Core Principle Of Diabetes Case Study

Core Principle Of Diabetes

Introduction - Core Principle Of Diabetes

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The global epidemiology and burden of diabetes

Diabetes is a chronic lifestyle disease and can have two main causes. For example, diabetes can occur due to lack of insulin production in the body, as the insulin producing cells get damaged. Another reason of diabetes malfunctions of the insulin receptors in the body. Therefore, this assignment aims to analyse diabetes from six different domains and will explore their effects on public health and welfare.

According to World Health Organisation (WHO), in 2019, around 1.5 million people across the world has died because of diabetes and associated problems (Who.int, 2021). Thus, approx 48% of all global deaths were due to this cause. In 2014, around 422 million people across the world were affected with diabetes type 1 and type 2, which has caught a significant growth ladder in recent days (Who.int, 2021). Currently, 462 million people across the world are affected due to this condition. However, the rising prevalence of diabetes is significantly noted in middle and low income countries, such as India, Bangladesh, African countries, compared to high-income nations, such as US, Japan and so on. Thus, diabetes can be called as the global epidemic.

According to Prakash and Chakrabart (2019), corresponding to the overall health care performance of all over the world globally, 6.28% of the world’s population have been suffering from the diseases. In between, 4.4% of people among them are from the age of 15 to 49 years. Along with this factor, 15% of people are between the age-group of 49 to 60 years. Besides, according to Blüher (2019), around 22% of people who belong to the age between 70 and above are affected with diabetes. Around 1 million of people die in every year due to this disease and the world is making the ninth leading charge of morality. It indicated that the burden of this disease has been rising globally. Mostly, in Western Europe has been affected by these diseases. In case of these diseases, the gender distribution is equal as per everyone affected due to these diseases. Mostly, the people who belong from the age between 55 and above are affected most due to this disease. Overall, the global prevalence of type 2 diabetes has been noticed to increase the 7079 individuals per 100,000 within the years 2030.

This overgrowing number of diabetes all over the world is associated with multiple risk factor, which affects health and wellbeing of people. According to Rosen et al. (2018), obesity or overweight is one of common reason behind the issue of diabetes. In this aspect, obese or overweight people in community setting are prone to face the issue of diabetes. It has to be mentioned here that overweight or obese people can make produce insulin however they failed to move glucose and level of glucose is increase in cell consequently, it develop the issue of diabetes. In addition, poor physical activity, polycystic ovary syndrome and high blood pressure are common factors that influence the issue of diabetes.

Diabetes diagnosis

Diagnosis of diabetes mellitus is the first step to plan for the treatment and enhance the rate of prognosis. For example, Type 1 and 2 diabetes mellitus can be detected with the random blood sugar level test in fasting condition. As per NIDDK guidelines, if the glucose level in plasma in fasting condition remains 126 mg/dl, then a person can be called as diabetic (Niddk.nih.gov, 2021). For better confirmation, the post-prandial plasma glucose test can be done. According to Udler et al. (2019), the fasting glucose test, this test will be best done at the time of the morning with 8 hours of fasting. Here, if the level remains beyond 200 mg/dl, then it can be confirmed that the person is diabetic. Glycosylated hemoglobin test or Hb1Ac test can be a significant test to determine the duration of being affected with diabetes. The test is done to check the presence and its amount of the glucose moieties in the RBCs (Niddk.nih.gov, 2021). A test reading of 6.5 or above will confirm that the person is diabetic since last 120 days. However, all these tests are done for people in non-pregnant conditions. For pregnant women, physicians conduct oral glucose-tolerance tests or OGTT for measuring blood glucose levels. Therefore, confirmation of gestational diabetes can be done with OGTT after being confirmed with plasma glucose test and Hb1Ac test (Niddk.nih.gov, 2021).

NIDDK says that if a person is detected with pre-diabetes conditions, then also, the treatment for managing the condition should be initiated. Otherwise, the concerned person can be affected with kidney, skin, eye and other cardiovascular problems. Ultimately, diabetes can be a significant co-morbid disorder with other lifestyle conditions (Niddk.nih.gov, 2021). 

Screening for diabetes

Screening of diabetes can be done by recognising the signs and symptoms of the concerned persons. For instance, people with frequent fatigue, frequent urination and drowsiness issues can be detected as the probable patients of diabetes. Diabetes Mellitus is known as the group of metabolic diseases, which is characterized by the hyperglycaemia. Thus, for confirmed diagnosis, tests need to be performed and the values have to be aligned with the standard clinical diabetes guidelines.

There can be various risk factors of diabetes. For instance, individuals with a family history of diabetes are more prone to develop diabetes than others. Chung and Miller (2020) highlighted that these people develop diabetes four times faster than other people. Further, this study indicated that family history of type-2 diabetes mellitus is associated with schizophrenia and non-affective psychosis in patients. Thus, screening for these issues is also necessary to improve overall quality of life. Overweight people with high BMI and physical inactive people are at high risk of developing diabetes mellitus compared to other patients. Other factors, such as hypertension, gestational diabetes and hypercholesterolemia are risk factors of developing diabetes.

Despite having all such indications, proper diabetes screening need to meet the following seven criteria. Firstly, diabetes is a significant healthcare burden. Secondly, a natural occurrence factor of diabetes is well understood. Third, patient is recognized at the primary or pre-clinical stage at an asymptotic condition. Fourth, screening will be efficient if all the tests are available and provide reliable results. Fifth, early detection and treatment will lead to better prognosis. Sixth, cost of health expenditure is reasonable and need to be balanced (Hillier et al. 2021). Finally, screening should be systematic and ongoing process. If healthcare professionals can follow these criteria, community screening of diabetes will be easy and cost of the disease will be manageable.

Prevention of diabetes and pre-diabetes

Diabetes damages different organs leading to complicated physical conditions. Hence, it should be prevented by taking proper measures. For instance, it can be prevented by changing lifestyles especially if patients are at high risk. Reducing excess body-weight can effectively help in reducing the extreme risk of diabetes. The risk of getting diabetes reduces almost by 60% if a proper lifestyle is maintained. Krischer et al. (2017) recommended that in order to reduce the risk of co-morbidity and improve quality of life, patients need to be more physically active. It is beneficial to burn excess calories and improves blood circulation. Exercise can also boost up insulin sensitivity which helps to keep the blood sugar level within the usual range. It helps to keep the blood sugar level within the usual range. Here, aerobic exercise and resistance exercise can help in preventing the severity or occurrence of extreme risk factors.

Pre-diabetes can be prevented also by taking proper steps. Eating healthy foods, being more active, losing excess weight, taking required medications, and avoiding the habit of smoking can help to prevent pre-diabetes (DeBoer et al. 2018). These activities can help people to get their level of blood sugar back to the normal range. In this regard, foods containing low fats and calories as well as rich in fibre should be consumed. Doctor-recommended medicines should be taken in case of high risks of diabetes to control the cholesterol level and high blood pressure. Physical activity should be done at least an hour every day to treat pre-diabetes. Sweetened coffee drinks, concentrated food juice, or consumption of soda should be avoided by pre-diabetic patients (Webmd.com, 2021). Eating a lot of vegetables can help to prevent this disease to a significant extent. There are multiple resources required to implement evidence-based intervention in a community including financial support, dieticians, physicians and health care professionals. Besides that, a multidisciplinary diabetes team also played fundamental role to reduces the issue of diabetes and improve quality of patients care. The members of such team and their key contribution in diabetes mitigation is provided in the table below-

Members	Contribution
Physicians	Physicians' roles are to assess ad diagnosis the issue of diagnosis. It has to be mentioned here that physician provide prescription and medication to people with the issue of diabetes to improve their health and well-being (Diabetes.org.uk, 2021). Further, physicians recommended multiple test such as blood test and sugar test to assess presence of diabetes.
Social workers	Social workers are important members in multidisciplinary team who promote awareness among community people regarding the consequences of diabetes and it improve engagement of community people.
Community leaders	Community leaders help to build transparent communication with target group and identify their needs and requirements. The community leader helps to increase engagement of people in diabetes prevention plan.
Dieticians	Dieticians provide accurate diet plan and healthy eating habits, which help to reduce the issue of diabetes (Diabetes.org.uk, 2021).

Table 1: Roles of multidisciplinary team for prevent diabetes

Classification of diabetes

Diabetes can be classified into several types such as “type 1 diabetes” and “type 2 diabetes.” Type 1 diabetes is also called insulin-independent diabetes. It is a persisting disease that occurs when the pancreas generates very little or almost no insulin. Insulin is a hormone that induces glucose entry in cells. Thus, it helps to produce energy by influencing glucose-metabolism. Several factors along with genetic causes and autoimmune causes are responsible for developing type-1 diabetes (DiMeglio et al. 2018). It usually takes place in childhood or during adolescence. However, it can also take place in adults. There are no preventive measures for treating diabetes type 1 despite researches going on. Treatments such as controlling blood sugar levels by using insulin, proper diet, and lifestyle can help to prevent complications that can arise from this specific type of diabetes. Increased level of thirst, frequent urge to urinate, extreme hunger, unexpected weight loss, mood swings, fatigue, blurred vision, and so on are the different symptoms of this type of diabetes. This disease can cause various complications and can damage certain organs such as nerves, blood vessels, kidneys, and others.

In the case of diabetes type 2, body regulation and sugar or glucose utilization take place at a faster rate. It is also a chronic disease that circulates excess levels of sugar in the bloodstream and damages the circulatory, nervous, and all kinds of immune systems. Pancreas cannot produce adequate insulin in this disease and body cells give a poor response to insulin by taking in less amount of sugar. Type 2 diabetes is also called adult-onset diabetes. It often leads to cardiovascular disease (Cannon et al. 2020). Both these kinds of diabetes occur during the time of childhood and adulthood. Type 2 commonly occurs in older adults. Nowadays, obesity in children has increased which has led to an increased number of cases of this disease in younger adults. The symptoms are almost the same as that of type 1 such as increased hunger, fatigue along with darkening of the skin in specific areas such as armpits. Hence, patients need to eat healthy foods and lose weight to control the severity of this disease.

Evidence-based medicines

A certain number of patients may not get any benefit from strict control of blood sugar levels. Evidence-based medicines (EBM) can help to prevent overtreatment for patients having type-2 diabetes. Moreover, overtreatment can be prevented through EBM as different patients have different requirements. EBM is used as a powerful tool to give personalised care to patients that can help to improve patient outcomes. This involves nutritional guidelines (Dyson et al. 2018). Physicians can enhance patient health by using the EBM approach. EBM is an effective means of making decisions by using modern evidence for treating individual patients. Diet therapy is used as an important theory for treating almost all diabetic patients. Different glucose-lowering drugs help to prevent cardiovascular issues. Nowadays, oral capsules are replaced by intravenous injections which are used for patients with specific needs.

EBM guidelines are implemented for treating diabetic patients by doctors. American Diabetes Association has widely disseminated EBM guidelines due to the increasing growth of diabetic patients worldwide (Evert and Franz, 2017). Particularly for treating type 2 diabetes, this type of diagnosis is very much effective. Physicians are responsible for controlling the blood sugar level strictly using EBM. Growth rate of diabetes is very high across the world. Nowadays, people of all age groups are getting affected by this disease due to various risk factors stated above. Diabetic patients are more prone to be affected by other chronic diseases as well such as cardiovascular disease, kidney and neurological diseases. Thus, managing lifestyle and diabetes-specific diet can be two good options for improving prognosis rate of the disease.

Beside evidence-based medicine, there is multiple evidence-based intervention, which helps to reduce the burden of diabetes. According to Hilliard et al. (2016), psychological and behavioural intervention is common and most effective method to control the issue of diabetes among community people. According to social cognitive theory self-efficacy is one of crucial factor which help to improve health and wellbeing of an individual This theory has been stated that psychological and behavioural intervention are effective for improve self-efficacy and improve quality of life. In context of behavioural intervention regular physical exercise, healthy eating habits helps an individual to control blood glucose control, glycaemic control (Hilliard et al. 2016). In addition, this literature stated that behavioural intervention create positive effect on psychological wellbeing of diabetes patients. Therefore, behavioural intervention is effective and most significant evidence based intervention to control the issue of diabetes. It is important to measure the effectiveness of all the practices discussed above for mitigating diabetes. Therefore, effectiveness of the evidence based health care intervention for diabetes patient could measure by observing body weight of community people after three months of evidence based intervention.

References

Blüher, M., 2019. Obesity: global epidemiology and pathogenesis. Nature Reviews Endocrinology, 15(5), pp.288-298.

Cannon, C.P., Pratley, R., Dagogo-Jack, S., Mancuso, J., Huyck, S., Masiukiewicz, U., Charbonnel, B., Frederich, R., Gallo, S., Cosentino, F. and Shih, W.J., 2020. Cardiovascular outcomes with ertugliflozin in type 2 diabetes. New England Journal of Medicine, 383(15), pp.1425-1435.

Chung, J. and Miller, B.J., 2020. Meta-analysis of comorbid diabetes and family history of diabetes in non-affective psychosis. Schizophrenia research, 216, pp.41-47.

DeBoer, M.D., Filipp, S.L. and Gurka, M.J., 2018. Use of a metabolic syndrome severity Z score to track risk during treatment of prediabetes: an analysis of the diabetes prevention program. Diabetes Care, 41(11), pp.2421-2430.

DiMeglio, L.A., Evans-Molina, C. and Oram, R.A., 2018. Type 1 diabetes. The Lancet, 391(10138), pp.2449-2462.

Dyson, P.A., Twenefour, D., Breen, C., Duncan, A., Elvin, E., Goff, L., Hill, A., Kalsi, P., Marsland, N., McArdle, P. and Mellor, D., 2018. Diabetes UK evidence?based nutrition guidelines for the prevention and management of diabetes. Diabetic medicine, 35(5), pp.541-547.

Evert, A.B. and Franz, M.J. eds., 2017. American Diabetes Association guide to nutrition therapy for diabetes. American Diabetes Association.

Hilliard, M.E., Powell, P.W. and Anderson, B.J., 2016. Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families. American Psychologist, 71(7), p.590.

Hillier, T.A., Pedula, K.L., Ogasawara, K.K., Vesco, K.K., Oshiro, C.E., Lubarsky, S.L. and Van Marter, J., 2021. A pragmatic, randomized clinical trial of gestational diabetes screening. New England Journal of Medicine, 384(10), pp.895-904.

Krischer, J.P., Schatz, D.A., Bundy, B., Skyler, J.S. and Greenbaum, C.J., 2017. Effect of oral insulin on prevention of diabetes in relatives of patients with type 1 diabetes: a randomized clinical trial. Jama, 318(19), pp.1891-1902.

Mishra, S., Tripathy, H.K., Mallick, P.K., Bhoi, A.K. and Barsocchi, P., 2020. EAGA-MLP—an enhanced and adaptive hybrid classification model for diabetes diagnosis. Sensors, 20(14), p.4036.

Niddk.nih.gov, 2021. Diabetes Tests & Diagnosis. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis [Accessed: 24/12/2021]

Prakash, H. and Chakrabarti, A., 2019. Global epidemiology of mucormycosis. Journal of Fungi, 5(1), p.26.

Rosen, E.D., Kaestner, K.H., Natarajan, R., Patti, M.E., Sallari, R., Sander, M. and Susztak, K., 2018. Epigenetics and epigenomics: implications for diabetes and obesity. Diabetes, 67(10), pp.1923-1931.

Udler, M.S., McCarthy, M.I., Florez, J.C. and Mahajan, A., 2019. Genetic risk scores for diabetes diagnosis and precision medicine. Endocrine reviews, 40(6), pp.1500-1520.

Websites

Diabetes.org.uk, 2021. Specialist diabetes team: role and members. Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/healthcare-professional-staffing-competency/specialist-diabetes-team-role-and-members [Accessed: 24/12/2021]

Idf.org, 2021. Diabetes facts & figures. Available at: https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html [Accessed: 24/12/2021]

Niddk.nih.gov, 2021. Diabetes Tests & Diagnosis. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis [Accessed: 24/12/2021]

Webmd.com, 2021. Prediabetes diet. Available at: https://www.webmd.com/diabetes/ss/slideshow-prediabetes-diet [Accessed: 24/12/2021]

Who.int, 2021. Diabetes. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes [Accessed: 24/12/2021]