these nations.

Prevention of this condition starts with lifestyle change practices among people. It begins with adjusting dietary patterns in the population (Leung et al., 2018). Persons should avoid eating unhealthy meals, such as fatty meals, which predisposes them to obesity. A high correlation between obesity with a high chance of developing type II diabetes mellitus exists. Regular exercise, especially in young individuals, helps burn the excess glucose in the blood and even fats in tissue and blood vessels. It also allows the body to utilize insulin better, thus lowering the risk of diabetes. In these routine modifications, the blood glucose is effectively regulated and decreases the chance of developing the condition.

Screening is another way to prevent the onset of diabetes mellitus in persons effectively. In these screening visits to the medical practitioners, a clinical assessment of individuals’ serum glucose levels is done (Millard et al., 2017). If the blood sugar concentration is above the set values, the person is advised to modify his life patterns to prevent the condition. The cholesterol levels, blood pressure, renal diseases, and heart diseases are also checked in these assessments. The client is also advised to stop practices such as smoking, as it worsens an individual’s health status. Smoking also makes it hard for people to exercise as it interferes with respiratory organs like the lungs. Alcohol drinking is also discouraged because it is easier to control blood sugar when not consuming beer and wine.

Health education can help promote health and, at the same time, help prevent diabetes. Education campaigns at all levels in society make people develop better thinking on healthy living (Millard et al., 2017). Medical practitioners helping to change the population’s unhealthy habits will help prevent diabetes, primarily type II. These education programs need integrated efforts from the local communities, the government, health practitioners, and the people. Individuals with inactive occupations, such as office workers, are educated on the importance of regular physical exercise. The public is sensitized through programs on practicing a good diet and maintaining the appropriate body weight.

References

Leung, E., Wongrakpanich, S., & Munshi, M. N. (2018). Diabetes management in the elderly.Diabetes Spectrum, 31(3), 245–253. Web.

Millard, A. V., Graham, M. A., Mier, N., Moralez, J., Perez-Patron, M., Wickwire, B., & Ory, M. G. (2017). Diabetes screening and prevention in a high-risk, medically isolated border community.Frontiers in public health, 5, 135. Web.

Petersmann, A., Müller-Wieland, D., Müller, U. A., Landgraf, R., Nauck, M., Freckmann, G., Heinemann, L., & Schleicher, E. (2019). Definition, classification and diagnosis of diabetes mellitus.Experimental and Clinical Endocrinology & Diabetes, 127(S 01), S1–S7. Web.

Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., Shaw, J. E., Bright, D., & Williams, R. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition.Diabetes Research and Clinical Practice, 157(157), 107843. Web.

Overview of Diabetes

• Diabetes mellitus is a health condition where the amount of glucose in the blood surpasses the required normal ranges.
• It is caused by a malfunction in the functioning of the pancreas, which fails to secrete adequate insulin.
• Two forms of diabetes exist namely:
  • Type 1 (insulin-dependent)-the pancreas fails to generate insulin.
  • Type 2 (insulin-independent)-failure of the body to utilise insulin (American Diabetes Association, n.d.).

Juvenile Type 1 Diabetes

• This is the form of insulin-dependent diabetes mellitus that occurs in children and adolescents.
• The precise cause of juvenile type 1 diabetes is unknown.
• However, the immune system plays a role in the development of the condition.
• Genetics also influence the development of the disease.
• The main indications of insulin-dependent diabetes in children comprise:
  • Increased need for water;
  • Regular urges to pass urine;
  • Extreme food cravings.
• Other symptoms include:
  • Weight loss;
  • Exhaustion and weariness;
  • Irritability and sudden mood changes;
  • Blurred vision (Majeed & Hassan, 2011).

Risk Factors

• There are two key risk factors for juvenile type 1 diabetes.
  • Genetics- the presence of the HLA genes (human leucocyte antigen) increases the likelihood of developing the condition.
  • Family history- individuals with parents or siblings with type 1 diabetes are more prone to developing the condition than those without a family history of the disease.
• Other risk factors include:
  • Viral infections-Epstein-Barr virus, rubella and Coxsackie stimulate the immune system to generate autoantigens that destroy the islet cells (Majeed & Hassan, 2011).
  • Ethnicity-Whites are more susceptible to type 1 diabetes than Blacks and Hispanics.
  • Diet-Previously, it was thought that an intake of vitamin D lowered the chances of having the condition (Hyppönen, Läärä, Reunanen, Järvelin, &Virtanen, 2001). However, it has been established that feeding infants with cow’s milk (a rich source of vitamin D) increases their chances of developing diabetes (Casu, Pascutto, Bernardinelli, The Sardinian IDDM Epidemiology Study Group, & Songini, 2004).
  • Obesity and rapid linear growth correlates with the incidences of type 1 diabetes (Hyppönen et al., 2000).
• The presence of elevated blood sugar levels and the typical diabetes symptoms must be established to identify diabetes. (American Diabetes Association, n.d.).
• The provision of care in diabetic children ought to keep in mind the disparities between kids and adults, and should be tailored to the age of the patient.
• Education needs to include the patient’s parent or caregiver.
• The management of type 1 diabetes involves the integration of insulin therapy into the individual patterns of diet and physical activity (American Diabetes Association, 2007).
• About 30% of all children with newly-diagnosed type 1 diabetes usually suffer from diabetic ketoacidosis and should be treated (Diabetes UK, 2013).
• Children without life-threatening symptoms are released and cared for in the comfort of their homes.

The education ought to call attention to age and developmentally suitable self-care, which should gradually empower the children to take care of themselves as they progress from childhood to adolescence and into adulthood.

North West England

• The region comprises one of the most socially deprived regions of England (Harwood, Mytton, & Watkins, 2004).
• The region comprises diverse ethnic groups including Asians and Blacks. Whites make up 94.4% of the population while other races make up 5.6%.
• 2.2% of people in North West England are living with type 1 diabetes.
• A large proportion of people in the region comprises skilled, partly skilled and unskilled manual workers while a tiny proportion works in professional, managerial and technical positions.
• Several studies indicate that there is a strong association between social deprivation and the prevalence of diabetes (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006).
• Therefore, it is expected that the incidence of chronic illnesses such as diabetes is high in such regions.

The Needs of the Population

• There is inadequate knowledge on the management of diabetes among the people of North West England, which can be attributed to the social class of a majority of the populace.
• The lack of adequate knowledge regarding the condition leads to poor management of the condition and leads to the underutilisation of preventive services.
• The Pakistani women living in North West England have inferior glycaemic control practices and know-how of self-monitoring due to their poor educational backgrounds.
• The population of North West England does not have adequate care for diabetic patients.
• Therefore, the National Service Framework for Diabetes has established a few policies to guide the delivery of proper health care to all diabetic patients.
• All diabetic children are set to get assistance and attention to improve the regulation of their blood glucose levels.
• The support aims at improving their bodily, mental, academic, didactic, and social development (Harwood, Mytton, & Watkins, 2004).

Incidences of Juvenile Type 1 Diabetes

• The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630 out of the 1,498,716 of children under the age of 17 in the region (Royal College of Paediatrics and Child Health, 2009).
• The incidence translated to a prevalence rate of 175.5 out of every 100,000 children aged seventeen and below.
• The prevalence was slightly lower than the expected incidence of 2,792.7 using the overall prevalence of type 1 diabetes in the entire country.
• Out of the 2630 children with type 1 diabetes, 97 fell in the age group of 0 to 4 years while 527 fell between the ages of 5 and 9 years.
• 1153 of the children were between the ages of 10 and 14.
• 302, 338 and 213 children were aged 15, 16 and 17 respectively.
• The age-related prevalence (per 100,000 population) of the disease in the region was:
  • 24.1 among children between the ages of 0 and 4 years.
  • 218.7 among those aged between 5 and 15 years.
  • 290.1 among teenagers between 16 and 17 years.
• The numbers of school-going children were:
  • 2,042 for the ages between the ages of 5 and 15.
  • 575 for those aged between 16 and 17.

Risk Factors and Access to Services

• Risk factors for juvenile type 1 diabetes in northwest England include:
  • Ethnicity;
  • Smoking;
  • Genetics;
• Access to services:
  • Children living with type 1 diabetes receive specialized care from paediatricians who are well-versed with endocrinology and diabetes.
  • Most of these professionals are also members of diabetic organisations (Harwood, Mytton, & Watkins, 2004).
  • The personnel involved include medics, nurses, the management, book-keeping staff, and allied health professionals such as dieticians.
  • In the UK, a number of groups have been developed to help the population cope with the incidences of type 1 diabetes. An example is the Dose Adjustment for Normal Eating (DAFNE) group, which was first established in Germany. The group provides an effective inpatient instructive program for type 1 diabetes patients.

Ethnicity -a large number of people hospitalized for type 1 diabetes-related complications come from multicultural centres.

Smoking- 15% of professionals in North West England are smokers while 42% of the manual labourers are smokers.

Though children do not smoke, they are exposed to secondary smoke from their parents in their homes and other surroundings.

Fatness-A large proportion of the children in northwest England is obese hence elevating the chances of having type 1 diabetes.

Genetics and family history also increase the chances of developing type 1 diabetes in the region.

Intervention Strategy and the Reduction of Type 1 Diabetes Disease Burden and Inequalities

Children and young people living with diabetes ought to have access to the best medical care that gives them the power to handle their condition on a daily basis.

They ought to receive specialized care that goes farther than hospital settings to ensure that they can lead their daily lives in a manner that is clinically favourable and psychologically appropriate.

The most appropriate intervention strategy to lower the problem of juvenile type 1 diabetes among children and adolescents in North West England is the provision of diabetic children and their families with adequate education on the disease.

The importance of education has been established in numerous studies involving children, adolescents as well as adults.

Evidence of the Effectiveness of Education in the Management of Type 1 Diabetes

• Proper education of families of children with type 1 diabetes leads to a substantial decline in incidences of hospitalization of children with the condition.
• These measures have reduced instances of emergency hospital visits and the overall cost of treatment.
• The success of patient education in the management of adult type 1 diabetes has been extrapolated into the management of diabetes in children.
• In a proposed randomized pragmatic clinical trial, George et al. (2007) suggested the use of Brief Intervention in Type 1 diabetes: Education for Self-efficacy (BITES).
• In the actual trial, George et al. (2008) enlisted the treatment group into educational sessions that extended for six weeks during which the patients were able to reflect and practice the knowledge gained.
• The intervention led to an improvement in diabetes treatment contentment. In addition, the patients were empowered to handle their diabetic condition in a better way.
• Similar findings were recorded by Couch et al. (2008).

Components of Education

• A comprehensive education program should consider the individual and cultural needs of the patient.
• The program also needs to consider the patients’ siblings who may feel disregarded due to increased attention paid to the patient because of the new diagnosis (NHS Diabetes, 2010).
• The information and mode of delivery need to be suited to paediatric needs.
• The family should not be burdened with many details on the management of the disease immediately after diagnosis because they may still be in shock or angered by the life-changing diagnosis (Silverstein et al., 2005).
• Some of the components of the education include:
  • Continued education:
    • Regular education and support to ensure the children develop more elements of self-care as they grow (Daneman, 2006).
    • Sessions can be flexible to allow diabetic adolescents to come along with their close friends for peer support (Greco, Pendley, McDonell, & Reeves, 2001).
    • Adolescents with diabetes often experience bodily, emotional, mental strain because of the pressure of a complex medical routine (Davidson, Penney, Muller, & Grey, 2004).
• Self-management is the foundation of effectual preventative care in diabetes.
  • Factors such as age, cognitive capabilities, emotive maturation, and the motor advancement of the patients influence their capacity to take part in self-management of diabetes.
• Blood glucose monitoring and glycaemic control:
  • The management of type 1 diabetes seeks to keep blood sugar levels within the acceptable ranges.
  • During adolescence, the numerous changes that occur lead to insulin resistance hence necessitate higher doses of insulin.
  • It has been reported that HbA1c levels in diabetic adolescents are one percent higher than in other diabetic patients (Australasian Paediatric Endocrine Group, 2005).
  • Education sessions prepare adolescents psychologically certain changes that affect their blood glucose levels.
• Parental presence is vital throughout to guarantee proper self-management and metabolic regulation.
• It is vital that certain self-management capabilities are present at various developmental stages.
• The use of insulin in the management of diabetes
  • Insulin doses are determined by the age, weight and state of puberty.
  • Younger children require small doses while older ones need elevated insulin doses due to hormonal alterations at puberty.
  • Advice on the preparation and administration of insulin is provided during educational sessions for diabetic patients.
• Nutrition advice focuses on:
  • Achieving blood glucose objectives devoid of extreme hypoglycaemia.
  • Average growth and development, as well as lipid and blood pressure targets.
  • These objectives can be attained through personalized meal planning and adaptable insulin routines and algorithms.

HbA1c is the ultimate yardstick for evaluating the control of diabetes. Reduced levels of HbA1c correspond to a low incidence of microvascular complications .

Implementation of the Intervention

• The implementation of patient education as a measure to manage juvenile type 1 diabetes is achieved with the help of various bodies.
• Successful outcomes can be realized with the help of organisations as well as local, national and professional bodies (Martin, Liveley, & Whitehead, 2009).
• Local intervention:
  • A local diabetes network has been established in North West England as stipulated by the National Services Framework for Diabetes.
  • This network finds local leaders and chooses network managers, clinical champions and diabetic patients to champion the views of the local people.
  • A local diabetes list and research unit have been established to recognize main areas for future research in the improvement of diabetes services to the people of North West England.
• Professional intervention:
  • Carried out by the health professionals that provide the education.
  • These professionals include endocrinologists, dieticians, nurses, and mental health care professionals.
  • They schedule appointments with the patients and their families once in a while to monitor the progress of the patient and advise accordingly (Harwood, Mytton, & Watkins, 2004).
• National implementation:
  • Initiatives such as “Saving Lives: Our Healthier Nation” are in place to establish national paradigms and outline service models to promote health.
  • The British Society for Paediatric Endocrinology and Diabetes promote the education of paediatric endocrinology hence helping children and adolescents with type 1 diabetes.
  • The Department of Health in the UK has authorized the Research Division of the Royal College of Paediatrics and Child Health (RCPCH) to carry out a study to determine the population of diabetic children.
  • Other organisations such as the Royal College of Nursing, the Association of Children’s Diabetes Clinicians and the NHS Diabetes among many others are also part of the study.
• Organisational implementation:
  • Organisations such as Diabetes UK oversee endeavours to promote the education of children with diabetes to enable them to lead productive lives.
  • The NHS undertakes local and national appraisal of diabetic services.
  • The members of staff involved in the provision of care to diabetic patients undergo training to improve and advance their health care delivery skills.
  • The Local Workforce Development Confederation takes part in the development of learning and training curricula for diabetic patients (Harwood, Mytton, & Watkins, 2004).

Resources

• Databases used included the general Google search engine and Google scholar database.
• The search terms used included:
  • Diabetes mellitus;
  • Type 1 diabetes;
  • Juvenile type 1 diabetes;
  • Juvenile type 1 diabetes in North West England;
  • Intervention against juvenile type 1 diabetes in North West England.
• There were millions of results after the searches. However, relevant sources were selected from the first 20 results of each search.

References

American Diabetes Association. (n.d.). Diagnosing diabetes and learning about pre-diabetes. Web.

American Diabetes Association. (2007). Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care, 30 (Supplement1), S48-S65.

Australasian Paediatric Endocrine Group. (2005). Clinical practice guidelines: Type 1 diabetes in children and adolescents. Web.

Casu, A., Pascutto, C., Bernardinelli, L., The Sardinian IDDM Epidemiology Study Group, & Songini, M. (2004). Type 1 Diabetes among Sardinian children is increasing. Diabetes Care, 27(7), 1623–1629.

Couch, R., Jetha, M., Dryden, D. M., Hooton, N., Liang, Y., Durec, T., Sumamo, E., Spooner, C., Milne, A., O’Gorman, K., & Klassen, T. P. (2008). Diabetes education for children with type 1 diabetes mellitus and their families. Web.

Daneman, D. (2006). Type 1 diabetes. The Lancet, 367(9513), 847-858.

Davidson, M., Penney, E. D., Muller, B., Grey, M. (2004). Stressors and self-care challenges faced by adolescents living with type 1 diabetes. Applied Nursing Research, 17(2), 72–80.

Diabetes UK. (2013). Diabetic ketoacidosis (DKA). Web.

George, J. T., Valdovinos, A. P., Thow, J. C., Russell, I., Dromgoole, P., Lomax, S., Torgerson, D. J., & Wells, T. (2007). Brief Intervention in Type 1 diabetes – Education for Self-efficacy (BITES): Protocol for a randomised control trial to assess biophysical and psychological effectiveness. BMC Endocrine Disorders, 7(6), 1-5.

George, J. T., Valdovinos, A. P., Thow, J. C., Russell, I., Dromgoole, P., Lomax, S., Torgerson, D. J., Wells, T., & Thow, J. C. (2008). Clinical effectiveness of a brief educational intervention in Type 1 diabetes: Results from the BITES (Brief Intervention in Type 1 diabetes, Education for Self-efficacy) trial. Diabetic Medicine, 25(12), 1447–1453.

Greco, P., Pendley, J. S., McDonell, K., & Reeves, G. (2001). A peer group intervention for adolescents with type 1 diabetes and their best friends. Journal of Pediatric Psychology, 26(8), 485–490.

Harwood, C., Mytton, J., & Watkins, F. (2004). Diabetes and inequalities in the North West of England. Liverpool: University of Liverpool.

Hviid, A., Stellfeld, M., Wohlfahrt, J., & Melbye, M. (2004). Childhood vaccination and type 1 diabetes. New England Journal of Medicine, 350(2004), 1398-1404.

Hyppönen, E., Läärä, E., Reunanen, A., Järvelin, M-R., &Virtanen, S. M. (2001). Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. The Lancet, 358(9292), 1500 – 1503.

Hyppönen, E., Virtanen, S. M., Kenward, M. G., Knip, M., Akerblom, H. K., & Childhood Diabetes in Finland Study Group. (2000). Obesity, increased linear growth, and risk of type 1 diabetes in children. Diabetes Care,23(12), 1755-1760.

Lopez, D. A., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. L. (2006). Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. The Lancet, 367(9524), 1747 – 1757.

Majeed, A. A. S. & Hassan, K. (2011). Risk factors for type 1 diabetes mellitus among children and adolescents in Basrah. Oman Medical Journal,26(3), 189–195.

Martin, C., Liveley, K., & Whitehead, K. (2009). A health education group intervention for children with type 1 diabetes. Journal of Diabetes Nursing, 13(1), 32-37.

NHS Diabetes. (2010). National Service Framework for Children, Young People and Maternity Services – Type 1 diabetes in childhood and adolescence. Web.

Royal College of Paediatrics and Child Health. (2009). Growing up with Diabetes: Children and young people with diabetes in England. Web.

Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman. F., Laffel, L., Deeb, L., Grey, M., Anderson, B., Holzmeister, L. A., &Clark, N. Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association. Diabetes Care, 28(1), 186-211.

Executive Summary

This field study took place at the Imperial Diabetes Center in Abu Dhabi. This facility is part of London’s Imperial College Hospital, and it specializes in diagnosing and treating endocrinological conditions [1]. The focus of the medical professionals is also on the research of diabetes and the promotion of public health initiatives. The purpose is to examine the leadership’s practices used to maintain and improve the quality and safety standards of the facility and, using the observations and scholarly research, offer recommendations for improvement. Under the model developed by Kouzes and Posner [2], there are five practices that CEOs can use to improve the processes and outcomes of their organizations, which are used to formulate the recommendations. The findings of this field study show that the center’s leadership uses tools such as Plan-Do-Study-Act (PSDA), benchmarking, and personnel training to monitor and enhance standards. The recommendations include involving stakeholders in the PDSA process, reviewing benchmarks twice a year, establishing clearer policy communication practices, having regular personnel training, and inspiring a shared vision for the personnel. This report will present the findings of the field study and offer recommendations.

Results

During this field study, the Imperial Diabetes Center in Abu Dhabi was observed, including the personnel and the leadership of this organization. The CEO and the executives of the facility were observed closely to determine what practices they use, both through direct observations and by examining the website and performance reports of this organization. The purpose was to evaluate the efficiency of quality and safety practices and develop recommendations based on evidence. Kouzes and Posner’s [2] model is based on five characteristics of a leader, which suggest that the latter should be the role models and visionaries of the organization. Hence, by observing the executives, one can determine whether the organization approaches the issues of safety and quality with precision or not.

Leaders regularly evaluate the culture of safety and quality using valid and reliable tools

The primary tool used by the Imperial Diabetes Center in Abu Dhabi’s leadership is the PDSA model. Under this approach, each change initiative is planned by preparing an outline consisting of evidence and policies, followed by an implementation. After this, the management monitors the new practice for several weeks or months and gathers data to determine whether any changes are necessary. If there is a need for changes, the PDSA cycle is repeated until the objective of quality and safety is met [3]. PDSA is a simple but comprehensive tool that allows the management to not only implement changes but also ensure that their adjustments allow reaching the goals of this medical center.

Leaders prioritize and implement changes identified by the evaluation

The management of this medical center uses benchmarks and dashboards to set standards and prioritize specific areas of quality and safety. For example, the management communicated the need to reduce readmissions for patients who have diabetes complications such as heart failure and other heart-related comorbidities, among other benchmarks. The management developed a dashboard with key priorities the personnel must pay attention to when working with these patients to ensure that upon being dismissed from the hospital, they are fully recovered and have sufficient information to self-manage their health at home. At the end of the year, the leadership will review the benchmark reports and determine whether the objective was met or not, and set a new priority for the following year.

Leaders provide opportunities for all individuals who work in the hospital to participate in safety and quality initiatives

The leadership of each unit has an open-door policy, which means that any individual working for this medical center can schedule a meeting and discuss their concerns or proposals regarding the existing processes. The open-door policy is a helpful tool in maintaining leader-follower communication [4].

The hospital has a code of conduct that defines acceptable, disruptive, and inappropriate behaviors

The hospital uses the Nursing and Midwifery Code of Conduct developed by the UAE Nursing and Midwifery Council [5]. This document outlines the ethical standards and norms of behavior that are acceptable at the facility and addresses some common problems that nurses may face in their work. Moreover, it is a “non-negotiable ethical standard” that each employee must adhere to work at this facility [5].

Leaders create and implement a process for managing disruptive and inappropriate behaviors

Disruptive and inappropriate behaviors are managed in accordance with the Nursing and Midwifery Code of Conduct [5]. Depending on the specific case of deviant behavior, an employee can receive either a warning or be under the investigation of a supervisory board that will determine whether they can proceed to work at this medical center.

Leaders provide education that focuses on safety and quality for all individuals

All the professionals working for this facility receive preliminary training on the safety and quality standards before beginning their work. Additionally, unit leaders can initiate training sessions n case a medical error or other problem occurred to remind the personnel of these standards.

Leaders establish a team approach among all staff at all levels

There is no clear framework for a team approach at all levels of the medical center, although professionals from different units often cooperate and work with each other on improvements. Hence, the personnel can approach employees or managers from other departments to work on patient cases or quality initiatives.

All individuals who work in the hospital, including staff and licensed independent practitioners, are able to discuss issues of safety and quality openly

There are no restrictions in the domain of discussing safety and quality issues, and nurses are encouraged to approach their supervisors in case they have any concerns. This approach allows ensuring that if an employee notices a practice that may be potentially harmful, they can report it. Moreover, nurses can offer quality and safety improvements by submitting proposals to the management, which must include data supporting the need for change and a brief summary f evidence-based practices that can be implemented to address this problem.

Recommendations

Recommendation 1

The first recommendation is to involve internal and external stakeholders in the PDSA process [3]. Currently, the leadership carries out the preparation of the change initiatives by themselves. However, asking for input from nurses or patients can help foresee potential barriers and address them at this stage [3]. As a result, fewer adjustments will be needed in the future, making the process of implementing new quality and safety standards less time-consuming.

Recommendation 2

The second recommendation is to review the benchmarks for safety and quality standards twice a year instead of once per year. This will help the management make adjustments more quickly in case the medical Center is not meeting the set benchmark after six months [6]. Moreover, adding dashboards for quality and safety monitoring can help the personnel track their work more efficiently. For example, if the medical center implements an initiative targeting dietary changes for patients, the physicians can use dashboards that outline the initial patient education, follow-up sessions, and adjustments to improve this process.

Recommendations 3

According to Manski [7], one issue with implementing safety and quality policies is the lack of clear communication practices that would specifically focus on the areas of the unknown. Hence, with a new dietary training standard, the leadership can openly discuss the areas of the unknown, such as the patient’s perception of this new practice, the ways of addressing non-adherence, and other issues. During this process, the personnel will be able to share their opinions, which can be used to create contingency plans.

Recommendation 4

Personnel training and development should be regular, and employees should be encouraged to participate in professional development training outside the medical facility. Although the medical training offers training focusing on medical errors and potential problems, it is more effective to hold these sessions on a regular basis. For example, a new study found that communication training for nurses that teaches them to handle handovers of patients reduces the number of adverse events [8]. These nurses are trained to ask more questions when interacting with patients and are able to assess their health journey more cohesively. Moreover, safety training can be held online for better efficiency [9]. These sessions should be regular and include all personnel who works in the hospital, not only physicians and nurses, but also managers, administration, assistants, cleaning staff, and other individuals [10].

Recommendation 5

Finally, following Kouzes and Posner’s [2] model, the management should create a unified vision for the safety and quality standards of the hospital and become the role models for this vision. Kouzes and Posner’s [2] approach suggests that the management sets the example for others in the organization and inspires them to act in ways that promote shared values. Hence, the leaders can address the personnel when introducing the benchmarks for the following six months and dedicate some time to explaining the vision and objectives to inspire the nurses and physicians to follow these new practices. This recommendation should help all employees work towards improving the safety and quality standards because they will work towards a common goal.

References

1. Imperial College London Diabetes Centre. About us. Abu Dhabi, Imperial College London Diabetes Centre.
2. Scouller, J, Chapman, A. What is the five practices of exemplary leadership model? Business Balls. n.d. Web.
3. Department of Health. PDSA: Plan-Do-Study-Act. Minnesota, Department of Health. n.d. Web.
4. Heathfiled, S. Open door policy. The Balanced Careers. n.d. Web.
5. UAE Nursing and Midwifery Council. Nursing and midwifery code of conduct. UAE, UAE Nursing and Midwifery Council, 2013.
6. DASON. Data and benchmarking. DASON. n.d. Web.
7. Manski, CF. Communicating uncertainty in policy analysis. PNAS, 2019;116(16): 7634-7641.
8. Slade, D, Pun, J, Murray, KA, Eggins, S. Benefits of health care communication training for nurses conducting bedside handovers: an Australian hospital case study. CNE, 2018; 10-20.
9. United States Department of Labor. Worker safety in hospitals. USDL. n.d. Web.
10. OSH Academy. Hospitals. OSH. n.d. Web.

Disease Introduction

Diabetes Insipidus (DI)

• A metabolic problem connected to antidiuretic hormone (ADH) issues.
• A rare condition (1:25000) (Kalra et al., 2016).
• Symptoms: polyuria (very diluted), thirst, night sweats, fatigue.
• Dangerous for children/infants (symptoms: vomiting, fever, convulsions) (Dabrowski, Kadakia, & Zimmerman, 2016).
• Not connected to diabetes mellitus (does not presuppose hyperglycemia).

DI is a rather rare metabolic concern that has diverse etiology but is technically related to a decrease in the levels of or response to the antidiuretic hormone (ADH), which is the hormone that regulates body fluids (Kalra et al., 2016). DI’s symptoms include excessive and very diluted urine and increased thirst; additional symptoms may be present, especially for particular groups of patients. For instance, children and infants demonstrate very violent symptoms, including vomiting and convulsions (Dabrowski et al., 2016). DI can be differentiated from diabetes mellitus due to the fact that DI patients do not exhibit hyperglycemia.

Risk Factors and Etiology

DI affects people of different age and gender, and its etiology varies depending on its type.

Causes/Etiology

Types (Abbas, Iqbal, Iqbal, Javaid, & Ashraf, 2016; Bockenhauer & Bichet, 2015; Kalra et al., 2016; Robertson, 2016):

• Central – the most common one (pituitary gland/hypothalamus ADH secretion/release issues). Usually acquired.
• Nephrogenic – less common, caused by unresponsiveness to ADH in kidneys. Can be hereditary or acquired.
• Gestational – during pregnancy, caused by cysteine aminopeptidase (a placenta enzyme), which reduces ADH.
• Primary polydipsia – excessive fluid intake can repress ADH production.

Thus, central DI is associated with dysfunction in the organs that secrete and release ADH, including the pituitary gland and hypothalamus. Nephrogenic DI, on the other hand, is related to kidneys failing to respond to ADH. Gestational DI is the type of this disorder that occurs only during pregnancy because of a particular enzyme that affects ADH. Finally, primary polydipsia is an issue that leads to ADH reduction because of excessive fluid intake. In any case, DI is connected to ADH problems.

Risk Factors

• Pituitary gland/hypothalamus/kidney damage (Kalra et al., 2016):
  • physical damage (e.g., head trauma, tumor, surgery meant to treat a tumor);
  • infection/diseases (e.g., meningitis, encephalitis);
  • drugs/toxins/radiation; other damaging factors.
• Developmental abnormalities in the gland (esp. in children) (Dabrowski et al., 2016).
• Hereditary factors (Kalra et al., 2016):
  • rare (10% of all cases);
  • usually kidney response failure (X-linked in males; mutations).
• Primary polydipsia causes (Kalra et al., 2016; Robertson, 2016):
  • psychiatric disorders;
  • specific drugs (that cause thirst).

Consequently, risk factors differ for different types of DI. The DI that is caused by dysfunction in particular organs is usually associated with damage dealt to those organs, for example, through physical harm or infection. Any exposure to toxins, as well as radiation, can also be risk factors. For instance, a person may have their pituitary gland damaged because of a tumor, but particular treatments for cancer can also become a cause of DI (Kalra et al., 2016). In addition to that, as can be seen from the cases of DI in children, the described organs might have developmental abnormalities resulting in DI (Dabrowski et al., 2016).

Hereditary DI is possible, especially in men since the defects that cause kidneys to fail to respond to ADH are X-linked. However, this problem is relatively rare; most DI cases are not hereditary (Kalra et al., 2016). As for primary polydipsia, it is a problem that is typically caused by psychiatric conditions or specific drugs that can increase thirst (Kalra et al., 2016; Robertson, 2016).

Disease Progression

The disease progression can be summarized as follows.

Disease Progression and Possible Outcomes

Progression according to the recent literature (Abbas et al., 2016; Kalra et al., 2016; Robertson, 2016):

• Initial cause (usually injury/hereditary condition).
• Reduction in ADH/improper reaction of organs to ADH.
• Disruption in the body’s water balance.
• Increased urination.
• Thirst as a defense mechanism.
• If enough hydration: relative balance, osmolality barely increased (Robertson, 2016).
• If not enough hydration: dehydration, fluid disbalance, increased plasma osmolality; becomes life-threatening (up to hypovolemic shock).
  • In children: weight loss, growth retardation (Dabrowski et al., 2016).
• High mortality: in people with hydration difficulties (e.g., age, unconsciousness, post-surgery, etc.) (Robertson, 2016).

The initial problem, which is often an injury in an ADH-related organ causes a reduction in ADH or an organ’s inability to respond to it appropriately. The result is a disruption in the body’s water balance, which leads to the common symptoms, including increased urination. From this perspective, the other common symptom (increased thirst) is a defense mechanism; if it functions well with the patient hydrating him- or herself, the fluid balance is mostly maintained (Robertson, 2016). In that case, the disorder is unlikely to have significant negative outcomes and simply requires appropriate management.

However, if a person cannot or does not want to rehydrate, they become dehydrated with the common negative outcomes of the condition, including hypovolemic shock (Cooper & Gosnell, 2019; Robertson, 2016). In addition, in children, the issue results in weight loss and growth retardation (Dabrowski et al., 2016). As a result, DI is predominantly dangerous for the people who fail to hydrate, for instance, infants or people who are unconscious after surgery.

Implications for Practitioners

The presented information is relevant for various groups of healthcare practitioners, including family nurse practitioners.

The Role of Nurse Practitioners

• Secondary prevention: considering risk factors (e.g., head trauma, surgery, brain tumor, etc.) (Cooper & Gosnell, 2019).
  • Especially important with patients who cannot self-hydrate.
• Tertiary (Cooper & Gosnell, 2019; Urden, Stacy, & Lough, 2016):
  • managing the condition (assessments, monitoring),
  • monitoring hydration,
  • monitoring complications,
  • prevention of negative outcomes (e.g., falls).

While most of the described DI causes cannot be prevented directly, DI can be spotted early and addressed in time. Therefore, the causes and risk factors need to be taken into account as a part of secondary DI prevention; it is especially important for the practitioners who work with the patients who cannot hydrate themselves, for example, because they are recovering after surgery. Furthermore, nurse practitioners need to prevent the potential negative outcomes of the issue by ensuring patients’ hydration, monitoring for the signs of complications, and assisting patients with the tasks that DI makes more difficult (Cooper & Gosnell, 2019; Urden et al., 2016).

Summary

• Different DI types – different etiologies; multiple risks to consider.
• Common risk factors: injury, surgery, infections; hereditary conditions, pregnancy.
• Symptoms: polyuria, thirst; no hyperglycemia.
• Prevention:
  • monitoring high-risk patients,
  • detecting DI early,
  • ensuring rehabilitation and preventing complications/negative outcomes.

The most common ones are various injuries, surgeries, and infections that can affect the organs that produce or respond to ADH, but DI can also be hereditary or pregnancy-related. The symptoms are mostly connected to excessive urination and thirst, but patients exhibit no hyperglycemia. The three levels of prevention include paying attention to patients who are at a high risk of DI, as well as the related symptoms, and providing the necessary care that would help a person avoid the potential consequences of DI.

References

Abbas, M., Iqbal, M., Iqbal, M., Javaid, R., & Ashraf, M. (2016). Diabetes insipidus: The basic and clinical review. International Journal of Research in Medical Sciences, 4(1), 5-11. Web.

Bockenhauer, D., & Bichet, D. (2015). Pathophysiology, diagnosis and management of nephrogenic diabetes insipidus. Nature Reviews Nephrology, 11(10), 576-588. Web.

Cooper, K., & Gosnell, K. (2019). Adult health nursing (8th ed.). St. Louis, MO: Elsevier Health Sciences.

Dabrowski, E., Kadakia, R., & Zimmerman, D. (2016). Diabetes insipidus in infants and children. Best Practice & Research Clinical Endocrinology & Metabolism, 30(2), 317-328. Web.

Kalra, S., Zargar, A. H., Jain, S. M., Sethi, B., Chowdhury, S., Singh, A. K., … Malve, H. (2016). Diabetes insipidus: The other diabetes. Indian Journal of Endocrinology and Metabolism, 20(1), 9-21. Web.

Robertson, G. (2016). Diabetes insipidus: Differential diagnosis and management. Best Practice & Research Clinical Endocrinology & Metabolism, 30(2), 205-218. Web.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2016). Priorities in critical care nursing (6th ed.). St. Louis, MO: Elsevier Health Sciences.

• A chronic autoimmune disease;
• Identified by increased blood glucose levels;
• Caused by the insulin deficiency that occurs as the consequence of the loss of the pancreatic islet β-cells.
• The most common form of diabetes in children.
• Has a strong genetic component.

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease that has an active genetic component, which is identified by increased blood glucose levels, also known as hyperglycemia. This type of diabetes is most common around kids and adolescents. It is caused by the insulin deficiency that occurs as the consequence of the loss of the pancreatic islet β-cells (Katsarou, et al., 2017).

Therefore, type 1 diabetes mellitus characterizes in the destruction of Langerhans cells and extreme lack of insulin in the body, which results in its inability to control blood sugar levels, that leads to the diagnosis of Type 1 diabetes mellitus.

Pathogenesis

The pathogenesis of type 1 diabetes mellitus is believed to be a process that can be divided into different phases that lead to the detection of autoantibodies and progress to β­cell destruction, dysglycaemia (Katsarou, et al., 2017).

Factors that trigger autoimmune response against the β-cells:

• Environmental.
• Genetic.

The pathogenesis of type 1 diabetes mellitus is believed to be a process that can be divided into different phases that lead to the detection of autoantibodies and progress to β-­cell destruction, dysglycaemia (Katsarou, et al., 2017).

The one thing that scientists are sure about is the etiology of β­cell-targeted autoimmunity. It most likely consists of a range of factors such as genetic and environmental, which trigger or permit the autoimmune response against the β-cells. Such actions usually occur much earlier than the disease itself.

Epidemiology

25 million people in the United States have Diabetes.

Each year nearly 90 000 children are being diagnosed with this disease.

Factors that cause T1DM:

• Immune system failure (body’s immune system damages the insulin-producing cells in the pancreas).
• Demographic factor (the highest rate of type 1 Diabetes is in Europe, however it is a rare disease in Asia).
• Gender factor (girls get diagnosed with Type 1 diabetes in an earlier age rather than boys).

Each year the incidents of the one diabetes are increasing. Nearly 90 000 children are being diagnosed with this disease every year. The World Health Organization reported in 2011 that almost 350 million people had diabetes, with 25 million in the United States alone (McConnell, 2013 p. 394).

The main cause of type 1 diabetes mellitus remains unknown, however, in many cases, the body’s immune system instead of destroying harmful viruses damages the insulin-producing cells in the pancreas.

The demographic factor plays a significant role when it comes to type 1 diabetes. The rates in different countries can significantly vary. The highest rate holds Scandinavian countries, followed by European countries (primarily, the United Kingdom), North America, and Australia. In Asian countries — such as China, Korea, and Japan — T1DM is a rare disease (Katsarou, et al. 2017).

The main reason for such contrast between countries is simply the genetic susceptibility as well as environmental and lifestyle factors, possibly including hygiene and childhood infections.

Gender factor. Because type 1 diabetes mellitus is usually diagnosed in children, it has been observed that girls get diagnosed with Type 1 diabetes in an earlier age rather than boys. It is explained by the fact that the incidence increase with age and height during puberty, which girls reach earlier. However, after the puberty phase, the rates of illness significantly drop among women, but men are put at a higher risk of getting type 1 diabetes up until 35 years of age.

Signs and symptoms

Initial Symptoms:

• Increased urination.
• Extreme thirst.
• Weight Loss.
• Nausea.
• Confusion.
• Weakness.

Chronic Symptoms:

• Eye damage (retinopathy).
• Nerve damage (neuropathy).
• Kidney damage (nephropathy).
• Heart and artery illnesses.
• Low blood sugar (hypoglycemia).

There are two groups of symptoms for type 1 diabetes mellitus: initial and chronic. The initial signs usually occur unexpectedly.

Initial symptoms of Type 1 diabetes mellitus are:

• Increased urination (increased glucose in the blood makes the liver produce more urine).
• Extreme thirst (caused by body’s dehydration).
• Weight Loss (is also an indicator of organizations dehydration, however, with no loss in appetite).
• Nausea.
• Confusion.
• Weakness.

The cause of the initial symptoms are either dehydration or ketoacidosis. Ketoacidosis is the result of cell’s inability to transform glucose into energy. As a result, the liver produces ketones – acids that are developed in the blood, which become alternative sources of energy. Therefore, this process is called ketoacidosis and may be the cause for many heart related diseases. Extreme ketoacidosis can put a person into a coma within hours (Harvard Health Publishing, 2018).

Chronic Symptoms. Type 1 diabetes can still affect the body after starting the treatment. However, the risk of it lowers if an individual carefully controls the levels of sugar in the blood continually. Some of the symptoms that may occur are:

1. Eye damage (retinopathy) — type 1 diabetes mellitus can damage the retina of eyes (part in the back of an eye that senses light). Damage caused by diabetes blocks blood to access the vessels where the retina is situated, or cause bleeding into the retina. Therefore, it causes severe damage to the eyes. The retinopathy may be prevented in its early stages, unless blood sugar remains at a high level it causes permanent blindness.
2. Nerve damage (neuropathy) — T1DM causes pain or numbness of nerves in particular body parts. The body parts that frequently get affected are legs and arms, as well as nerves within the digestion and urination system.
3. Kidney damage (nephropathy) – high blood sugar can cause damage to the small blood vessels or the units in the kidney that clean the blood. A severe condition of nephropathy may result in kidney failure.
4. Heart and artery illnesses — patients who are diagnosed with type 1 diabetes have a high predisposition of heart diseases such as strokes or poor blood circulation.
5. Low blood sugar (hypoglycemia) – can be a result of overusing medicine that lowers blood sugar or skipping food intake. The ultimate result of the hypoglycemia may be a coma if it is not managed properly.

Tests Performed

Besides the apparent symptoms, type 1 diabetes mellitus can be diagnosed by performing blood sugar tests. Several initial tests help determine the severity of the illness:

• Fasting plasma glucose (FPG) test.
• Oral glucose tolerance test (OGTT).
• Random blood glucose test.
• Hemoglobin A1C (glycohemoglobin).

Besides the common symptoms, type 1 diabetes mellitus can be diagnosed by performing blood sugar tests. Several initial tests help determine the severity of the illness:

Fasting plasma glucose (FPG) test. In this case, the blood of the patient is taken upon the morning after fasting during night. Healthy people’s blood sugar levels vary between 70 and 100 mg/dL. However, diabetic people have their blood at 126 mg/dL or higher level.

Oral glucose tolerance test (OGTT). Two hours upon measuring the blood sugar level, a person must drink 75 grams of glucose. Diabetes is diagnosed if the 2-hour blood sugar level is 200 mg/dL or higher.

Random blood glucose test. Any time that a patient has blood sugar levels above 200 mg/dL alongside common diabetic symptoms, a person immediately gets diagnosed with T1DM.

Hemoglobin A1C (glycohemoglobin). With these tests, doctors and patients are able to measure their average glucose level over the prior two to three months. Diabetes is diagnosed if the hemoglobin A1C level is 6.5% percent or higher (Harvard Health Publishing, 2018).

Pertinent Lab Value

Patients who have fasting (more than 8 hours) blood glucose over 126 mg/dL or blood sugar excesses 200 mg/dL immediately get diagnose with Type 1 Diabetes.

For nondiabetic healthy people, the two-hour fasting blood glucose steadily stays in the range of 70-110 mg/dl. This is the average level of blood sugar, which varies slightly from one laboratory to another according to technical factors (McConnell, 2013 p. 394). Patients who have fasting (more than 8 hours) blood glucose over 126 mg/dL or blood sugar excesses 200 mg/dL immediately get diagnosed with Type 1 Diabetes.

Treatments

1. Daily insulin injections.
2. Checking blood sugar levels all the time to regulate the intake of the medication.
3. Exercising.
4. Diet.

The standard treatment of type 1 diabetes is daily insulin injections. It balances the deficit of the insulin that the body is unable to produce. The daily dose of these injections for people with T1DM varies from two to four injections a day.

Besides the constant insulin intakes, patients must check their blood sugar levels all the time to regulate the intake of their medication. The specific blood tests are produced with the help of which a person has the ability to test their blood sugar within seconds at any time.

Another requirement for people with diabetes is regular exercise and strict diet because it keeps the amount of glucose in the blood relatively constant as well as protects the heart and the blood vessels (Harvard Health Publishing, 2018).

Prevention

Primary:

• Genetic susceptibility:
• Family history;
• Genetic Testing.
• Tests for any evidence of immune activation.

Secondary:

• The detection and treatment of pre-clinical pathological changes.

The prevention of T1DM divides into primary and secondary methods.

Primary prevention: specifically for type 1 diabetes, primary prevention is defined by genetic susceptibility, which is determined by family history or genetic testing. Moreover, the tests for any evidence of immune activation directed against the islets are also considered as primary prevention.

Secondary prevention: The detection and treatment of pre-clinical pathological changes lead to the prevention of severe type 1 diabetes progression after a person has been diagnosed. In T1D, the earlier confirmed marker of immune activation is the post autoantibody detection period.

Prognosis

• Patient diagnose with type 1 diabetes must adjust to the continual strict treatment of the disease.
• Constant monitoring of the blood sugar levels is required to maintain a healthy level of life.

Poorly treated type 1 diabetes can result in fatal consequences; it can cause severe chronic symptoms.

A patient diagnosed with type 1 diabetes must adjust to the continual strict treatment of the disease. Constant monitoring of blood sugar levels is required to maintain a healthy level of life.

With constant, careful treatment, the risk of complications is substantial. However, it can be significantly reduced if you strictly monitor and control your blood glucose levels (Harvard Health Publishing, 2018).

References

Harvard Health Publishing. (2018). Type 1 Diabetes Mellitus. Web.

Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J., … Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature Reviews Disease Primers, 3(1). Web.

McConnell, T. H. (2013). The nature of disease: pathology for the health professions(2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Topic: Type II Diabetes Mellitus

• Patient: a 47-year-old female with a three-year-old history of Type II DM.
• It is her third visit to a hospital.
• Chief complaints: weakness during the last five days and frequent urination.

In this presentation, we are going to develop a care plan for a 47-year-old woman with a 3-year-old history of Diabetes Mellitus Type 2 (also known as Type II DM). Type II DM (ICD-10-CM: E11.9) is one of the common public health problems caused by a failed production of insulin and an insufficient production of beta-cell receptors (Coelho et al., 2016). It is a chronic condition in which the body metabolizes a high level of glucose (sugar) (Pradeep & Haranath, 2014). The patient visits a hospital for the third time with such symptoms as weakness during the last five days. She observes that her urination has become more frequent. Frequent urination and weakness are not the only symptoms that prove the development of this disorder. It is also necessary to focus on such changes as slow-healing sores, weight loss, increased hunger, and the color of skin.

Pathogenesis

Pathophysicologic abnormalities:

• Insufficient secretion of insulin.
• Insulin resistance caused by a wrong work of beta-cells.
• Decreased peripheral glucose uptake.
• Augmented endogenous glucose production.
• Increased lipolysis.
• Elevated free fatty acid levels (oxidation).

Type II diabetes is caused by insufficient secretion of insulin that is produced by beta-cells or insulin resistance that results in the inability of cells to respond to the insulin hormone (Pradeep & Haranath, 2014).

It is possible to define several important abnormalities to explain the pathogenesis of the chosen disease, including (Cersosimo, Tiplitt, Mandarino, & deFronzo, 2015):

• Insufficient secretion of insulin is connected with tissue requirements in terms of which the level of blood glucose may be controlled;
• Insulin resistance caused by a wrong work of beta-cells – insulin secretion is usually regulated by glucose metabolism, and the work of beta-cells defines the quality of this process;
• Decreased peripheral glucose uptake – this change influences the work of glucose transporters which are connected with skeletal muscle and adipose tissue;
• Augmented endogenous glucose production – this processes has to be controlled to report on any possible deviation in the body;
• Increased lipolysis – this condition includes a breakdown of stored fat that can lead to unpleasant chemical reactions in the body;
• Elevated free fatty acid levels (oxidation) proves insulin resistance and causes endothelial dysfunction.

Epidemiology

In 2014, more than 422 million of a global population have Type II DM.

1.6 million people died because of diabetes.

Prevalence of diabetes among adults has increased to 8.5% and among children – up to 2.8%.

Diabetes leads to blindness, heart attacks, and strokes.

People from low- or middle-income families are under a threat.

According to the investigations of the World Health Organization (2017), the number of people with diabetes has considerably increased during the last decade. For example, at the end of the 1900s, only 108 million people with diabetes were recorded, and at the beginning of the 2000s, approximately 422 million people have this disease globally. Besides, about 1.6 million deaths are caused by diabetes. Regarding Type II diabetes patients, 8.5% of them are adults, and 2.8% of them are children or adolescents (Reinehr, 2013; World Health Organization, 2017). Diabetes is a serious disease that may be characterized by different complications, the most dangerous of which are blindness, heart attacks, and strokes. The World Health Organization (2017) states that people from middle- and low-income families are exposed to having diabetes more frequently than rich people.

Clinical Presentation: History

• Hypertension history – 15 years.
• Considerable weight loss at the age of 27.
• Smoking history (two packs per week) – 2o years.
• Alcohol – 1-2 glasses of wine on weekends.
• No drugs, no allergies, no surgeries.
• Noticeable weakness during the last five days.
• Frequent urination even if she drinks or eats nothing.
• Red flags: obesity, weight loss, and frequent urination.

When the patient comes to a hospital, she has to share her medical history. Her hypertension history began 15 years ago. At the age of 27, she tried several diets to deal with her several extra pounds. She lost about 15 kg and continued doing physical exercises regularly. She has been smoking for the last 20 years. She finds that it is normal to smoke 1-2 packs per week and does not find it necessary to quit smoking. Her alcohol usage is about 1-2 glasses on Sunday evening with a company of her close friends. She denies the usage of drugs. No surgical history. No allergies. Her last observations include the fact that she feels fatigue and weakness even if she does not take hard exercises. Besides, she goes to bathroom frequently, even if she does not drink or eat at the moment or before.

Clinical Presentation: Physical Exam

• BP: 160/100;
• HR: 95;
• RR: 28;
• T: 98.6;
• Wt: 170;
• Ht: 85;
• BMI: 26.23;
• General: the patient is calm and prefers to sit due to her constant weakness.
• Chest: no auscultations.
• Abdomen: soft, no tender, active bowel sounds.

During a physical examination of a patient, the vital signs have to be mentioned. These clinical findings help to obtain a clear picture of a patient and investigate if they are normal or not. Blood pressure is 160/100. This sign proves chronic hypertension of the patient. Pulse is 95 beats per minute. It is a norm for women. Still, it is close to a high level. Respiration rate is 20 beats per second. This number is defined as high. Finally, the patient’s BMI is 26.23. It is a sign of overweighing. Her weight is 170 cm, and her height is 85 cm. Though she does some physical exercises, this category of overweight is the lowest and can be fixed in case certain measures are taken.

Differential Diagnoses

• Overweight (ICD-10-CM: E66.3): high BMI, weakness, genetics.
• Heart failure (ICD-10-CM: I50.9): weakness, fatigue, reduced ability to exercise, increased need to urinate.
• Kidney failure (ICD-10-CM: N17.9): weakness, high blood pressure, frequent urination, and Type II diabetes as the main cause.

Three possible differential diagnoses can be given to the patient regarding her main complaints, including weakness, frequent urination, and other associated complications like the impossibility to exercise frequently and confusion due to fatigue.

1. Overweight is a complex disorder that is usually characterized by an excessive body fat. Overweight is a risk factor for women with diabetes (Ollila et al., 2017). The number of health problems may be considerably increased due to overweight.
2. Heart failure is a condition when a heart cannot pump the required amount of blood. Type II DM increases the risk of having a heart failure in women older than 40 years (Zannad et al., 2015). Glucose-lowering medications may lead to a serious cardiovascular harm.
3. Kidney failure is a condition when kidneys are not able to control waste products obtained from blood. Blood chemicals may be dangerous for the body, and Type II diabetes is a disease that is characterized by such complications as kidney failure (American Diabetes Association, 2015). It is necessary to optimize glucose control and stabilize blood pressure to avoid the development of further complications.

Diagnostic Tests: FPG or RPG

To identify the category of diabetes, it is suggested to take plasma glucose tests. There are two types of tests available to patients. Both of them aim at measuring the level of glucose in blood. First, there is a Fasting Plasma Glucose test that has to be taken in the morning as a result of fasting (meaning not eating during the last eight hours). If the level of sugar is 126 mg/dL and more, a patient has diabetes (American Diabetes Association, 2015). Second, there is a Randon Plasma Glucose test with the help of which it is possible to measure the level of sugar any time because fasting is not required. It is used in case urination becomes more frequent and other symptoms are observed.

Diagnostic Tests: A1C

A1C – Glycated Hemoglobin Test:

Measures the level of blood glucoses during the last three months.

It is allowed to eat and drink before this test.

Such factors as age and co-morbidities are taken into consideration.

• 5.7% – normal level;
• 5.7% – 6.4% – prediabetes;
• 6.5%> – diabetes.

Glycated hemoglobin test, also known as A1C or HbA1C, is used to indicate an average level of glucose in blood in the period of the last three months. The peculiar feature of this test is the possibility to identify an average level of sugar during the last three months. There are no measurements that make this test sensitive because it is allowed to eat and drink anytime. The specificity of A1C is the consideration of age and different co-morbidities of a patient. A predictive level in this test is as follows: 5.7% – normal, 5.7% – 6.4% – prediabetes, 6.5%> – diabetes (American Diabetes Association, 2015).

Diagnostic Tests: OGTT

OGTT – Oral Glucose Tolerance Test:

Measures a fasting blood sugar level.

It is necessary to fast the night before taking the test.

Blood is drawn, glucose liquid is taken, and blood is drawn again.

• 140 mg/dL – normal level;
• 140 -199 mg/dL – prediabetes;
• 200 mg/dL> – diabetes.

Oral Glucose Tolerance test is taken by the patients who have to measure their sugar level. This test should be repeated annually to understand if the level of sugar changes, and if a new treatment approach is required. Patients should fast at least 8 hours before taking OGTT. Its specificity is the necessity to draw blood before and after taking specific glucose liquid. Then, the analysis of the results should be developed. According to American Diabetes Association (2015), the norms are following: 140 mg/dL (normal), 140 -199 mg/dL (prediabetes), 200 mg/dL> (diabetes). If FGP or RPG tests have already been taken, OGTT is not necessary (Pradeep & Haranath, 2014).

Medications: Glucotrol

Sulfonylurea is a class of medications which include such types as “tolbutamide, glibenclamide, chlorpropamide, glipizide, acetohexamide, gliclazide and tolazamide” (Pradeep & Haranath, 2014, p. 26). Glucotrol is a medication of this class that belongs to a group of glipizide which helps to control the level of blood sugar. The patient should take it before breakfast (5 mg). This medication is responsible for the improvement of pancreas and its insulin production. The patient should know about contraindications such as allergies, problems with liver or kidneys, or hyponatremia. Glucotrol interactions with beta-blockers, cold products, and ethanol have to be observed carefully. Besides, the patient should follow a diet, do physical exercises, and inform a doctor about any changes in the body due to the possibility of such side effects as blurred vision, dizziness, depression, or joint pain. Blood and urine glucose levels have to be periodically monitored.

Medications: Glumetza

Glumetza is a drug from the Metformin class that is used to control the level of blood sugar. It is usually suggested to obese people because it helps to improve glucose tolerance and lower plasma glucose. Patients have to be careful with contraindications such as allergies, renal dysfunction, and problems with breathing or blood. A certain attention should be paid to interactions with such drugs as beta-blockers, cationic drugs, Glyburide, and Furosemide. Patients should never share this medication with other people and be careful not to overdose. If such side effects as sweating, dizziness, or hunger are observed, it is necessary to address a doctor. Lactic acidosis is a dangerous outcome. Renal function, as well as the level of blood glucose, has to be regularly monitored.

Medications: Acarbose

Acarbose is a medication of an alpha-glucosidase inhibitor class the goal of which is to deal with hyperglycemia patients and promote blood-glucose concentration. Its mechanism of action is closely connected with the work of enzymes and their effects on carbohydrates in the body. If people suffer from diabetic ketoacidosis, bowel disease, or chronic intestinal disease should consult their physicians before taking this drug. Besides, the interactions with such substances as thiazides, estrogen, and phenothiazine or some oral contraceptives. Patient education includes the discussions about possible overdoses, the necessity to control the level of glucose in blood, and its main side effects (diarrhea, flatulence, or abdominal pain). Monitoring of blood glucose is required.

Medications: Insulin

Insulin is a form of medication that is used to treat diabetes and provide patients with a hormone with the help of which it is possible to stabilize the necessary level of blood sugar. It is used as injection. Patients with allergies and hypoglycemia should consult their doctors before taking it. Education about its interactions with beta blockers, alcohol, ACE inhibitors, and clonidine is required to prevent the dysfunction of lungs. The main side effects are pruritus, edema, rash, and hunger. Allergies to some of the insulin components may be observed. Body weight and blood glucose have to be regularly monitored.

Medications: Actos

Actos is a brand name of the medications of pioglitazone class the goal of which is to lower the level of sugar in blood. This antidiabetic agent aims at decreasing insulin resistance and increasing glucose disposal. Such conditions as pregnancy, hepatic impairment, bladder cancer, and macroscopic haematuria should be defined as the main contraindications of the drug. The patient should learn about possible allergies caused by Actos and the nature of interactions with different oral contraceptives, metformin, glipizide, and warfarin. Change of weight, overdose, blurred vision, and problems with hearing or livers should be identified.

Prescription

• Name of a Facility
• Date: 22/11/17
• Patient Name: ________ Birthday: _________
• Name of Medication: Humulin 70/30 (calculated regarding the level of glucose in blood).
• SIG: injection 30 min before meal
• # dispensed: 100 Refill None.
• Signature: __________.

All above-mentioned medication require prescriptions that have to be given by a doctor. It is hard to find a place where it is possible to buy some diabetes drugs without prescriptions. Besides, all reliable associations and well-known organizations suggest not buying diabetes drugs which are over-the-counter. It is unsafe and may lead to a number of negative outcomes. Still, if a person is in need of some medication at the moment, it is possible to pay attention to the places where insulin can be sold without a prescription.

Care Plan

• Follow-Up:
  • regular meetings with a primary health care provider;
  • annual tests;
• Referrals:
  • podiatrist;
  • psychologist;
• Education:
  • what to expect;
  • why to follow a diet;
  • what lifestyle to follow;
  • how to encourage physical activities;
• Care:
  • blood pressure control;
  • dietary issues;
  • vaccination.

It is important for a patient never omit meetings with a primary healthcare provider and take all necessary test to control the level of glucose or indicate other body changes. It is possible to address such specialists as podiatrists or psychologists in case certain problems bother a patient. Education should cover different aspects of routine life, including expectations, diets, lifestyle, and physical activities. A certain attention should be paid to blood pressure control, dietary issues, and vaccination.

References

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 33(2), 97-111.

Cersosimo, E.,Tiplitt, C., Mandarino, L.G., & deFronzo, R.A. (2015). Pathogenesis of type II diabetes mellitus. Web.

Coelho, G. D. P., Martins, V. S., Amaral, L. V. D., Novaes, R. D., Sarandy, M. M., & Gonçalves, R. V. (2016). Applicability of isolates and fractions of plant extracts in murine models in type II diabetes: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2016. Web.

Ollila, M. M., West, S., Keinänen-Kiukaanniemi, S., Jokelainen, J., Auvinen, J., Puukka, K., … Piltonen, T. T. (2017). Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus—A prospective, population-based cohort study. Human Reproduction, 32(2), 423-431.

Pradeep, T., & Haranath, C. (2014). A review on diabetes mellitus type II. International Journal of Pharma Research & Review, 3(9), 23-29.

Reinehr, T. (2013). Type 2 diabetes mellitus in children and adolescents. World Journal of Diabetes, 4(6), 270-281.

World Health Organization. (2017). Diabetes. Web.

Zannad, F., Cannon, C. P., Cushman, W. C., Bakris, G. L., Menon, V., Perez, A. T., … Lam, H. (2015). Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: A multicentre, randomised, double-blind trial. The Lancet, 385(9982), 2067-2076.

Diabetes: Presentation Objectives

• Introduce diabetes as a serious public health burden in the United States.
• Provide statistical background.
• Learn current diagnostic and treatment methods for diabetes.
• Investigate recent interventions in treating diabetes.
• Understand how to apply a nursing theory in clinical practice.

This presentation is about diabetes, its types, diagnoses, and treatment interventions. At the end of this presentation, the audience will be able to:

• Understand diabetes as a serious public health burden in the United States and describe its main symptoms, causes, and treatment details;
• Use statistical data on the disorder;
• Investigate different current diagnostic and treatment methods for diabetes;
• Evaluate recent interventions in treating diabetes;
• Apply a nursing theory in clinical practice in order to treat diabetes and provide patients with a possibility to prevent this disorder.

Diabetes Basics

• What: A metabolic disorder group that is characterized by a high level of sugar in the blood.
• Types: Type I, Type II, Gestational.
• Symptoms: frequent urination, thirst, weight loss, fatigue, blurred vision.
• Causes: the immune system destroys cells that produce insulin in the pancreas.

Diabetes is a serious public health concern that introduces a group of metabolic disorders caused by changes in the sugar blood level. There are three main types of this disorder (American Diabetes Association, 2014):

• Type I – a disorder caused by an absolute insulin secretion deficiency;
• Type II – a disorder caused by insulin resistance and an inadequate insulin secretory response;
• Gestational diabetes –a disorder that is characterized by high blood sugar during pregnancy.

The main symptoms include frequent urination, increased thirst, unexplainable weight loss, fatigue, and blurred vision. Still, the list of symptoms is not complete, and each type of diabetes has its own symptoms such as depression, anxiety, and frequent infections (Boyanova & Mitov, 2013). Almost all symptoms result from the main cause of this disorder, which is the destruction of insulin-producing cells in the pancreas by the immune system.

Diabetes: Epidemiology

• Number of people with diabetes:
  • 30.3 million Americans have diabetes (9.4%);
  • 1.25 million children have diabetes;
  • 7.2 million people are not diagnosed (not aware);
  • 1.5 million new cases occur annually;
  • 84.1 million people are pre-diabetic.
• Number of deaths due to diabetes:
  • Under 20 years – 193,000 deaths;
  • 17,900 – Type I;
  • 5,300 – Type II.
• Risk factors for diabetes:
  • Family history, diet, weight, inactivity, high blood pressure;
  • Age: >18, Race: American Indians, Hispanics and Blacks.

According to the National Report of the Centers for Disease Control and Prevention (2017), diabetes afflicts 9.4% of the US population. The number of people who have diabetes increases regularly, including the number of people who remain unaware of having the disease. In addition to the fact that 30.3 million Americans have diabetes (Type I or II), there are approximately 84.1 million who are pre-diabetic. Diabetes is the seventh leading cause of death among Americans and it takes about 193,000 lives annually (Tucker, 2017). People should be aware of such risk factors for diabetes as family history, poor diets and inactivity that lead to overweight and obesity (fatty tissue promotes a high resistance of cells to insulin), and high blood pressure or glucose (Ferrannini & Cushman, 2012). People under 18 years who are American Indians, Hispanics and non-Hispanic Blacks are more likely to have different forms of diabetes.

Diagnosis of Diabetes

• A1C – Glycated hemoglobin test.
• RPG – Random plasma glucose test.
• FPG – Fasting plasma glucose test.
• OGTT – Oral glucose tolerance test.

If people have a BMI more than 25, and they are older than 45, it is recmmended to take a test for diabetes regularly. There are four main tests that can be offered to patients for diagnosis (American Diabetes Association, 2014; Ferrannini & Cushman, 2012):

1. A1C (Glycated hemoglobin test): indicates an average blood glucose level over the last three months (5.7% – normal, 5.7-6.4% – pre-diabetic, 6.4%> – diabetic);
2. RPG (Random plasma glucose test): measures blood glucose level, can be taken anytime, fasting is not usually required (200 mg/dL> – diabetic);
3. FPG (Fasting plasma glucose test): measures blood glucose level, has to be taken in the morning, fasting period is at least eight hours (126 mg/dL> – diabetic);
4. OGTT (Oral glucose tolerance test): indicates a level of sugar in the blood, has to be taken annually, fasting during the last eight hours (140 mg/dL – normal, 140-199 mg/dL – pre-diabetic, 199 mg/dL> – diabetic.

Diabetes: Treatment Interventions

• Routine Activities:
  • Blood sugar/glucose monitoring;
  • Insulin monitoring;
• Non-Pharmacological Treatment:
  • Healthy diet;
  • Physical exercises;
  • Lifestyle changes.
• Pharmacological Treatment:
  • Insulin;
  • Metformin;
  • Sulfonylurea;
  • Alpha-glucosidase inhibitors;
  • Pioglitazone.

In scholarly articles, much attention is paid to different methods of treatment that can be offered to patients with diabetes. For example, despite the type of diabetes, patients have to follow several routine tests, such as monitoring and control of the level of blood sugar, glucose, and insulin. Any change should be reported to a physician or a nurse (Tucker, 2017).

Non-pharmacological treatment may include: the necessity to keep to a healthy diet, engage in physical exercise regularly (if age allows), and consider certain lifestyle changes (American Diabetes Association, 2014).

Pharmacological treatment should be based on taking medications from such groups as insulin (a hormone that controls the level of sugar in the blood), metformin (an antihyperglycemic agent that improves glucose tolerance in the blood), sulfonylurea (a hormone that controls the level of sugar in the blood), alpha-glucosidase inhibitors (promote blood glucose concentration), and pioglitazone (decreases the level of blood sugar) (Pradeep & Haranath, 2014).

Research Article on Diabetes

• Article: Roumie et al. (2014) on treatment of diabetes patients with metformin, insulin, and sulfonylureas.
• Method: Retrospective cohort; medical records of veterans who are treated with metformin, insulin, and sulfonylurea.
• Strengths: Evaluation of different pharmacological treatment methods, insulin-associated risks, and cardiovascular outcomes.
• Weaknesses: Attention to refill data only, sample size, and the presence of difficult-to-measure factors.
• Future Implications: Deep investigation on risks associated with insulin use.

The article for analysis was published in JAMA in 2014. Its title is “Association between intensification of metformin treatment with insulin vs. sulfonylureas and cardiovascular events and all-cause mortality among patients with diabetes.” Roumie et al. (2014) aim to investigate diabetes medications, including insulin, metformin, and sulfonylurea, and to compare the time to acute myocardial infarction, stroke, or death among patients. The research method is a retrospective cohort of the Veterans Health Administration, Medicare, and National Death Index databases from 2001 to 2008. The strong points of this article include the possibility of evaluating the effects of different medications on patients with diabetes, identifying treatment outcomes that may be avoided, and investigating insulin-related risks. The authors admit such limitations as difficult-to-measure factors (patient frailty or diabetes severity), the chosen sample size, and the usage of refill data only (Roumie et al., 2014). It is suggested to use the results of this investigation in new research on cardiovascular risks associated with diabetes.

Nursing Theory: Basics

Roy’s Adaptation Theory:

• Physical and psychological adaptability => life quality;
• Goal of nursing => adaptation;
• Person => adaptive system;
• Environment => reasons for adaptation;
• Health => outcome of adaptation;
• Nursing => means of adaptation.

Callista Roy is a nurse theorist and writer who introduced her Adaptation theory in 1989. According to this theory, all individuals are bio-psycho-social beings who have to improve their physical and psychological adaptability, which can influence the quality of their lives. This theory aims at promoting adaptation as the only way to maintain constant interaction with the environment. The success of adaptation depends on how well patients and nurses are able to use their conscious awareness and take correct steps. A patient has to develop an appropriate adaptive system in terms of which all internal and external environmental changes (as stimuli for adaptation) can be interpreted correctly. Health is the main outcome of an adaptive process, and nurses have to support and educate patients on how to cope with health problems and challenges.

Nursing Theory: Application

• WHY:
  • Diabetes is a chronic disease.
  • Patients have to adapt to it.
  • Diabetes treatment includes lifestyle changes.
  • Integration and adaptation are integral points.
• HOW:
  • Life with diabetes is full of fears, conflicts, and anxiety.
  • Balance is supported by Roy in her adaptation theory.
  • Balance is what diabetes patients may need.
  • New improvements and changes are required.

Roy’s adaptation theory may be a helpful tool in treating patients with diabetes due to the fact that it is based on the idea of adaptation to environmental changes. Diabetes is a chronic disease that can go away in a short period. Patients have to know how to live with this disease, what changes should be considered, and what treatment is appropriate. Nurses and doctors offer an integration of lifestyle, diet, activities, and medications to control the level of sugar in the blood. This theory helps patients to accept the fact that a new life with diabetes may be full of fears, conflicts, anxiety, and uncertainty. Adaptation offers a possibility for finding balance. Changes may be not enough, and adaptation can be an answer.

How to Improve Patient Outcomes

• Self-management education.
• Promotion of behavioral changes.
• Nutritional improvements.
• Planning, monitoring and control.
• Cooperation between a patient and a health care provider.
• Medication importance.
• Readiness for adaptation.

Based on Roy’s adaptation theory, the research of Roumie et al. (2014), and the analysis of scholarly articles, several ways to improve diabetes patient outcomes may be identified.

1. Self-management education (nurses and other health care providers should educate their patients about the importance of changes as soon as they are diagnosed with diabetes);
2. Promotion of behavioral changes (changes have to be explained and supported);
3. Nutritional improvements (diets must support healthy outcomes);
4. Planning, monitoring and control (sugar and glucose level in the blood should be checked regularly);
5. Cooperation between patients and health care providers (patients must understand that they can turn to their health care providers anytime they need help or an explanation of a disease-related problem);
6. Importance of medication (insulin is a medication that cannot be neglected);
7. Readiness for adaptation (patients have to accept new rules and requirements).

Conclusion

• Diabetes is a chronic disease that touches upon millions of American lives.
• Diagnoses and treatment cannot be neglected by diabetes patients.
• Insulin is the main treatment.
• Health care providers have to support their patients.
• Adaptation is a solution for diabetes patients.
• Diabetes may kill, and people should treat it properly.

At the end of this presentation, the following conclusions can be made:

1. Diabetes is a serious public health concern that touches millions of American lives and is caused by a high level of sugar in the blood.
2. More than 193,000 people die due to diabetes annually.
3. Diagnosis (A1C, FPG, RPG, OGTT) and treatment (physical activities, diets, medications such as insulin) are important for patient care.
4. Health care providers are responsible for patient education and support.
5. Roy’s theory of adaptation can be used to explain the possibility of coping with health challenges and lifestyle changes caused by diabetes.
6. Diabetes can kill, and early diagnosis is a way to save lives.

References

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(1), 81-90.

Boyanova, L., & Mitov, I. (2013). Antibiotic resistance rates in causative agents of infections in diabetic patients: Rising concerns. Expert Review of Anti-Infective Therapy, 11(4), 411-420.

Centers for Disease Control and Prevention. (2017). National diabetes statistics report. Web.

Ferrannini, E., & Cushman, W. C. (2012). Diabetes and hypertension: The bad companions. The Lancet, 380(9841), 601-610.

Pradeep, T., & Haranath, C. (2014). A review on diabetes mellitus type II. International Journal of Pharma Research & Review, 3(9), 23-29.

Roumie, C. L., Greevy, R. A., Grijalva, C. G., Hung, A. M., Liu, X., Murff, H. J., … Griffin, M. R. (2014). Association between intensification of metformin treatment with insulin vs sulfonylureas and cardiovascular events and all-cause mortality among patients with diabetes. JAMA, 311(22), 2288-2296.

Tucker, F. M. (2017). America’s diabetes crisis: There is no reason! Exigence, 1(1). Web.

The health of the population is the most valuable achievement of society, so the preservation and strengthening of it is an essential task in which everyone should participate without exception. Proper diagnosis and treatment of patients play a vital role in the profession of a nurse practitioner. A precise analysis of the available data will help correctly formulate the next steps in helping the patient and prevent complications.

The name of the patient chosen for the study is Doris Greek-Martin. She is a fifty-seven-year-old female with diabetes type 2, elevated blood pressure (HTN), and coronary artery disease (CAD). She says that she is constantly feeling tired and do not want to do much. This feeling has significantly intensified in the last few months. In addition to fatigue, the patient also experiences a loss of appetite. Moreover, the woman pointed out that she has slightly swollen legs. When studying the medical record, it turned out that the woman takes several medications. Every day she takes Januvia, Atorvastatin, Lisinopril, and ASA. Once a week, she takes Fosamax and medications such as Xanax for anxiety and Coreg.

Doris Greek-Martin’s preventive care shows immunization history. The patient’s last pap was two years ago, which had positive results. Her mammogram was two years ago and which also was normal. The woman had undergone colonoscopy five years ago without any harmful results. The patient’s Dexacan was done two years ago and concluded T scope of -2.3 in her left hip, which indicates the case of Osteopenia or thin bones. The presence of Osteopenia requires a change in lifestyle and the provision of a diet with sufficient calcium and vitamin D in the diet (Aggarwal & Bains, 2020). Treatment of the underlying disease that causes malabsorption may increase bone density.

Physical examination showed a generally alert obese female in no apparent distress. Pupils were in acceptable condition and reactive to light. Transcranial magnetic stimulation is normal bilaterally. Nares are patent, and the throat is without erythema or lesions. Respirations are appropriate rate and rhythm as well as cardiac. The skin has warm and dry, with spider angiomas present in the upper extremities and jaundice.

The skin of patients with diabetes often acquires a pronounced yellowish coloration. Laser correction is recommended for the treatment of spider angiomas (Zaouak et al., 2020). This is one of the preferred procedures, as it is not complex, fast, no side effects, and most importantly, painless. Laboratory examination showed that the patient’s complete blood count, thyroid-stimulating hormone, and comprehensive metabolic panel were normal, except for AST and ALT, which were both elevated. These are essential indicators of the state of various organs. An increase in these enzymes indicates damage to organs such as the liver, heart, muscles. Thus, a decrease in their level in the blood occurs independently when the underlying disease is eliminated.

I would screen the patient for type 2 diabetes, as a woman’s fatigue may be due to this disease. Then, based on the examination results, I would refer the patient to effective preventive measures. In addition to blood pressure control and weight loss, diet and physical activity are recommended for the primary prevention of type 2 diabetes. Moderate but regular motor activity increases the sensitivity of cells to insulin, so it can be considered as a preventive measure.

However, the patient complained of swelling of the legs, which can interfere with her physical activity. Edema is the accumulation of lymph in the muscle tissues due to a pathological process associated with a violation of the water-salt balance (Kim, 2019). In diabetic patients, fluid can largely linger in the body, leading to severe puffiness. In almost all cases of leg swelling in diabetes, treatment is complex. Medications are prescribed to normalize sugar levels, treat or relieve urinary system dysfunction, improve cardiovascular system activity and dietary nutrition.

Since the swelling in the leg area can affect the patient’s joints, I would order a second Dexascan. After it is performed, the doctor can compare the condition of the bone tissue; in other words, comparing the base scan with the second scan can show whether the bone density improves, worsens, or remains the same. In type 2 diabetes, nurse practitioners can limit hypoglycemic drugs if they have an effect, and the level of glucose level in the blood is not too high. Therefore, it is necessary to conduct a patient’s blood test, prescribe new drugs, or change the dosage of medications that the patient is already taking.

Diabetes mellitus is common in patients with hypertension and significantly increases the risk of cardiovascular disease. To prevent high blood pressure, the patient takes particular medications, such as Coreg. The pharmacological treatment of patients with hypertension and diabetes is controversial due to concerns about the metabolic effects of certain antihypertensive drugs (Fragasso et al., 2019). In diabetes, the use of antihypertensive therapy is recommended in cases where blood pressure remains at the level of 140/80 mm Hg even with lifestyle adjustments through diet and exercise. To reduce the cardiovascular risk, it is necessary to combat hyperdynamic, after which blood circulation is activated, the myocardium and vascular walls are strengthened, and the removal of harmful cholesterol is accelerated.

Medicine is one of the most important branches of human activity, which requires the involvement of enormous resources, including human resources. Therefore, the profession of a nurse practitioner is relevant, in-demand, and respected. This type of specialist can provide a timely diagnosis to patients and prevent the risks of complications in various diseases. This is especially important in the treatment of diabetes and its consequences. A precise examination and study of the patient’s tests in such cases is especially critical.

References

Aggarwal, R., & Bains, K. (2020). Protein, lysine and vitamin D: critical role in muscle and bone health. Critical Reviews in Food Science and Nutrition, 1-12.

Cummings, J. N., Butler, B., & Kraut, R. (2014). The quality of online social relationships. Communications of the ACM, 45(7), 103–108.

Fragasso, G., Margonato, A., Spoladore, R., & Lopaschuk, G. D. (2019). Metabolic effects of cardiovascular drugs. Trends in cardiovascular medicine, 29(3), 176-187.

Kim, E. J., Lin, W. V., Rodriguez, S. M., Chen, A., Loya, A., & Weng, C. Y. (2019). Treatment of diabetic macular edema. Current diabetes reports, 19(9), 1-10.

Zaouak, A., Bouhajja, L., Jrad, M., Jebali, A., Hammami, H., & Fenniche, S. (2020). Dermoscopic features of spider angioma in a healthy child. Our Dermatology Online, 11(1), 101-102.