Diabetes
The Diabetic Epidemic
The issue of diabetes and particularly type 2 diabetes has reached alarming proportions in many developed societies today. As one study notes; “…approximately 4,110 people are diagnosed every day with diabetes. In 2005, 1.5 million new cases of diabetes were diagnosed in people age 20 years or older” (Galvin, 2006, p. 157). However, while there is a radical growth in the prevalence and the extent of this disease, there is also a concomitant growth in knowledge and this form of diabetes and methods of managing and treating it.
There are two forms of diabetes mellitus. Type 1 is insulin dependent while Type 2 is non-insulin-dependent. In Type 2 sufficient insulin is formed in the pancreas, but the body has difficulty in processing and using the insulin. Type 2 is more common and is often found in older adults. An important aspect to take into account in terms of management is that diabetes is as progressive disease and treatment can begin with aspects such as diet and then progress to a combination of oral anti-hyperglycaemic agents, ending with insulin injections (Jerreat, 2009, p.50).
Treatment and management also have to take into account the fact that this disease can result in a wide range of health problems and issues. These can include, for example, “…damage to eyes, blood vessels, nerves and kidneys through high sugar levels. This can also result in the increase of the risk of heart attack and stroke. Short-term effects can include episodes of hypoglycemia, hyperglycemia and ketoacidosis” (Diabetes).
The reasons for the increase in the incidence and prevalence of diabetes are multivalent. However, a few central aspects can be isolated. One of these is weight and obesity as contributing factors. As Jerreat (2009) states, “Insulin resistance is increased with obesity and lack of physical activity. At diagnosis, 80% of those with type 2 diabetes are overweight” (p.50). Many experts attribute the causes of this disease to a combination of genetic and hereditary factors: “Diabetes occurs as an interaction between the genes that you inherit and the environment in which you live” (Masharani, 2008, p. 13). However, in type 2 the causes “…are largely unknown” (Masharani, 2008, p. 13). What is known, however, is that obesity and lack of exercise are important environmental risk factors (Masharani, 2008, p. 13).
Obesity is a relevant factor if one takes into account the increases in reports of obesity in the United States and many other developed counties; in other words, “The increase in the rate of diabetes parallels the increase in the rate of obesity” (Masharani, 2008, p. 18). Another factor is that this form of diabetes tends to occur with more frequency among older people and one should consider the fact that the general population in the world is ageing. Ethnic factor also need to be taken into account; for example, “African-Americans, Hispanics, and Asian- Americans, have a higher risk of type 2 diabetes, and there has been an increase in these populations in the United States”(Masharani, 2008, p. 18). Furthermore, recent changes in the diagnoses of this disease have made diagnosis easier and therefore increased the awareness and prevalence of the disease (Masharani, 2008, p. 18).
2. Management
Management and treatment of this disease from a nursing perspective should take into account the fact that Type 2 diabetes is usually associated with hypertension, hyperlipidaemia, central obesity and a tendency to develop thrombosis; as well as a high cardiovascular risk and can lead to complications of large and small blood vessels (Jerreat, 2009, p.51). What this implies for treatment and management is that treatment should involve the reduction of all risk factors including “…glycaemia, blood pressure, lipids, obesity, smoking, clotting and the promotion of a healthy lifestyle”(Jerreat, 2009, p.51).
There have been various technological and therapeutic advances made in recent years that have allowed for a more effective treatment of diabetes mellitus. For example, “…results from large clinical trials have shown that intensive blood glucose control with diet, exercise, and medications can significantly reduce the incidence of microvascular complications in patients & #8230;” (George, 2009, p. 477). It has also been realized that managing a chronic disease like this is”… one of the most important components of health care delivery” (Melchior et al. 2010,p. 7) There is also an increased demand for health services for this disease as a result of the increase of incidence in the older population. The long-term costs of care for diabetes are another factor that has placed more emphasis on self-management programs. Furthermore, “Studies have shown that high-risk individuals can prevent or delay the onset of diabetes by simple lifestyle changes” (Dabelko and Decoster, 2007, p. 279).
This has meant that the promotion of self-care and management has become a nursing priority. In this regard there have been a number of developments and advances in diabetes education and improved self- management. These include, among others, flexibility and resistance training; food label education; depression care management as well as community-based methods to improve activity (Dabelko and Decoster, 2007, p. 279).
The nurse therefore should be cognizant of new methods and strategies for improving self-management. As Jerreat (2009) states, “Structured education should be offered to all people with type 2 diabetes and/or their carers at the time of diagnosis, with annual reinforcement and review” ( p. 51). An important aspect of this education is that it should be structured according to the needs of the individual patient. In essence the nurse should help and train the individual in the adoption of a healthier lifestyle as well as providing information and practical help in the reduction of vascular risk factors.
Among the many new programs to the nurse is DESMOND or the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (Jerreat, 2009, p. 51). The nurse can be extremely influential in dietary control and weight reduction. A method that is being touted as being very effective in terms of self-management guidance is DSM of disease state management. This method differs for the compartmentalized approach to treatment which refers only to the health practitioner’s area or areas of expertise. DSM on the other hand “…focuses on integrated and inter-disciplinary patient care, where providers from multiple disciplines (e.g., physicians, nurses, pharmacists, and therapists) collaborate to provide care that focuses on all aspects of the patient’s condition(s)” ( Melchior et al., 2010, p. 6). This method also focuses on patient education and the method is intended to ensure that “… the patient gains the knowledge he/she needs to actively manage his/her disease and avoid poor lifestyle choices that may exacerbate the disease and reduce the length and/or quality of life” ( Melchior et al., 2010, p. 6).
Evaluation of ethical considerations in Thoolen et al. (2008)
The study by Thoolen et al. (2008), entitled Beyond Good Intentions: the development and evaluation of a proactive self-management course for patients recently diagnosed with Type 2 diabetes, is aimed at providing a process and method of enabling the patient to play a major role in the management of their illness. The study appears to have upheld strict ethical considerations in its implementation.
In the first instance, the protocols of the study provided adequate information as to the aims and intentions of the study to the selected patients. Consent and permission was obtained at every stage; for example,” Following consent, patients were assigned to one of two treatment groups” and “Both patients and their caregivers were aware of the randomization process and patient’s allocation (Thoolen et al. 2008, p. 55). Furthermore, “The control group received a brochure on diabetes self-management (Thoolen et al. 2008, p. 55). The study was also approved by the Medical Ethics Committee of the University Medical Center, Utrecht (Thoolen et al. 2008, p. 55).
The study also clearly stated that the patients were invited and that they agreed to participate. There was therefore no coercion, evasion or unethical procedure in the study. The authors also make it clear that adequate information was provided to all those agreed to participate. There was obviously an open and transparent sharing of informstion about the project.
After discussing the homework, the theme of the session was introduced and patients were invited to share their beliefs, emotions and experiences with regard to the theme. Subsequently, participants wrote their own individual action plans to attain a goal and discussed these with the group (Thoolen et al. 2008, p. 56).
This is also evidenced by the positive evaluation that the patient’s gave the course and their trainers.
References
Diabetes. Retrieved from http://www.emedicinehealth.com/diabetes/article_em.htm
Canning, C. (2009, January). Diabetes — a Global Health Concern. The Middle East 38. Retrieved March 7, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5030241539
Dabelko, H.I., & Decoster, V.A. (2007). Diabetes and Adult Day Health Services. Health and Social Work, 32(4), 279+.
Galvin, J.R. (2006, March). Diabetes. Ebony, 61, 157.
George, C.M. (2009). Future trends in diabetes management. Nephrology Nursing
Journal, 36(5), pp. 477- 483 .
Jones, M. (2006, November). Taking Control of Your Diabetes: Managing the Disease Is Key to the Quality of Your Life. Ebony, 62, 132+.
Jerreat L. (2009) Treatment of hyperglycaemia in patients with type 2 diabetes.
Nursing Standard. 24 (1).
Masharani, U. (2008). Diabetes Demystified. New York: McGraw-Hill. Retrieved March 7, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=116452890
Melchior L. et al. ( 2010) the Diabetes Disease State Management Exemplar.
NURSING ECONOMICS, 28 (1).
Thoolen et al. (2008), entitled Beyond Good Intentions: the development and evaluation of a proactive self-management course for patients recently diagnosed with Type 2 diabetes. HEALTH EDUCATION RESEARCH, 23(1), pp. 53 — 61.
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