Category: Diabetes

Diabetes is one of the most widespread chronic diseases that influence not only humans’ health but also their life. Its spreading is associated with the increased consumption of unhealthy food and minimum physical activity of modern people. Therefore, it is necessary to identify what steps could be taken to stop its expansion. The Affordable Care Act (ACA) is a healthcare policy that plays an essential role in preventing diabetes through the provision of access to healthcare services to all citizens (Konchak et al., 2016). The National Diabetes Prevention Program (NDPP) is a national policy that focuses on stopping the development of this chronic condition (Ackermann, 2017). The analysis of these policies and the other strategies provides the opportunity to understand what role they might play in the improvement of human health. The ability of diabetes prevention policies and strategies to increase awareness about the disease and improve the population’s well-being demonstrates that the health system’s performance in the United States influences population health status.

The differences between these policies concern the aspects of the life of people that they involve. Mainly, the ACA policy focuses on the healthcare system in general, organizing and structuring its elements. The problem of diabetes is viewed as a central component in this structure because this disease concerns a considerable number of citizens. NDPP policy, on the other hand, emphasizes the role of lifestyle and sports in the prevention of the problem (Ackermann, 2017). It introduces the idea that the identification of diabetes in the early stages and healthy habits play a significant role in reducing disease development cases. This focus on different areas of life reveals that these policies regard the issue from different angles.

The comparison of these two policies contributes to the identification of their similarities. First, both these policies aim to improve the health conditions of the population, regarding diabetes as one of the major problems in the United States. Second, they both emphasize the authorities’ role in the formation of appropriate conditions and values among the population. Mainly, the ACA policy identifies that the officials should focus on expanding the ideas of a healthy lifestyle and its role in preventing the disease. According to Konchak et al. (2016), the policy guarantees the “financial and technical support for expanding wellness programs” (p. 7). NDPP also values the role of “lifestyle intervention programs,” understanding that limiting the spread of the disease requires universal decisions (Ackermann, 2017, p. 1298). This understanding of the necessity to cope with the problem using multidimensional approaches unites these two policies.

Diabetes has had a significant impact on the population in the United States. More than twelve percent of the adult population in the country suffer from this illness (Konchak et al., 2016). One of the significant problems was that the majority of these citizens did not take the tests and were unaware of their situation. Consequently, their condition aggravated, and it determined the healthcare system’s difficulties when dealing with these patients. Such complications as amputations and disabilities demonstrated what consequences the disease might have when people did not acknowledge their state. In addition, diabetes led to problems with the cardiovascular system and increases in death rates (Konchak et al., 2016). This situation reveals that the disease affects the citizens’ quality of life, making them suffer from various troubles connected with it.

Diabetes is a significant burden for the healthcare system in the United States. The results of the research indicate that “economic costs of diabetes increased by 26% from 2012 to 2017” (“American Diabetes Association,” 2018, p. 917). This situation is associated with the increased costs of medical care per person and the growing number of people diagnosed with diabetes. As a result, this situation imposes a significant economic burden on the healthcare system in the country. Moreover, it contributes to the reduction in personnel productivity, the cases of absenteeism, and the death rate of medical workers. Thus, it influences the healthcare system in general, increasing the expenses and affecting the work of medical specialists.

The strategy of educating the population about the disease is a central step in the solution of the problem. Diabetes self-management education and support (DSMES) is the strategy aimed at increasing awareness about the specifics of the disease and the measures of its prevention among the citizens. It comprises such elements as specific knowledge about the illness, the cooperation with the team of specialists, the skills of coping with the problems and stress, and the decision-making process (Powers et al., 2020). The introduction of the strategy allows the health workers to guarantee that their patients are aware of the complications of the disease. Besides, patients should know how to manage their lives to decrease the influence of diabetes.

The next strategy is the spread of the information by the Centers for Disease Control and Prevention (CDN). This strategy comprises the spread of agreements with the healthcare institutions to improve the health situation in the communities (Rutledge et al., 2018). It supports such initiatives as introducing physical activity among youth, nutrition regulations, explanation of the signs of diabetes, identification of the risk groups, and the presentation of the programs aimed at self-management. These elements of the strategy contribute to improving the situation among individuals with prediabetes and those who are not aware of their health problems. It provides the chance to introduce preventive measures in schools, which might affect all the future habits of schoolchildren, who are aware of the issues.

The current progress in preventing the spread of the disease is associated with scientific research in the field. Mainly, randomized controlled trials play a significant role in identifying the methods of reducing the chances of complications. Various studies identify that such factors as blood pressure and glucose level can help measure the possible threat of developing diabetes symptoms. Consequently, the researchers’ ability to find the reasons and risk factors contribute to the decreased chances of suffering from the complications. Lee, Greenfield, and Pappas (2018) describe the application of various technological tools explaining how they help manage diabetes and improve the condition of patients. These findings demonstrate that modern science progress in identifying the risk factors and the methods to cope with the problem.

However, the attempts to reduce the effect of diabetes also encounter various challenges. First, the socioeconomic status of such citizens as immigrants and ethnic minorities prevents these people from having sufficient coverage of their insurance. At the same time, these representatives of the communities are among those who suffer from the disease more frequently (Konchak, 2016). The next challenge is the difficulty associated with the involvement of many people in the programs, which can identify diabetes in the early stages of its development. Mainly, the low engagement of the population in the programs signifies that a considerable number of the citizens have no chance to prevent the health issue because they are not aware of their condition. Finally, the insufficiency in the number of specialists, limited access to services, and geographic factors determine the inability of some people to cope with diabetes complications.

The first effective strategy that might help increase awareness and help prevent the disease is the restrictions in marketing. Since diet and nutrition influence the development of diabetes, it is necessary to toughen the regulations framing the marketing strategies of the companies producing unhealthy products. In particular, the policymakers should restrict these companies’ possibility to target youth in schools. Timpel et al. (2019) explain that such initiatives might decrease the availability of unhealthy food and promote awareness about the healthier replacement of these snacks. This approach is an essential element in increasing education because it aims at the schoolchildren who might form new habits in society in the future.

The second strategy is the introduction of additional sugar taxes that might decrease the consumption of unhealthy food. Timpel et al. (2019) assume that the sugar taxes and labeling of the products containing high amounts of sugar might help increase awareness about the adverse effects of this substance on human health. Although this initiative can encounter criticism, future generations might benefit from it because they would consume more healthy ingredients. After all, such food and beverages would be available and cheap.

Various policies and strategies aimed at preventing diabetes contribute to improving the situation with the disease, which signifies that the health system’s performance affects the population’s health status. Such policies as ACA and NDPP help spread the information and improve the health system condition in the country, which enables it to cope with diabetes. DSMES and CDN strategies allow the policymakers to guarantee sufficient awareness and knowledge about methods of managing the disease. Although policymakers achieve some progress in reducing the number of diabetes patients, such strategies as introducing restrictions in marketing and sugar taxes might help to cope with the troubles caused by the disease.

References

Ackermann, R. (2017). From programs to policy and back again: The push and pull of realizing type 2 diabetes prevention on a national scale. Diabetes Care, 40(10), 1298-1301.

American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928.

Konchak, J., Moran, M., O’Brien, M., Kandula, N., & Ackermann, R. (2016). The state of diabetes prevention policy in the USA following the Affordable Care Act. Current Diabetes Reports, 16(6), 1-12.

Lee, P. A., Greenfield, G., & Pappas, Y. (2018). The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: A systematic review and meta-analysis of systematic reviews of randomised controlled trials. BMC Health Services Research, 18(1), 1-10.

Powers, M., Bardsley, J., Cypress, M., Funnell, M., Harms, D., & Hess-Fischl, A. et al. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636-1649.

Rutledge, G., Lane, K., Merlo, C., & Elmi, J. (2018). Coordinated approaches to strengthen state and local public health actions to prevent obesity, diabetes, and heart disease and stroke. Preventing Chronic Disease, 15.

Timpel, P., Harst, L., Reifegerste, D., Weihrauch-Blüher, S., & Schwarz, P. E. (2019). What should governments be doing to prevent diabetes throughout the life course?. Diabetologia, 62(10), 1842-1853.

Introduction and Rationale

This paper contains the description and analysis of vulnerability and an appropriate holistic care plan for a 50-year-old male with type 2 diabetes. According to the Nursing & Midwifery Council (NMC) (2018, p. 9), a nurse has a duty of confidentiality to those who receive care, so the patient will be named Jack. Today, millions of people are aware of diabetes mellitus and the inability to cure this disease. In Scotland, the number of diabetic patients has dramatically increased in the past decade, and approximately 5.6% of the population of all ages live with type 2 diabetes (Scottish Diabetes Data Group, 2018, p. 8).

About 27,500 individuals with type 1 diabetes were registered in 2008 and 32,800 individuals in 2018 (Scottish Diabetes Data Group, 2018, p. 8). Diabetes is a chronic disease caused by a failure to produce insulin in pancreatic cells or respond appropriately to insulin (Galicia-Garcia et al., 2020). This metabolic condition challenges people whose bodies cannot make the necessary hormone, resulting in a high glucose level in the blood (Scottish Public Health Observatory, 2019). Diabetes is managed by taking insulin regularly and never missing blood sugar check-ups.

One of the main rationales to use this particular long-term condition is that despite the intention to manage diabetes, it remains a leading cause of death among people of all ages. According to the World Health Organization (2021), in 2019, 1.5 million deaths were directly related to diabetes, while 2.2 million deaths were indirectly related (high glucose levels). Therefore, the goal of choosing diabetes is to enhance an understanding of this condition and develop an effective care plan for diabetic patients. People who have diabetes spend more time in hospitals and require improved inpatient and outpatient care (Nikitara et al., 2019).

Personal and healthcare needs are increased due to diabetes, and nurses have to pay attention to patient education, holistic care, and support. Nurses work with diabetic people to examine facilitators and barriers in care, promote health, manage the disease process, prevent complications, and explain self-management basics. This paper focuses on a particular person with diabetes to investigate this vulnerability and introduce a holistic approach to care.

Vulnerability and Resilience

Vulnerability is a commonly used but not adequately defined term in health care. Many scholars and researchers have recently demonstrated their interest in understanding vulnerability and its relation to care quality. Clark and Preto (2018, p. 308) explain vulnerability as a characteristic of the human condition of being harmed physically or emotionally. Illnesses and diseases like diabetes prove people’s physical vulnerability and lead to emotional instability (Boldt, 2019). Jack has diabetes and needs to monitor his blood glucose level regularly. Risk factors of diabetes vary, depending on the type of the condition.

For example, in one-third of diabetic cases, diabetes vulnerability is due to genes, while two-thirds are due to environmental factors (Masharani, 2021). The genetic risk is recognised in the HLA locus (type 1 diabetes) and TCF7L2 (type 2 diabetes) (Masharani, 2021). Several relatives in Jack’s family have already been diagnosed with diabetes, which increased the risk of having the same diagnosis with time.

Genetic factors are not the only risks for Jack and people with a similar condition. Many healthcare providers could identify diabetes at an early stage, examining environmental factors. If humans cannot change their genes and natural predisposition to a disease, environmental causes of diabetes are recognised and managed to reduce the chances of developing diabetes at an early stage (Angi and Chiarelli, 2020). The food environment and feeding habits are related to weight changes and obesity-related problems from childhood (Angi and Chiarelli, 2020). The quality of physical activities also contributes to obesity and the likelihood of adverse cardiovascular outcomes and uncontrolled hypertension (Dendup et al., 2018).

Jack does not control his feeding habits and eats fat and high-calorie products. His body mass index is already above the normal, but Jack does nothing to change the situation but lives with obesity and body-related changes. However, increased thirst and appetite, frequent urination, weight changes, and fatigue are the early symptoms of diabetes (Kahanovitz, Sluss and Russell, 2017, p. 37). Jack could not differentiate between the outcomes of obesity and the signs of insulin deficiency because of poor knowledge about diabetes.

Despite examining early signs, genetic factors, and the environment, the current life-long condition is impossible to cure, and individuals need additional support to improve resilience and develop appropriate self-management and lifestyle modifications. In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges (Barasa, Mbau and Gilson, 2018, p. 496).

Resilience proves the necessity of diagnosing a disease, following a treatment plan, managing the condition, and not initiating new problems and complications. Jack does not want to give up on his life, and he tries not to forget about the basics of his treatment and cooperation with the hospital staff when he was diagnosed with diabetes. Jack neglected the necessity to evaluate family history because of limited knowledge about diabetes management, which is a significant protective factor in a care process (Lv et al., 2020). Jack’s resilience lies in his family support and the improvement of individual behaviours linked to microenvironments like his colleagues and neighbours (Angi and Chiarelli, 2020). The elimination of junk food and communication with family members are resilient protective factors for Jack.

Many theories may promote positive changes in managing the person’s diabetes, and one of them includes Erikson’s stages of psychosocial development. This theory was introduced in the middle of the 1900s to reflect Freud’s development theory and the role of social dynamics in human life. The theorist proved that it was possible to achieve positive development by learning specific outcomes at a particular age, like confidence at school or care for middle adults (Erikson and Erikson, 1997, p. 57).

Adults aged between 40 and 65 years should be ready to take care of people or thoughts at this period and contribute to their well-being by any possible means (Erikson and Erikson, 1997, p. 67). If diabetes is a chronic condition that contributes to the person’s disability status and makes him vulnerable, the chosen theoretical framework allows understanding adults’ capabilities for self-management (Perry et al., 2015, p. 254). Diabetes is a challenging condition for all individuals, and the application of eight stages of psychosocial growth should help create a holistic care approach.

Jack’s experience and diabetes management may be considered through eight stages in Erikson’s theory of development. First, regarding his age, Jack is at his generativity vs. stagnation crisis. Generativity is associated with making commitments, developing relationships, and contributing to improved living conditions (Erikson and Erikson, 1997, p. 67). Stagnation is a pathology when a person cannot find an appropriate way to contribute to development and maturity due to a lack of interest, no properly taken efforts, or self-centredness (Erikson and Erikson, 1997, p. 68). Thus, Jack is in his stagnation stage when he does not want to take some steps and change his health.

He demonstrates no interest in developing himself, which means Jack could possibly make some mistakes or failures in the past. Second, it is necessary to investigate each stage of development, starting from trust vs. mistrust and understanding hope (Erikson and Erikson, 1997, p. 60). Sometimes, previous stages of development may be reviewed but never neglected to make sure that all psychosocial skills are used.

Appropriate Care

The development of an appropriate care plan is critical for Jack and his diabetes management tactics. A person with type 2 diabetes is at risk of getting several severe conditions that challenge human health, including kidney failure, cardiovascular diseases, neuropathy, blindness, and mortality (Cole and Florez, 2020, p. 378). At this moment, Jack should be educated on the diet standards to be maintained because obesity contributes to diabetes, challenges blood sugar levels’ monitoring, increases blood pressure, and provokes new heart problems. Physical activities must be improved as well to establish better well-being.

Finally, communication and social support are critical elements in any care plan where nurses cooperate with patients and their families. As such, there are two main aspects of health, obesity and sugar blood levels, that may be affected by diabetes and managed by nursing care (Scottish Intercollegiate Guidelines Network, 2017, p. 9). Lifestyle managements depends on the patient and his readiness to cooperate with the nurse.

According to Erikson’s theory of development, an adult person should properly understand and experience such feelings as fidelity, hope, and confidence in any activity. In case there is a conflict between what has to be achieved and what is achieved at the moment, a person should address an expert and find support to make the necessary improvements (Erikson and Erikson, 1997). In Jack’s case, diabetes cannot be cured for good, and the goal of a care plan is to manage the symptoms, monitor the level of blood sugar, and predict the growth of adverse conditions.

According to Helgeson, Van Vleet and Zajdel (2020), older age is associated with less psychological diabetes distress. In other words, with age, people know how to live with diabetes, what habits to avoid, and what decisions to make. Jack needs education on diet standards like the avoidance of carbohydrates and sugar that slow the absorption process and complicate maintaining glucose levels (Kahanovitz, Sluss and Russell, 2017, p. 39). Drink and food alternatives exist, and Jack could hear about some of them due to his age and diabetic experience.

In addition to individual resilience and responsibility, the role of nurses in a holistic care plan is vital. As a part of a health care team, a nurse works with a doctor and coordinates the patient’s health care needs (National Institute for Health and Care Excellence, 2015, p. 7). Although the nurse is not able to watch what Jack eats all the time, communication helps underline the main aspects of the food environment (Lawler et al., 2019). Some nurses have special degrees that allow them to prescribe medicines and counsel about self-management (Nikitara et al., 2019). However, not all patients trust nurses more than doctors, and oral recommendations and emotional support are expected from nurses in most cases.

From the personal focus, blood sugar monitoring is one of the most important things the patient can do to manage diabetes mellitus. Some people do not know how to make the necessary calculations, and that is how the nurse contributes to a holistic care approach (cited in Nikitara et al., 2019). For example, the HbA1c test shows the average blood sugar level in the last three months, and some tests require people to fast a certain period (Kahanovitz, Sluss and Russell, 2017, p. 38).

In diabetes care, nurses perform the role of educators to help people understand their new condition, the specifics of the disease, possible complications, and complications (Lawler et al., 2019). Doctors usually inform how often to monitor the blood, and nurses remind and motivate not to miss the deadline and report the results. Today, the person can choose among a variety of portable blood sugar meters with respect to personal interests, finances, and even the style of life. Diabetes is a chronic condition, but it is possible to live with it and establish some fashionable trends.

From the environment focus, physical activity is an element of a weight-loss program for the diabetic person. A low level of activity is one of the severe vulnerabilities of a person that is explained by increased television viewing time and reduced sleep (Angi and Chiarelli, 2020; Linder et al., 2018). Therefore, Jack has to be introduced to different physical activities and aerobic exercises that do not contradict other health recommendations (Scottish Intercollegiate Guidelines Network, 2017, p. 17).

Physical activity resources include swimming, running, biking, and walking (Dendup et al., 2018). The role of a nurse, in this case, is not to keep company but to share information and give clear instructions on how exercises are related to diabetes management. Inpatient care depends on nurses and an understanding of their roles. If inadequate information, delays in data exchange, and the lack of diabetes knowledge may prevent self-management success (Nikitara et al., 2019). Jack needs more information about the two concepts, diabetes and physical activity, and the nurse is the most reliable and nearest source.

Conclusion

Personal learning from this task has improved understanding diabetes as a chronic condition that makes an individual vulnerable across the lifespan. A holistic care approach was offered to Jack because it was necessary to combine self-management steps like regular physical activities or blood sugar level monitoring and cooperate with a nurse to be educated and counselled properly. Diabetes may be provoked by genetic and environmental factors, and if Jack cannot resist genetics, he can manage the environment. Although diabetes does not have a cure, certain recommendations may facilitate patients’ conditions and predict adverse outcomes.

In this scenario, a 50-year-old man does not recognise his obesity as a problem for his health and a contributor to diabetes. Therefore, the nurse had to educate and motivate Jack not to neglect physical activity and the necessity of monitoring blood sugar levels regularly. Student nurses could use this case and understand that not all people know enough about diabetes and its monitoring details. Many healthcare practitioners are involved in diabetes diagnosis, management, and treatment, but nurses are the authentic sources of education, communication, and support.

Reference List

Angi, A. and Chiarelli, F. (2020) ‘Obesity and diabetes: a sword of Damocles for future generations’, Biomedicines, 8(11). Web.

Barasa, E., Mbau, R. and Gilson, L. (2018) ‘What is resilience and how can it be nurtured? a systematic review of empirical literature on organizational resilience’, International Journal of Health Policy and Management, 7(6), pp. 491-503. Web.

Boldt, J. (2019) ‘The concept of vulnerability in medical ethics and philosophy’, Philosophy, Ethics, and Humanities in Medicine, 14(1). Web.

Clark, B. and Preto, N. (2018) ‘Exploring the concept of vulnerability in health care’, CMAJ, 190(11), pp. 308-309.

Cole, J.B. and Florez, J.C. (2020) ‘Genetics of diabetes mellitus and diabetes complications’, Nature Reviews Nephrology, 16(7), pp. 377-390. Web.

Dendup, T., Feng, X., Clingan, S. and Astell-Burt, T. (2018) ‘Environmental risk factors for developing type 2 diabetes mellitus: a systematic review’, International Journal of Environmental Research and Public Health, 15(1). Web.

Erikson, E.H. and Erikson, J.M. (1997) The life cycle completed (extended version). New York: W. W. Norton & Company.

Galicia-Garcia, U. et al. (2020) ‘Pathophysiology of type 2 diabetes mellitus’, International Journal of Molecular Sciences, 21(17). Web.

Helgeson, V.S., Van Vleet, M. and Zajdel, M. (2020) ‘Diabetes stress and health: Is aging a strength or a vulnerability?’, Journal of Behavioral Medicine, 43(3), pp. 426-436.

Kahanovitz, L., Sluss, P.M. and Russell, S.J. (2017) ‘Type 1 diabetes–a clinical perspective’, Point of Care, 16(1), pp. 37-40.

Lawler, J. et al. (2019) ‘Does the diabetes specialist nursing workforce impact the experiences and outcomes of people with diabetes? a hermeneutic review of the evidence’ Human Resources for Health, 17(1). Web.

Linder, S., et al. (2018) ‘A population-based approach to mapping vulnerability to diabetes’, International Journal of Environmental Research and Public Health, 15(10). Web.

Lv, X. et al. (2020) ‘Early-onset type 2 diabetes: a high-risk factor for proliferative diabetic retinopathy (PDR) in patients with microalbuminuria’, Medicine, 99(19). Web.

Masharani, U. (2021) ‘Diabetes mellitus & hypoglycemia’, in Papadakis, M.A., McPhee, S.J. and Rabow, M.W. (eds,) Current medical diagnosis & treatment 2021. New York: McGraw Hill. Web.

National Institute for Health and Care Excellence (2015) Type 2 diabetes in adults: management. Web.

Nikitara, M. et al. (2019) ‘The role of nurses and the facilitators and barriers in diabetes care: a mixed methods systematic literature review’, Behavioral Sciences, 9(6). Web.

Nursing & Midwifery Council (2018) The code. Web.

Perry, T.E. et al. (2015) ‘Applying Erikson’s wisdom to self-management practices of older adults: findings from two field studies’, Research on Aging, 37(3), pp. 253-274.

Scottish Diabetes Data Group (2018) Scottish diabetes survey 2018. Web.

Scottish Intercollegiate Guidelines Network (2017) Management of diabetes: a national clinical guideline. Web.

Scottish Public Health Observatory (2019) Diabetes: introduction. Web.

World Health Organization (2021) Diabetes. Web.

The client was a 71-year-old female who was admitted to the hospital for diabetes. The client had a history of gestational diabetes. According to Keresztes and Peacock-Johnson (2019), about 10 percent of the population in the United States has diabetes mellitus, and type 2 diabetes is prevalent in most cases. Diabetes presents one of the most common diagnoses in causes of ED visits among adults and one of the leading causes of death in the United States (Keresztes and Peacock-Johnson, 2019). Therefore, antidiabetic drugs constitute a significant part of medications prescribed to patients in the United States, and not all nurses are familiar with mechanisms used in antidiabetic drugs and their adverse effects.

The main factors that influence the development of type 2 diabetes, according to Keresztes and Peacock-Johnson (2019), are physical inactivity and obesity caused by uncontrolled dietary intake. The hospitalized patient was morbidly obese with an MBI index of 40.0. The article states that obesity contributes to the development of systemic inflammation, which is associated with the dysfunction of the beta-cell (Keresztes and Peacock-Johnson, 2019). The patient was suffering from fungus infection in the right lower extremity. Moreover, obesity in diabetes creates insulin resistance, as it defects the insulin’s ability to bind to the cell’s receptor. The patient experienced delirium and expressed anxious behavior in complaints about pain in extremities. According to the article, the pain could be caused by adverse effects of antidiabetic drugs, such as α-glucosidase inhibitors, DPP-4 inhibitors, and thiazolidinediones.

In conclusion, the prescription of antidiabetic drugs in type 2 diabetes should be performed considering the patient’s age, physical activity data, and weight. In this case, the patient should be educated about the possible adverse effects of antidiabetic drugs as they all have different intake recommendations based on their work mechanisms. Overall, in cases of diabetes, nurses should educate the patients about the importance of physical activity and control of dietary intake and the impact of weight and obesity on the efficiency of antidiabetic drugs.

Reference

Keresztes, P., & Peacock-Johnson, A. (2019). Type 2 diabetes: A pharmacologic update. American Journal of Nursing, 119(3), 32-40. Web.

Alternative Drug Therapies

Insulin injections are a conventional drug option for people suffering from type 1 diabetes, usually serving as the basis for treatment. However, recent studies note that insulin therapy is associated with extreme weight gain as well as hypoglycemia (Lingow et al., 2019). An alternative to insulin is pramlintide, which has received approval from the U.S. Food and Drug Administration. According to Lingow et al. (2019), this therapy “delays gastric emptying, blunts pancreatic secretion of glucagon, and enhances satiety” (p. 164). Other options include metformin, thiazolidinediones, sodium-glucose cotransporter (SGLT) inhibitors, as well as glucagon-like peptide 1 (GLP-1) receptor agonists (Lingow et al., 2019). It is important to note that these insulin alternatives have not yet been approved by the FDA.

Patient Education Strategies

In regards to patient education strategies, the goal of physicians is to ensure individuals suffering from the disease attain the necessary knowledge and attitudes to help them manage diabetes themselves, at least partially. Firstly, medics have to adopt a patient-centered model of educational interventions and communication. Then, they have to assess the existing levels of literacy and numeracy a patient has (American Diabetes Association, 2016). Apart from that, educational programs have to be designed considering specific problems a patient might face and cultural nuances they might be particularly vulnerable to. Tailoring educational initiatives to a person’s unique ethnic and cultural background is the basis of cultural competence in patient education. Both individualized and group education must be continuous and supported throughout a lifetime (Smith & Harris, 2018). These strategies ensure that patients receive a solution adapted specifically for them to confirm that they understand what factors might affect their health condition and lead to chronic complications.

References

American Diabetes Association (2016). Strategies for improving care. Diabetes Care, 39(Supplement 1): S6-S12.

Lingow, S. E., Burke, S. D., Brooks, A. D., & Rafferty, P. S. (2019). Role of noninsulin therapies in the treatment of type 1 diabetes. Diabetes Spectrum, 32(2), 164-170.

Smith, A., & Harris, C. (2018). Type 1 diabetes: Management strategies. American Family Physician, 98(3), 154-162. Web.

A Summary of the Article

The article discussed the value of the online diabetes community (DOC) and its practice applications. According to the article, diabetes is a chronic health condition that requires daily control of glucose balance in the body (Litchman et al., 2017). Another essential term that was discussed in the article is peer health and its management. Peer health is an interaction between peers who share similar health conditions (Litchman et al., 2017). Peer interactions promote education and support in treating diseases such as diabetes (Litchman et al., 2017). DOC is a form of peer health that allows people with diabetes to share their experiences and feedback with other members of the community (Litchman et al., 2017). The article’s study covered older adult users of DOC in the United States who were born between 1946 and 1964 (Litchman et al., 2017). The researchers applied the method of telephone interviews to determine the results and effectiveness of the program. The article studied the applications and effectiveness of DOC among older people.

Reason

The article was chosen for the research of a modern approach to the problem of diabetes. In addition, the article emphasizes the effectiveness of technology in supporting older patients. Such a modern approach allows scientists to analyze a larger number of senior citizens. The article’s information provides insight into the effectiveness of online platforms in addressing the issue of diabetes. According to the authors, their research on relationships between older adults and DOC was the first in the field (Litchman et al., 2017). By applying modern research techniques, the authors could accurately analyze the DOC’s value. Therefore, the article was chosen as a source and the foundation of this research paper for its valuable data and relevance to the topic studies.

Implications

Nursing specialists can apply the results of the article to the development of modern techniques in healthcare. An online community, for example, can expand coverage of older adults with diabetes and promote support for patients who do not have immediate access to nursing services. Nurses can use the article’s data to analyze the effectiveness of other online communities and develop specialized approaches. In addition, nurses can learn the value of online diabetes treatment and support. The article’s information can facilitate the integration of modern systems into healthcare delivery. By analyzing the study’s results, nurses can improve their knowledge of technological advancements in the treatment of diabetes among older adults. Thus, the article provides an essential contribution to nursing practices and increases the knowledge of the treatment of diabetes in the older population.

Objects

The aim of the study was to analyze the value of the online diabetes community in supporting older adult patients. In addition, the goal was to describe why senior citizens cooperated with the DOC (Litchman et al., 2017). Then, the research attempted to illustrate how healthcare providers connected with the DOC and provide details of their interconnection (Litchman et al., 2017). In summary, the research aimed to understand the value of interactions between older adults and healthcare specialists in a specialized online platform designed to provide support and education.

Methods

To conduct the study, researchers used the method of telephone interviews. Participant recruitment was completed using social media platforms such as Facebook and Twitter (Litchman et al., 2017). As a result, a sample group of 76 people was formed. (Litchman et al., 2017). All of the participants were born between 1946 and 1964 and represented an older population (Litchman et al., 2017). In addition, the adults were instructed with regard to the details and questions of the interview beforehand (Litchman et al., 2017). Equally important was the requirement of a verbal agreement to participate in the studies. Therefore, the researchers requested permission at the start of the telephone calls (Litchman et al., 2017). During the interviews, the answers of the participants were recorded and transcribed verbatim (Litchman et al., 2017). To ensure the accuracy of the transcriptions, one of the researchers periodically reviewed the written texts and compared them with the audio recordings (Litchman et al., 2017). The interviews offered valuable data that supported the research’s objectives and functioned as a consistent inquiry method.

The Study’s Findings

The study described the value of DOC in providing support and knowledge to older diabetes patients. The study described in the article was the first attempt to analyze the usage of the DOC by senior citizens (Litchman et al., 2017). The participants expressed their support of the online platform and the ability to share their experiences with peers with identical health issues (Litchman et al., 2017). In addition, they greatly benefited from users who demonstrated extensive experience living with diabetes (Litchman et al., 2017). According to the study, the online community filled one of the gaps in the healthcare system (Litchman et al., 2017). Specifically, healthcare programs were not able to provide sufficient mental support to every patient, and platforms such as DOC increased the knowledge and confidence of older adults in diabetes management (Litchman et al., 2017). The study provided an essential analysis of the implications of the DOC by utilizing effective methods of collecting information.

Reference

Litchman, M. L., Rothwell, E., & Edelman, L. S. (2017). The diabetes online community: Older adults supporting self-care through peer health. Patient education and counseling, 101(3), 518-523. Web.

General Information

• Diabetes mellitus is a chronic endocrinologic condition.
• It is characterized by an increased concentration of glucose in the blood (WHO, 2018).
• There are two main types of diabetes mellitus:
  • Type 1 diabetes – the pancreas does not produce enough insulin (insulin deficiency);
  • Type 2 diabetes – the insulin produced by the pancreas is ineffective (insulin resistance and relative insulin deficiency).

Diabetes mellitus is a chronic endocrinologic disease, which is characterized by increased blood glucose concentration. There are two main types of diabetes mellitus. Type 1 diabetes is associated with insulin deficiency. It occurs when the pancreas fails to produce enough insulin to promote a healthy breakdown of glucose. Type 2 diabetes is associated with insulin resistance and relative insulin deficiency. In this type of diabetes, insulin produced by the pancreas is ineffective, as the cells are resistant to it.

Symptoms of Diabetes Mellitus

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, 2016), diabetes results in the following symptoms:

• polyuria (increased urination);
• fatigue;
• increased hunger and thirst;
• weight loss;
• blurred vision;
• numbness in the extremities;
• persistent sores.

The three main symptoms of diabetes are increased urination, or polyuria, persistent hunger, and increased thirst (NIDDK, 2016). Some patients also develop persistent ulcers. However, diabetes mellitus can also cause symptoms similar to other endocrinologic diseases, including fatigue, weight loss, numbness in the extremities, and blurred vision.

Causes of Diabetes Mellitus

The causes of diabetes vary by type:

• Type 1 diabetes is caused by autoimmune destruction of beta-cells in the pancreas (American Diabetes Association, 2014).
• Genetic predisposition and viral infections are the leading causes of this process (NIDDK, 2016).
• Type 2 diabetes develops due to hereditary factors, as well as obesity and physical inactivity.

The causes of type 1 and type 2 diabetes are different. Type 1 diabetes is primarily genetic. It develops due to an autoimmune reaction, which leads to the destruction of beta-cells in the pancreas (American Diabetes Association, 2014). Viral infections and some environmental factors can also contribute to its development (NIDDK, 2016). Type 2 diabetes can be connected to genetic predisposition but is also influenced by body weight and physical inactivity.

Epidemiology

• In 2014, the global prevalence of diabetes mellitus in adults was 8.5% (422 million) (WHO, 2016).
• In 2016, the prevalence of diabetes mellitus in adults in the United States was 9.44% (McKeever Bullard et al., 2018):
  • Type 1 diabetes – 0.55%;
  • Type 2 diabetes – 8.38%;
  • Other types of diabetes – 0.31%.
• The prevalence of type 1 and type 2 diabetes in American children and adolescents is 0.24% (Dabelea et al., 2014).
• The rate of diabetes mellitus has doubled since the 1980s (WHO, 2016).

According to the World Health Organization (2016), the prevalence of diabetes across the world was 8.5% in 2014. In the United States, 9.44% of adults had diabetes mellitus in 2016 (McKeever Bullard et al., 2018). Type 2 diabetes is the most common and affects 8.38% of the American population, while type 1 and other types are evident in 0.55% and 0.31%, respectively. Among American children and adolescents, the prevalence of diabetes is 0.24% (Dabelea et al., 2014). The WHO (2016) also states that the rates of all types of diabetes have doubled since the 1980s.

Risk Factors

Based on the current research, the risk factors for diabetes include:

• A family history of diabetes;
• Overweight and obesity;
• Physical inactivity;
• Insulin resistance or prediabetes;
• Diseases of the pancreas (pancreatitis, pancreatic cancer, etc.);
• Hormonal diseases (Cushing’s syndrome, hyperthyroidism, etc.).

According to the NIDDK (2016), the main risk factors for diabetes are family history, excess weight or obesity, physical inactivity. Conditions such as insulin resistance or prediabetes also indicate a high risk for diabetes. In addition, diseases of the pancreas, as well as hormonal conditions, contribute to the development of diabetes mellitus.

Medications: Metformin

• Class: biguanides.
• Widely used to treat type 2 diabetes.
• Supported by most clinical guidelines, including those of the American Association of Clinical Endocrinologists and the American College of Endocrinology (Handelsman et al., 2015; Garber et al., 2018).
• Indications: type 2 diabetes, insulin resistance, prediabetes, and high blood glucose.
• Side effects: bloating, diarrhea, anemia, anorexia, and lactic acidosis (Marín-Peñalver, Martín-Timón, Sevillano-Collantes, & del Cañizo-Gómez, 2016).

Metformin is the main type of diabetes medication, which is used to treat type 2 diabetes. The use of metformin is supported by most clinical guidelines, including those of the American Association of Clinical Endocrinologists and the American College of Endocrinology (Handelsman et al., 2015; Garber et al., 2018). The critical indications for prescribing metformin are type 2 diabetes, insulin resistance, prediabetes, and high blood glucose. The medication has a variety of gastrointestinal side effects (bloating, diarrhea) and may lead to anorexia, anemia, and lactic acidosis (Marín-Peñalver et al., 2016).

Medications: Rosiglitazone

• Class: thiazolidinediones (TZDs).
• TZDs work by directly reducing insulin resistance.
• Also recommended for use by the guidelines of the AACE and the American College of Endocrinology.
• Indications: type 2 diabetes, high blood glucose, and insulin resistance.
• Side effects: weight gain, increased risk of bone fracture, chronic edema, and heart failure (Marín-Peñalver et al., 2016).

Rosiglitazone belongs to the class of drugs called thiazolidinediones. These drugs are used in type 2 diabetes and are “the only antihyperglycemic agents to directly reduce insulin resistance” (Garber et al., 2018, p. 98). Rosiglitazone is recommended for use by the guidelines of the AACE and the American College of Endocrinology. Indications for rosiglitazone include type 2 diabetes, high blood glucose, and insulin resistance. Side effects may include weight gain and increased risk of bone fracture, chronic edema, and heart failure (Marín-Peñalver et al., 2016).

Medication: Insulins

• A class of drugs used to treat type 1 diabetes (Handelsman et al., 2015).
• It can also be used in combination with metformin in some patients with type 2 diabetes (Garber et al., 2018).
• The use of insulin in type 1 and type 2 diabetes mellitus is consistent with guidelines of the American Association of Clinical Endocrinologists and the American College of Endocrinology.
• Indications: glycemia in type 1 diabetes; symptomatic hyperglycemia or ineffective therapy in type 2 diabetes.
• Side effects: hypoglycemia, headaches, blurred vision, fatigue, and nausea.

Insulins are a class of drugs used to treat type 1 diabetes (Handelsman et al., 2015). They can also be used in combination with metformin in some patients with type 2 diabetes (Garber et al., 2018). The use of insulins in type 1 and type 2 diabetes mellitus is consistent with guidelines of the AACE and the American College of Endocrinology. Insulins are indicated for glycemia in type 1 diabetes, as well as symptomatic hyperglycemia or ineffective therapy in type 2 diabetes. Patients treated with insulins may develop hypoglycemia, headaches, blurred vision, fatigue, and nausea.

Clinical Presentation of Diabetes Mellitus

• Symptoms of hyperglycemia: polyuria, polydipsia, polyphagia.
• Plasma glucose concentration of ≥200 mg/dL 2 hours after a 75-g oral glucose load – this test is taken in the morning.
• Fasting plasma glucose (FPG) concentration ≥126 mg/dL (after at least 8 hours of fasting).
• Random (casual, non-fasting) plasma glucose concentration of ≥200 mg/dL.
• Hemoglobin A1C level ≥6.5% (Handelsman et al., 2015).

According to the guidelines of the AACE and the American College of Endocrinology, the clinical presentation of diabetes mellitus includes the symptoms of hyperglycemia and plasma glucose concentration of ≥200 mg/dL 2 hours after a 75-g oral glucose load after at least 8 hours of no caloric intake. Alternatively, clinical presentation of diabetes mellitus can include FPG concentration at or above 126 mg/dL, random glucose concentration at or above ≥200 mg/dL, or Hemoglobin A1C level at or above 6.5% (Handelsman et al., 2015).

Examination of Patients with Diabetes: Key Considerations

• Complications of diabetes:
  • kidney failure – “80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension or a combination of the two” (WHO, 2016, p. 30);
  • vision loss – the rate of retinopathy in diabetics is 35%;
  • foot ulcers leading to lower limb amputation;
  • adverse cardiovascular events – the risk correlates with FPG concentration (WHO, 2016).
• Examinations should assist in discovering and preventing potential risks.

Diabetes is associated with multiple health risks and complications, including kidney failure, vision loss, foot ulcers leading to lower limb amputation, and cardiovascular disease. For instance, as estimated by the WHO (2016), “80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension or a combination of the two” (p. 30). Vision loss, foot ulcers, and adverse cardiovascular events are also prevalent among diabetics. Thus, examinations of patients with diabetes should be aimed to discover and prevent potential risks.

Examination of Patients with Diabetes: General

• General examination of patients with diabetes must include:
  • weight;
  • abdominal circumference;
  • height;
  • body mass index (BMI).
• Identify obesity and set weight goals if overweight/obese.
• Normal weight lowers the risk of adverse CV events (American Diabetes Association, 2016).

In patients with diabetes, excess weight contributes to the risk of adverse cardiovascular events (American Diabetes Association, 2016). Therefore, the general part of the examination serves to identify obesity and set weight loss goals if the patient is overweight or obese. The medical practitioner should collect measurements of weight, abdominal circumference, and height, and calculate the patient’s BMI.

Examination of Patients with Diabetes: Eyes

• Eye examination should include:
  • visual activity check;
  • eye examination for xanthelasmata, cataract or ophthalmoplegia;
  • referral to an ophthalmologist for an annual dilated eye examination and/or a POC screening for retinopathy;
• These help to establish retinopathy and other visual impairments associated with diabetes.
• Annual eye examinations assist in preventing vision loss (Handelsman et al., 2015).

As diabetes is also connected with visual impairment and ophthalmologic conditions, it is essential to perform an eye examination. It should include a visual activity check and an inspection of the eye for pathological changes, such as xanthelasmata, cataract formation or ophthalmoplegia. In addition, it is necessary to refer the patient for an annual dilated eye examination and a POC screening for retinopathy. These steps can help in identifying an ophthalmologic condition early on, thus preventing vision loss and impairment (Handelsman et al., 2015).

Examination of Patients with Diabetes: Skin

• Skin examination should target ulcer prevention.
• Inspect the skin for ulcers, redness, or acanthosis nigricans;
• Assess foot deformities;
• In patients with type 1 diabetes, check injection sites for adverse reactions;
• Assessing skin conditions in patients with diabetes aids in preventing complications and determining adverse reactions to therapy (American Diabetes Association, 2016; Garber et al., 2018).

The key dermatologic risk for patients with diabetes is diabetic ulcers, which may lead to amputation. However, a detailed skin examination can also identify other conditions associated with diabetes. Firstly, the practitioner should inspect the skin for ulcers, redness, and acanthosis nigricans. Then, it is critical to assess the feet for deformities and check insulin injection sites for reactions. As noted by the American Diabetes Association (2016) and by Garber et al. (2018), assessing skin condition in patients with diabetes aids in preventing complications and determining adverse reactions to therapy.

Examination of Patients with Diabetes: Cardiovascular and Neurological

• A cardiovascular assessment involves:
  • pulse and blood pressure check;
  • a full vascular assessment, including pulses in the legs and feet.
• A neurological assessment requires:
  • examination for diabetic amyotrophy;
  • peripheral limb sensation examination (10-g monofilament testing);
  • pinprick or vibration testing or inspection of ankle reflexes.

In order to assess a diabetic patient for cardiovascular disease, it is crucial to perform a pulse and blood pressure check, as well as a full vascular assessment, including pulses in the legs and feet. A detailed neurological examination involves the evaluation of diabetic amyotrophy, peripheral limb sensation, and ankle reflexes. A thorough cardiovascular and neurological assessment of the patient could identify essential complications of diabetes, including heart failure, diabetic amyotrophy, and hypertension (American Diabetes Association, 2016).

Examination of Patients with Diabetes: Laboratory Tests

• A1C – every 3 months;
• Urine analysis for Spot UACR, serum creatinine, and eGFR – at least annually;
• Fasting lipid profile;
• Liver function testing;
• FPG concentration (American Diabetes Association, 2016).

In the management of diabetes, monitoring the patient’s laboratory test results is critical to promoting positive outcomes. Laboratory tests could help to identify liver or kidney dysfunction, the risk of heart disease, and the effectiveness of the chosen diabetes treatment plan. Hemoglobin A1C testing is required every three months. Annual testing of urine for Spot UACR, serum creatinine, and eGFR is also advised (American Diabetes Association, 2016). Fasting lipid profile and liver function testing should be performed regularly to identify cardiovascular and hepatological risks. Finally, a test for FPG concentration should be done during every visit.

Patient Education

• Promote treatment compliance (Garber et al., 2018):
  • discuss treatment options, side effects, and benefits;
  • encourage reporting of side effects or health concerns.
• Facilitate healthy diet and lifestyle changes (American Diabetes Association, 2016):
  • recommended physical activity: 50 minutes/3 days a week;
  • explain carbohydrate counting, healthy eating choices, and portion control;
  • establish weight loss objectives, if obese or overweight.

The two main goals of patient education in diabetes management are to promote treatment compliance and facilitate healthy lifestyle changes. Following the recommendations provided by Garber et al. (2018), medical practitioners should discuss treatment options, their side effects, and benefits and encourage patients to report any side effects or health concerns. A healthy lifestyle could also assist in the management of diabetes mellitus. In particular, practitioners should advise patients to engage in physical activity for at least 150 minutes per week (American Diabetes Association, 2016). They should also promote healthy eating habits by explaining carbohydrate counting, healthy eating choices, and portion control. Finally, if the patient is obese or overweight, it is vital to set healthy weight goals and discuss plans for weight loss.

References

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(1), S81-S90.

American Diabetes Association. (2016). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 34(1), 3-21.

Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … Hamman, R. F. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA, 311(17), 1778-1786.

Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., … Umpierrez, G. E. (2018). Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm–2018 executive summary. Endocrine Practice, 24(1), 91-120.

Handelsman, Y., Bloomgarden, Z. T., Grunberger, G., Umpierrez, G., Zimmerman, R. S., Bailey, T. S., … Zangeneh, F. (2015). American Association of Clinical Endocrinologists and American College of Endocrinology– Clinical practice guidelines for developing a diabetes mellitus comprehensive care plan–2015. Endocrine Practice, 21(s1), 1-87.

Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & del Cañizo-Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World Journal of Diabetes, 7(17), 354-395.

McKeever Bullard, K. M., Cowie, C. C., Lessem, S. E., Saydah, S. H., Menke, A., Geiss, L. S., … Imperatore, G. (2018). Prevalence of diagnosed diabetes in adults by diabetes type—United States, 2016. Morbidity and Mortality Weekly Report, 67(12), 359-361.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2016). Symptoms & causes of diabetes. Web.

World Health Organization (WHO). (2018). Diabetes mellitus: Fact sheet N°138. Web.

World Health Organization (WHO). (2016). Global report on diabetes. Web.

Diabetes mellitus is among the top causes of death in America. Unregulated diabetes may affect related systems such as renal and cardiovascular systems. More than 29 million of the total united states population have diabetes. The cost associated with the management of diabetes is high. In 2012, the cost of diabetes was approximately 245 billion (American Diabetes Association, 2021, p.74). High glucose levels can result in dehydration, polyuria, polydipsia, and weight loss. Since it is associated with metabolic derangements, it may cause sensory and peripheral neuropathy, foot ulcers, myocardial infarction, vision loss, and end-stage renal disease. Proper strategies of reducing blood sugar can decrease complications, although drastic lowering can cause harm.

There are various ways used to measure blood glucose levels. The most effective way is through glycosylated hemoglobin (HbA1C) which measures the average sugar levels for three months. It was a parameter studied in most clinical trials and showed the benefits of improved glycemic control in patients with diabetes. It is an accurate measure in the management of diabetes. Guidelines have recommended intensification of pharmacological management to achieve a specific target of glycosylated hemoglobin depending on the population (American Diabetes Association, 2021, p.76). The targets should benefit the patients and bring no harm.

Management of blood glucose is one of the critical issues in the care of people with diabetes. Glycemic control is done through monitoring of the glycosylated hemoglobin (AC1). There are two main goals of treatment for diabetic patients; regulating the blood sugar level, and second one is to prevent both microvascular and macrovascular associated with diabetes. Blood sugar targets for each individual differ according to the drug they are taking and their condition. For example, a pregnant mother may have a lower blood glucose target.

Self-blood monitoring of blood glucose (SMBG) is also vital in self-management and adjustment of the medications to achieve the target glycemic control. Continuous assessment of blood glucose has played a critical role in the treatment regimen’s effectiveness and safety in patients with T1DM. There is limited data on its effectiveness among T2DM diabetes patients, especially those on intensive insulin regimens (American Diabetes Association, 2021, p.78). According to American Diabetes Association (2021, p.81), Initial testing of HbA1c inform care and treatment of the patients.

Moreover, A1C has a solid predictive capacity of complications of diabetes. Thus, the test should be performed in the initial assessment of all the patients with diabetes. The period of measurement, which is three months, defines whether the glycemic aims were achieved and preserved. Clients with type 2 diabetes whose blood glucose is tightly controlled may only need the test twice a year, while those whose blood has not met the targets blood sugars or under intensive treatment may need to be tested frequently (Imran et al., 2018, p.39). Therefore, the interval of the A1C testing should also depend on the condition of the patient, the physician’s decision, and the treatment regime of the patient.

Glycemic Targets

Workout is a cheap and easy way to decrease sugar levels. However, the glycemic goals majority of the older adults who are nonpregnant are less than 7% (53mmo/l) (Saeed and Ballantyne, 2017, p.19). However, healthcare providers may suggest more stringent goals of 6.5% in patients whose targets can be achieved without marked side effects of the drugs and also hypoglycemia (Tian et al., 2020, p.1291). Studies have shown the glycemic target of 7% reduces microvascular complication cases in type 2 diabetes patients (American Diabetes Association, 2021, p.84). It was associated with a 50-60% reduction in complications in most randomized controlled trials. The majority of the patients with short-term experience marked benefits from the strict glycemic control.

The most common adverse effect includes polypharmacy. The most appropriate patients for the 6.5% glycemic target have type 2 diabetes, short-duration diabetes, patients on metformin only, without cardiovascular disease, or patients with long life expectancy (Miyamoto and Shikata, 2021, p.70). Less stringent targets such as more than 8% (64mmol/l) are appropriate for patients with microvascular and macrovascular complications, history of severe hypoglycemia, cardiovascular diseases, long-standing history of diabetes, and other comorbidities (American Diabetes Association, 2021, p.81). It also includes whose patients whose self-management has not been achieved through education, diet, and treatment regimen.

Thus, the targets should be reassessed based on life expectancy, cardiovascular disease, macro and microvascular complications, other comorbidities, patient preference and resources, and support systems. The UK Prospective Diabetes (UKPD) studies have shown that having a tight glycemic control reduces the risk of kidney disease, peripheral neuropathy as wells, as macrovascular complications (Imran et al., 2018, p.42). Studies have shown that lowering blood glucose to 6% further reduces microvascular chances, although the absolute risk reduction decreases (Rodriguez-Gutierrez et al., 2019, p.371). Due to the significant increase in hypoglycemia in T1DM and polypharmacy in T2DM the risk of low glycemic goals outweighs the advantages of the microvascular complications. There is enough evidence on reducing or slow the progression of cardiovascular risks in T2DM when tight glycemic control is affected (Qaseem et al., 2018, p.572). Therefore, tight glycemic control reduces the rates of myocardial infarction at considerable rates.

Disadvantages of Tight Glycemic Control

Although most of the guidelines recommend tight glycemic control, they may have less significant effects on reducing microvascular and macrovascular risks in patients who have already complicated diabetes (Miyamoto and Shikata, 2021, p.69). According to ADVANCE studies, there was no significant decrease in the cardiovascular cases for the patients who had a vascular disease (Tian et al., 2020, p.1293). The vascular complication reduction did not reach statistical significance as per ACCORD (Singleton et al., 2020, p.2190). Some of the medications are related to lower cardiovascular risk.

Tight glycemic control may have marked hypoglycemia complications in T1DM and polypharmacy in T2DM. Some evidence does not support tight glycemic control because studies have shown that it does not prevent 10 of the 11 common microvascular complications (Imran et al., 2018, p.41). Achieving the targets has no impact on the progression of end-stage renal disease. The putative effect recorded in some studies regarding amputation is not precise as tight glycemic controls reduce myocardial infarction rates by 15% only (Rodriguez-Gutierrez et al., 2019, p.376). The narrow focus on glycemic targets has reduced stress on the other interventions of preventing microvascular complications.

Cardiovascular Risk Assessment in Diabetes

Cardiovascular Disease Risk (CVD) risk assessment is critical in diabetic patients as it informs the decision made by the clinician regarding the treatment regimen and other therapeutic interventions. ADA (2021, p.70) recommends using a risk factor approach in the assessment of CVD threat. The risk factor included in the assessment consists of low-density lipoprotein (LDL) of more than 100mg/dl, smoking, obesity, hypertension, and family history of atherosclerotic cardiovascular disease (ASCVD) (Saeed and Ballantyne, 2017, p.17). Moreover, people with diabetes have the highest cardiac or cardiovascular disease risks.

Identification of the Risk Factors

Some of the modifiable risk factors or features include age. Studies have shown a high risk of CVD in men aged 48 years and women aged 54 years (Tian et al., 2020, p.1295). Shifting from to moderate risk from the lower category occurs at 35 years in males and 45 in females. Men are at a greater danger of CVD when matched to women in the healthy population (Saeed and Ballantyne, 2017, p.19). In diabetic patients, women are at a more significant threat of CVD as compared to their male counterparts. Studies showed a substantial rise in CVD risk in T2DM females than in T2DM males (American Diabetes Association, 2021, p.69). Studies have shown a 50% increase in the risk of coronary artery risk in women (Saeed and Ballantyne, 2017, p.16). This is due to the less favorable risks such as hyperlipidemia in women.

T2DM is associated with higher CVD compared to T1DM. Evidence has shown individuals with T2DM are at a higher risk of getting myocardial infarction (Saeed and Ballantyne, 2017, p.19). The association between the myocardial infarction and the family history of CAD is significant. Diabetic patients with first-degree relatives with CAD developed myocardial infarction compared to those that no family history of coronary artery disease (American Diabetes Association, 2021, p.84). Smoking is a modifiable cause of CVD in diabetic patients.

Furthermore, evidence has shown that the risk of myocardial infarction was high in men and women who smoked more than five packs of a cigarette than those who do not smoke (Sehgal et al., 2020, p.276). The active smoker is at higher risk of CVD compared to both former smokers and nonsmokers. In both T2DM and T1DM, hypertension is a significant cause of complications. From the body of evidence, lowering the systolic blood pressure by 10mmhg lowers cardiovascular events by more than 50%. ADA (2021, p.72), Recommends a target blood pressure of 140/90mmhg in diabetic patients. A study that followed diabetic patients for 16 years reported that CVD deaths were higher in patients with LDL than 100mg/dl compared to those with normal LDL (Tian et al., 2020, p.1296). Moreover, cholesterol increased CVD risk, potentiated by diabetes (Bertoluci and Rocha, 2017, p. 16). It is worth noting that patients with diabetics have a high risk of high cholesterol levels.

Identification of the Risk Enhancing Factors

The last part is to identify risk enhancing factors essentially. These are significant threat aspects that may alter the development of CVD events in different subsets of diabetes. The double risk enhancing characteristics stated the following factors as enhancements of the disease (Imran et al., 2018, p.38). Family background of ASCVD, long-lasting kidney illness, metabolic disorder, chronic inflammatory disorders, primary high cholesterol levels, lipid abnormalities, and biomarkers such as C reactive proteins (Bertoluci and Rocha, 2017, p.10). The above are the main risk factors associated with CVD occurrences.

Estimation of CVD Risk using Risk Score Calculators

The calculators assess cardiovascular risks depending on the magnitude of the independent risk factors through a formula. The generated score is based on the different outcomes. There are approximately 110 calculators, and 45 of them are specific to diabetic patients. UKDPS is the most popular global calculator (Kavaric et al., 2018, p.605). The components include age, gender, smoking status, LDL, race, ethnicity, duration of diabetes, systolic blood pressure, and atrial fibrillation. Patients with more than ten years of diabetes are considered to be at higher risk of diabetes. There are various calculators, and the clinician should choose the appropriate one for them.

Reference List

American Diabetes Association, (2021), ‘6. Glycemic targets: standards of medical care in diabetes – 2021’, Diabetes Care, 44(Supplement 1), pp. S73-S84. Web.

Bertoluci, M.C. and Rocha, V.Z., (2017). ‘Cardiovascular risk assessment in patients with diabetes’, Diabetology & Metabolic Syndrome, 9(1), pp.1-13. Web.

Imran, S.A., Agarwal, G., Bajaj, H.S. and Ross, S., (2018), ‘Targets for glycemic control’, Canadian Journal of Diabetes, 42, pp. S42-S46. Web.

Kavaric, N., Klisic, A. and Ninic, A., (2018), ‘Cardiovascular risk estimated by UKPDS risk engine algorithm in diabetes’, Open Medicine, 13(1), pp.610-617. Web.

Miyamoto, S. and Shikata, K., (2021), ‘Glycemic control and future perspectives for treatment’, In Wada T., Furuichi K., Kashihara N. (eds) Diabetic Kidney Disease (pp. 73-86). Springer, Singapore. Web.

Qaseem, A., Wilt, T.J., Kansagara, D., Horwitch, C., Barry, M.J. and Forciea, M.A., (2018), ‘Hemoglobin A1c targets glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: A guidance statement update from the American College of Physicians’, Annals of Internal Medicine, 168(8), pp.569-576. Web.

Rodriguez-Gutierrez, R., Gonzalez-Gonzalez, J.G., Zuñiga-Hernandez, J.A. and McCoy, R.G., (2019), ‘Benefits and harms of intensive glycemic control in patients with type 2 diabetes’, BMJ, 367, pp73-86. Web.

Saeed, A. and Ballantyne, C.M., (2017), ‘Assessing cardiovascular risk and testing in type 2 diabetes’, Current Cardiology Reports, 19(3), p.19. Web.

Sehgal, A., Sibia, R.P.S., Kaur, J., Bhajni, E. and Sehgal, V.K., 2020, ‘A cross-sectional study to evaluate cardiovascular risk score in type 2 diabetes mellitus’, International Journal of Applied and Basic Medical Research, 10(4), p.276. Web.

Singleton, M.J., Soliman, E.Z., Bertoni, A.G., Whalen, S.P., Bhave, PD, and Yeboah, J., (2020), ‘Effect of intensive glycemic and blood pressure control on QT prolongation in diabetes: The ACCORD trial’, Diabetes, 69(10), pp.2186-2193. Web.

Tian, J., Ohkuma, T., Cooper, M., Harrap, S., Mancia, G., Poulter, N., Wang, J.G., Zoungas, S., Woodward, M., and Chalmers, J., (2020), ‘Effects of intensive glycemic control on clinical outcomes among patients with type 2 diabetes with different cardiovascular risk levels and hemoglobin A1c in the ADVANCE trial’, Diabetes Care, 43(6), pp.1293-1299. Web.

I agree that diet and relevant physical activity are crucial in preventing diabetes. Regular consumption of functional foods, like vegetables, fruits, fish, olive oil, and nuts, might be related to enhanced anti-oxidant, anti-inflammatory, insulin sensitivity, and anti-cholesterol functions, which are viewed as integral to preventing Type 2 diabetes (T2D) (Alkhatib et al., 2017). Another step that is generally seen as crucial to take is reconsidering consumed drinks. Polyphenols within metabolic diseases (MD) and polyphenol-rich herbs, such as coffee, green tea, or black tea, have shown clinically significant benefits. They influence metabolic and microvascular activities, cholesterol, fasting glucose-lowering, anti-inflammation, and anti-oxidation in high-risk and T2DM patients (Alkhatib et al., 2017). Moreover, patients should supply themselves with devices that are intended to monitor their glucose levels. Flash glucose monitors (FGMs) and continuous glucose monitors (CGMs) are the available devices that can help patients manage their disease more effectively (Fagherazzi & Ravaud, 2019). All the approaches mentioned above will help patients prevent and manage diabetes.

I support the idea that Urinary Incontinence treatment depends on the water consumption schedule. Fluid-management strategies promote frequent intake of small amounts of fluid, for instance, 4-5 oz/hour, up to 2 L a day of predominantly water instead of large, episodic fluid intakes (Lukacz et al., 2017). A timed water schedule may help to reduce the involuntary loss of urine. In addition, losing extra weight may help as well. A randomized clinical trial of a 6-month structured weight loss program vs. education alone in 338 obese women reported a 47% reduction in mean incontinence episodes compared with a 28% reduction in the control group (Lukacz et al., 2017). Moreover, physicians should not ignore the importance of providing psychological support to patients. Most recent reports indicate that a physiotherapy procedure gives a positive result in up to 80% of patients with stage I or SUI and mixed form and 50% of patients with stage II SUI (Kołodyńska et al., 2019). Timely consultation with a doctor can help prevent serious consequences.

References

Alkhatib, A., Tsang, C., Tiss, A., Bahorun, T., Arefanian, H., Barake, R., Khadir, A., & Tuomilehto, J. (2017). Functional foods and lifestyle approaches for diabetes prevention and management. Nutrients, 9(12), 1–18. Web.

Kołodyńska, G., Zalewski, M., & Rożek-Piechura, K. (2019). Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Menopausal Review, 18(1), 46–50. Web.

Lukacz, E. S., Santiago-Lastra, Y., Albo, M. E., & Brubaker, L. (2017). Urinary incontinence in women. JAMA, 318(16), 1592–1604. Web.

Fagherazzi, G., & Ravaud, P. (2019). Digital diabetes: Perspectives for diabetes prevention, management and research. Diabetes & Metabolism, 45(4), 1–8. Web.

COVID-19 pandemic became the most unexpected health challenge the world faced within the last century, forcing the countries to change their policies and people to get through massive updates in their daily lives. The demand in maintaining distance, performing various preventative measures, and carefully track how they felt significantly adjusted people’s perception of healthcare and made them more critical about it (Ryan et al., 2020). For the clinical practice, COVID-19 leads to the continuous emergency, required mobilization, and restructuration for systems and medical professionals.

The selected topic is “COVID-19 disease management for pregnant women with type I diabetes.” Qualitative research methods are created to retrieve and analyze rich descriptive data such as experiences and reactions, thus they can be applied for studying how the identified group dealt with the infection. Type I diabetes is the condition that puts an individual’s health at high risk in the case of COVID-19, and specialized clinical practices must be exercised for such patients (Trevisani et al., 2020). Pregnancy complicates the conditions as, for example, hospitalization or some emergency procedures cannot be applied (Ryan et al., 2020). The selected topic leads to the research question “How pregnant women with type I diabetes and COVID-19 received treatment?”

The research question can be studied via the three most common qualitative research methods, such as phenomenology, ethnography, or grounded theory. Indeed, the first one addresses the approach of gathering information from living experience, and the second is dedicated to identifying how participants’ backgrounds or setting influence the results, and the third retrieves specific conclusions (Gray et al., 2021). Ethnography is the least appropriate methodology for exploring how pregnant women with type I diabetes and COVID-19 received treatment because the study does not include any cultural environment or social phenomena. In contrast, phenomenology is suitable because the information will be gathered via interviews, observations, and experiences, and the results occur from the noticed patterns (Smith & Firth, 2011). Grounded theory is also a profound approach to explore how women received treatment because theoretical models can be generated based on the conclusions (Gray et al., 2021). Consequently, the last methodology is the best for the selected research topic as it addresses both the outcomes and study design.

Multiple challenges might be faced while studying how pregnant women with type I diabetes and COVID-19 received treatment because the topic requires narrow sampling, credibility, and proper design for questionaries. Ethical issues might be related to the scope of data gathered, therefore anonymity must be promised, and informed consent with all conditions must be signed by each participant (Ryan et al., 2020). Qualitative research methodologies might luck justification as personal experiences are subjective, thus credibility challenge needs to be addressed by providing a detailed explanation of study design, sampling, and analysis.

The grounded theory was selected for the given topic, and there are benefits and drawbacks of utilizing it to study the experiences of pregnant women with type I diabetes and COVID-19. The strength of that methodology is that a general idea of the treatment was sufficient or not can be stated, and the interviews built around it. Moreover, different types of coding can be utilized to analyze the results and make conclusions (Smith & Firth, 2011). The weakness of the grounded theory is that the scope of retrieved information might be too broad and difficult to manage.

Another qualitative method appropriate to explore how pregnant women with type I diabetes and COVID-19 received treatment is phenomenological. The approach is based on an individual’s life experiences and can help the study retrieve the unique events that participants got through and then build conclusions and categories based on that data (Gray et al., 2021). The benefit of phenomenological methodology is that no specific theory narrows the information gathering, thus some unexpected disclosures might be noted during the study (Smith & Firth, 2011). Qualitative research might receive better outcomes if multiple techniques are selected and exercised simultaneously.

References

Gray, J.R., Grove, S.K., & Sutherland, S. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Saunders Elsevier.

Ryan, G. A., Purandare, N. C., McAuliffe, F. M., Hod, M., & Purandare, C. N. (2020). Clinical update on COVID‐19 in pregnancy: A review article.Journal of Obstetrics and Gynaecology Research, 46(8), 1235-1245.

Smith, J. & Firth, J. (2011). Qualitative data analysis: The framework approach. Nurse Researcher, 18(2), 52-62. Web.

Trevisani, V., Bruzzi, P., Madeo, S. F., Cattini, U., Lucaccioni, L., Predieri, B., & Iughetti, L. (2020). COVID-19 and type 1 diabetes: concerns and challenges. Acta Bio Medica: Atenei Parmensis, 91(3), e2020033.

Introduction

Diabetes causes harm to the blood vessels in the body over time, causing the walls of the blood vessels to stiffen, resulting in high blood pressure, which results in a heart attack or stroke. Diabetes is a severe ailment resulting from this, so regular screening is required. It is critical that people are taught about the condition and how they can treat and avoid it. This research paper will describe the numerous methods for preventing diabetes in my immediate community, where the research will be conducted. In addition to addressing the medical specialists who will be of service in disease prevention, it will emphasize the intervention programs required to help control the spread of the illness.

Contributions of Healthcare Professionals Who Will Help Prevent Diabetes

Dietitians play a significant part in the treatment and prevention of the disease. They recommend to patients who have diabetes the kinds of meals that are suitable for them to consume. These recommendations will be tailored to the patient’s specific dietary needs. It guarantees that they always have the optimal levels of nutrients within their body by ensuring that they maintain these levels. This is a highly significant consideration when establishing a treatment plan for the individual affected by the condition.

Another vital healthcare professional is the endocrinologist who treats disorders that impact the endocrine system. The condition ranges from obesity and diabetes to infertility and sexual dysfunction. The endocrine system regulates the body’s processes and consists of the glands that are dispersed throughout the human body and the hormones that are released from those glands. Since diabetes is brought on by problems with the body’s blood sugar levels, insulin levels will be the intention of the doctor’s focus.

Diabetes can sometimes lead to complications involving the blood vessels found in the eyes. Therefore, to treat the eyes, one needs to visit an optometrist. An optometrist is a specialist in eye care who works to improve patients’ vision (Powers et al., 2020). A diabetic patient should see an eye doctor at least once per year, even if they perceive their eyes to be healthy.

Nurses have a vital role in researching and developing new medical treatments. As a direct consequence of this, the nurse will tend to diabetes patients and instruct them on how to look after themselves. In addition, the nurse will teach them how to deal with the symptoms of diabetes, make the most of the medications prescribed to them, and track the progression of the disease.

Evidence-Based Interventions Needed to Prevent Diabetes in My Locality

As part of the evidence-based treatments that can be applied to patients to control diabetes, patients can be discouraged and prevented from smoking. In addition, it is vital to encourage them to consume light alcohol if they have to. Diabetic individuals should be encouraged to engage in regular exercise as part of the evidence-based treatments that can be applied to control diabetes among patients (Hood et al., 2018). Patients can be provided with the appropriate nutrition. The medical facility can devise plans to ensure that at least some of its patients are engaging in physical activity. For example, the facility could make it mandatory for patients who can walk briskly for at least thirty minutes per day. Additionally, the facility could provide gyms, playground equipment, and other similar amenities.

In addition, to effectively manage diabetes patients’ conditions, the facility ought to offer diabetic patients diets that are reduced in both sugar and fat content. It should always opt for whole grains rather than processed ones, avoid offering sugary drinks in favor of water, choose healthy fats, and avoid delivering red meat whenever possible. It has been demonstrated that insulin is subjected to less stress when the diet is proper and contains less fat, and as a consequence, diabetes is better controlled. Patients with a light to moderate alcohol intake can regulate their diabetes through increased insulin and glucose absorption efficiency in their cells.

Identifying Diabetic At-Risk Individuals

Individuals at high risk of diabetes include the obese and aging population. Pregnant women who have a history of recurrent skin, genital, or urine infections need to be screened. People who have prediabetes, glucose intolerance, hypertension, hyperlipidemia, and high-risk ethnicity are at an increased risk of diabetes; hence, they should be closely monitored (Hood et al., 2018). Another category of at-risk individuals that need to be screened regularly includes individuals with unhealthy eating habits and who fail to exercise frequently.

Resources Needed to Help Prevent Diabetes

Human resources in terms of healthcare specialties will come in handy to help address diabetes within the local community. Other resources that will be instrumental in helping prevent the disease include the establishment of local gyms where local people can exercise, thus increasing their physical activity. A better diet and the consumption of nutritious meals should be encouraged as one of the most critical factors in reducing the chances of being diagnosed with diabetes.

Evaluation of the Interventions

Evaluation of the project is vital in ensuring that the project achieves the desired outcome of preventing diabetes in at-risk individuals. At random, sample some individuals that will be monitored throughout the entire process and categorize them into two groups. One group is to be subjected to the project’s activities while the other group is allowed to continue with their activities normally. Screening can be done after six to twelve months, which will help determine whether the project is a success.

Conclusion

Individuals need to be taught how to appropriately care for their bodies to make the treatment of diabetes and the prevention of diabetes possible. The availability of relevant information is the single most crucial factor in ensuring the continued health of a nation and its communities. Consequently, the project will set the stage for future presentations by medical professionals and researchers who have ideas for innovative treatments for diabetes conditions.

References

Hood, K. K., Iturralde, E., Rausch, J., & Weissberg-Benchell, J. (2018). Preventing diabetes distress in adolescents with type 1 diabetes: Results 1 year after participation in the steps program.Diabetes Care, 41(8), 1623–1630. Web.

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the association of diabetes care & education specialists, the academy of nutrition and dietetics, the American Academy of family physicians, the American Academy of PAS, the American Association of Nurse Practitioners, and the American Pharmacists Association.Diabetes Care, 43(7), 1636–1649. Web.