In the last century life expectancy in the United Kingdom (UK) has increased intensely. According to the Office of National Statistics (ONS) twenty percent of the current population are regarded as older people (seventy-five or older), causing a major demand on all aspects of the health service. This essay will focus Type 2 Diabetes Mellitus (T2DM) within the community setting. Diabetes is ever growing worldwide. A study by Peirce (1999) stated that by 2052 people living with diabetes will have rose to over 300 million from 16 million in 1994.
Another study completed by McPherson (2010) showed that by 2050 a ninety-eight percent rise in obesity related diabetes within the UK (Guardian online 2010). The Department of Health (DOH) has stated that Diabetes is more predominant with age, with one in twenty people at the age of sixty-five suffering from this disease. The risk of becoming diabetic increases more to one in five at the age of eight-five. It is widely understood that diabetes is becoming a subject of great importance within the world of medicine.
T2DM is an irrepressible, longstanding condition that is increasing at a fast rate because more people are becoming overweight or obese. There is also Type 1 Diabetes Mellitus (T1DM). Research shows that T1DM accounts for ten to fifteen percent of all diabetes diagnosed, therefore leaving eighty-five to ninety percent of diabetes diagnosed as T2DM (ONS 2006). Diabetes mellitus can be classified as a group of diseases which are characterised by impaired glucose homeostasis resulting from a relative or absolute insufficiency of insulin (Underwood and Cross 2009).
Insulin deficiency causes high blood sugars (hyperglycaemia) and the production glycosuria (Levene 2003). Insulin is produce by the pancreas which is fundamental to regulating carbohydrate and fat metabolism in the body (Sudesh and O’Rahilly 2005). More specifically it is produced from Beta cells (? cells) which are located on The Islets of Langerhans. The main metabolic function of the ? cells is regulation and reduction of raised blood glucose levels (Waugh and Grant 2006). As mentioned there are two different types of Diabetes T1DM and T2DM.
The difference between the two is that in T1DM the pancreas fails to produce insulin due to the body’s immune system destroying their own supply ? cells (Knipp et al 2005). Whereas T2DM have the ? cells that produce an amount of insulin but an insufficient amount for the body’s basic requirements (Marieb 2009). There have been many studies throughout the years to see if weight has an effect on diabetes. The ONS released statistics in 2008 that showed the more people that were overweight suffered from a type of diabetes.
It is suggested that obesity promotes insulin resistance through the inappropriate inactivation of a process called gluconeogenesis (Montminy 2009). This process is the main mechanism humans use to keep blood glucose levels from dropping too low and causing hypoglycaemia. It is also stated that people who are obese are at a higher risk of getting diabetes as their ? cells are slower to react to an increase in glucose levels than those who are of a ‘healthy’ weight (Waugh and Grant 2006).
As the glucose levels elevate there are many different symptoms that may develop such as; increased thirst, tiredness, weight loss, neuropathy in the hands and feet, frequent urination and retinopathy (NHS Choices 2010). As well as these symptoms the patient may also have frequent infection of the body and wounds that have a delayed healing process. However with T2DM these symptoms may not all be present and therefore could be mistaken for another medical condition.
There are many healthcare based interventions involving Diabetes, these include preventative strategies such as assessment strategies, such as regular blood glucose monitoring and urinalysis. Diet and exercise management plays a major part in the prevention of diabetes. There are also some medications that can help patients steer clear of or manage diabetes. These strategies are essential to help prevent T2DM as it enables the patient to reduce the risk, significantly, for being treated for a long term condition (LTC).
One preventative scheme to help regulate T2DM is assessment techniques. The main technique for diabetes is blood glucose testing. This method helps to monitor the level of sugar in the blood. Taking a reading of the glucose levels once a day by gently jabbing the patient’s finger and attaining a minor about of blood, when then is tested and interpreted by a blood glucose machine. The concept behind blood glucose testing is to heighten the patient’s knowledge and educate them so they know if they are at risk of being either hyperglycaemic or hypoglycaemic (Klonoff 2007 and Benjamin 2002).
It is thought that this method of assessment is more effective for patients who are taking medication for diabetes, either on insulin or Sulphonylureas. This is because the patients who fall under as this category have an increased risk of becoming hyperglycaemic. It is important that Healthcare Professionals, including Nurses have knowledge about the significance of blood glucose monitoring and educate the patient so the patient can understand the significance of the results. According to figures published but the DOH in 2003 the NHS spent ? 90million on blood glucose monitoring in 2001.
Although this disbursement is high, the Government are saving millions by providing blood glucose testing. Hypothetically the Health Care Practices could be overwhelmed with patients demanding this test frequently. As well as blood glucose monitoring, Urinalysis is another possibility for testing glucose levels. Studies have shown that this option is popular for some individuals as it does not involve acquiring blood from the patient. Coster et al (2000) assessed one hundred and seventy-seven patients with T2DM and seventy percent of them preferred the Urinalysis method to blood glucose testing.
From a clinical viewpoint there is mixed evidence about which method is more effective. However the urinalysis test does not show when hypoglycaemia is present, which means this method would be unsuccessful to help avoid this attack. Another fault to urinalysis, although cost effective, the results are less reliable and imprecise readings can be contingent on what time the test is taken, for example postprandially (after a meal). Another prevention strategy is Health Promotion, of diet and exercise. Health Promotion is a vital job for nurses.
According to the World Health Organisation (WHO), health promotion tries to empower individuals and communities to take more control over, and thereby improve, their health. The aim of promoting a healthy diet and regular exercise is to diminish the number of overweight and obese patients, which in turn will reduce the amount of patients that will have an obese-related health problem, such as Diabetes. All Nurses, but mainly the community Nurses aim to stimulate a healthy lifestyle for patients, by encouraging them to exercise more, preserve a healthy weight and also a healthy Body Mass Index (BMI).
It is proven that people who are regular at physical activity are less likely to contract T2DM. A study conducted in 1994 by Helmrich et al, proves this point. They conducted a study of approximately six thousand men over a fourteen year follow up. Men who took part in regular adequate to hearty activity compared to men who took part in no activity had a considerably reduced risk of developing T2DM. There have been many studies to show that exercise benefits patients with T2DM both short term and long term.
They have shown that in respect with short term benefits it will help the body to reduce the insulin resistance (Peirce 1993 and Staunton 2004) and the long term benefits of exercise can help decrease the possibility of cardiovascular disease (Roglic 2008), which Gilligan and Field (2006) state is the most common cause of fatality in T2DM. A number of practices across the UK in an attempt to improve the physical fitness and decrease the risk of diabetes in obese and overweight patients have resulted to taking part in a national recognised ‘Exercise on Prescription’ (EoP) scheme.
The whole idea of the scheme enables General Practitioners (GP’s) and Nurse Prescribers (NP’s) to refer patients onto this scheme (Leven 2003). The EoP scheme has been successful across mainland Europe and the United States of America. In the UK healthcare professionals can set ‘Goals and ‘Targets’ for the exercise programme relevant to the patient. This is done in agreement with the patient and may include ‘Goals’ such as; how much weight loss the patient want to achieve, how much exercise a patient wants to do and how long the exercise.
Guidelines in the UK for Diabetes and exercise acknowledge and endorses that a mixture of adequate to energetic levels of activities can benefit a patients physical health (Diabetes UK 2010). Physical activity is associated with the prevention of chronic diseases; this is supported by the National Health Service (NHS). The NHS recommends people should try to complete at least five, thirty minutes of moderate exercise/activity a week. This recommendation is vital to maintain a healthy lifestyle.
Nevertheless for patient’s to get the best possible results from the EoP it is all dependent on their attitude of the patient. After all health care professionals can’t do the exercise for them. The government established a National Service Framework (NSF), which ‘Standard 8’ clarifies that reinforcement of an active life in older adults is vital. This in turn has therefore meant that the NHS has recognised a specialised programme of action which aims to get more and more people active and consequently reduce the risk of a mountain of patients developing T2DM (NSFOP 2001).
An additional cause that can be manageable for T2DM is the diet, Powers (1996), Jhingan (2005) and Ezrin et al (1999) all state that diet is an essential aspect in Diabetes health care and weight loss. Kagan (2010) and Berstein et al (2011) show that being conscious of and obeying to a suitable diet has advantageous outcomes on metabolic control, weight and healthy lifestyle, which also result in lowering the risk of vascular disease.
There are many different models of diet advice that help diabetics to establish a well round diet, but the one diet model that stands out is ‘The Health Eating Pyramid’ which was created by Krentz and Bailey in 2005. This model has three key points, the first is to minimise the ingesting of fats, sugars and alcohol. Furthermore it suggests eating small amounts of food that contain protein for instance lean meat, eggs and fish. And finally eat the majority of foods that are rich in starch such as pasta, rice, and vegetables.
This model is a good visual aid that is simply laid out for people who suffer from or are at risk of T2DM. Moreover Standard 4 of the NSFOP advocates that older adults with T2DM will obtain support throughout the time they live to help curb the control of blood pressure and glucose through diet. The National Institute for Health and Clinical Excellence (NICE) propose that people with diabetes have the availability of structured education. From this came an education course that is used by service providers all over the UK and also from June 2011 in Australia.
This educational programme is called ‘Diabetes Education and Self-Management for Ongoing and Newly Diagnosed’ (otherwise known as DESMOND). DESMOND offers a programme in which patients with diabetes (mainly T2DM) to be taught in an informal way about how to maintain a healthy lifestyle with the disease through the change of diet and also any information patients’ need about their diagnosis. Unfortunately in some cases diet control and regular physical activity won’t be sufficient to control T2DM and thus another intervention is needed.
There are many different types of medication used to control T2DM, however Biguanide tablets are the most common used. Biguanide tablets work in two different ways; they assist the insulin to carry glucose into the muscle and fat cells more successfully and they thwart the liver from making new glucose. The main Biguanide drug used is Metformin, which cause side effects such as nausea. This can be deterred consuming the tablets before or after a meal.
In conclusion it is fairly apparent that Diabetes is a condition that is on the increase in today’s population. Although there are many preventative strategies in place for example Blood Glucose Testing and Urinalysis, diet and exercise and treatment through anti-diabetic medication which can either help treat or prevent this disease. Furthermore there are many service provisions in place and are suitable for the community together with the Standard Four and Eight in the NSFOP in which the efficiency is debatable.
Although it seems that the concept of these provisions sound respectable, in practice the effectiveness is not a good as maybe it should be. Consequently the attribution of diabetes is still in the increase and will continue to expand as time goes on. Wild et al (2004) put forward that the increase of diabetes will continue to rise until 2030, even if the obesity levels stay the same. Consequentially to maximise amenableness and reduce pervasiveness of diabetes then the efficiency of policies must essentially progress.