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Running Head: DIABETES MELLITUS
Diabetes Mellitus in the Community Setting
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Abstract
The swell of people having diabetes has gone over 30 million to 230 million last 2006, taking millions of lives and spending much of the health care system’s funds in dealing with the epidemic. Claiming about three million deaths a year, it is the fourth leading cause of death by disease globally. Two countries are the highest when it comes to the largest number of diabetics: China and India. China holds 39 million of diabetic people while India comes in second with 30 million persons diagnosed with the disease. There are also other countries that have very high rates in diabetes, but these two were among the highest because of the size of their population (Santora, 2006). This paper aims to discuss the epidemiology of diabetes, and all the other subject matter that is associated with it. The researcher hopes that the reader will become more aware and more understanding of the growing number of diabetics that roams around the community and in our lives. You’ll never know, you might just be as well the next victim.
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INTRODUCTION
This research is all about the epidemiology of diabetes mellitus that affects in the East Sussex (local) and the United Kingdom (national). The writer will discuss the incidence and prevalence rate in the mentioned areas, effects of the disease towards an individual, interventions done to address diabetes, and the associated risk factors that put the people at stake for developing the disease. The rationale of this study based on a theoretical sense is to support the concept of the Central Obesity. This Central Obesity pertains to the fat concentrated around the waist, level to the abdominal organs. But this kind of fat is not related to subcutaneous fat. This theory is identified to predispose people for insulin resistance. The factor found in more or less 55% of Type 2 diabetes patients in obesity. This type of diabetes has increasingly started to affect children and adolescents, instead of usual adult population. More than likely, this is due to the also increasing prevalence rate of childhood obesity in the last decade. Other factors are aging and family history.
From a subjective point of view with regard to observation in practice, the rationale of this paper is to convey evidence-based information coming from journals and articles about proper management of diabetes mellitus in the public health setting. People having diabetes in the United Kingdom particularly in East Sussex increase at alarming numbers over the years. As indicated by the National Health Service (NHS) of the Department of Health, the health profile of East Sussex last 2007 showed that 17,851 people are affected with diabetes.
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To better guide the reader as to the structured approach of this study, the outline includes:
Main Body
- Epidemiology of Diabetes Mellitus
- Associated Risk Factors
- Sociological (age, sex, sociological class, ethnic background, occupation)
- Environmental (housing, geography, pollution, season)
- Behavioral/lifestyle (diet, smoking, alcohol, exercise)
- Incidence and Prevalence Rate
– East Sussex
– United Kingdom
(Sociological, Ethical, and Environmental Perspectives)
— Subgroups and groups
— Ethics
–Multi-agency approaches
- Effects (normal life, capacity to earn, NHS)
— Short term
— Long term
- Social policy (recent news about diabetes mellitus)
- Actions done to address diabetes mellitus
– Role of nurse (prevent dm/limit effects)
– Health promotion at the national and local level
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MAIN BODY Epidemiology of Diabetes Mellitus
To start off, let us define Diabetes Mellitus. As stated by NHS, diabetes is a long-term condition, which is caused by too much glucose in the blood. If the body does not make enough of the hormone insulin, the blood sugar level can be too high. The pancreas produces insulin and moves glucose out of the blood and towards the cells, where it is broken down to be absorbed and then in turn produces energy. If left untreated, it can cause chronic health problems because high glucose levels in the blood damage the blood vessels.
Two Main Types of Diabetes Mellitus Type 1 or Insulin Dependent Diabetes
With an abrupt onset, Type 1 diabetes starts at a young age. The body produces little or no insulin when one has this kind of diabetes. He must regularly check his blood glucose levels and be wary of its complications. He needs treatment for the rest of his life because he will be injected or injecting insulin shots under his skin, in the fat – for the faster absorption into the blood stream where it can gain access to all the cells in the body which requires insulin. There is a greater risk of developing Type 1 diabetes if it runs in your family. The cause of Type 1 diabetes unknown except that it is an autoimmune disorder. This occurs when the body’s immune system acts differently and starts to see its own tissues as a foreign material. The cells that produce insulin in the pancreas are perceived by mistake as an enemy, thus the body will naturally react and
sends antibodies to fight this foreign enemy. Eventually, it will then destroy the islet
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cell’s ability to produce insulin. Also known as juvenile diabetes, Type 1 diabetes usually develops often in the teenage years, before the age of forty.
Type 2 or Non-Insulin Dependent
Occurring during the middle age or later than that, Type 2 diabetes is more common. Among the people who have diabetes, nine out of ten persons have Type 2 diabetes. The usual representation of a Type 2 diabetic patient is either overweight or obese. This type of diabetes is linked with insulin resistance rather than the lack of insulin, unlike that of Type 1 diabetes. Obtained as a hereditary tendency from one’s parents, Type 2 diabetes is most prevalent (greater that 40%) in the Pima Indians of Arizona. One factor where the larger percentage of diabetes is is the degree of obesity. Moreover, studies showed that 90-100% of the time, diabetes occurs when one of them develops the disease. Causes of diabetes are multifactorial. The strongest one is the genetic predisposition. Obesity and high caloric intake are also another causes of Type 2 diabetes. Treatment for this kind of diabetes is the taking in of oral hypoglycemics, but may still need insulin shots at some point.
Associated Risk Factors
There are several which factors which can lead to the most common type of Diabetes, which is Type 2 diabetes. These factors range mostly from sociological to the type of lifestyle that one leads. Although there are some factors based on the sociological side, most common risk factors are due to the type of lifestyle a person has. The following are the sociological risk factors of Type 2 diabetes: age, family, and ethnic ancestry, while these are the behavioural or lifestyle factors that affect Type 2 Diabetes: obesity, an
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apple shaped figure, having a sedentary lifestyle, alcohol and tobacco, high blood pressure, and impaired glucose tolerance.
It has been shown that people in ages 40 and above in the UK have a higher risk of acquiring Type 2 diabetes. This risk increases with age, but that doesn’t mean that it is a guarantee that younger people do not have the risk of getting this disease. There have been reports in Canada of the occurrences of Type 2 diabetes among children and that these occurrences have been increasing. This problem has been reported to be seen among aboriginal girls between ages 10 – 12. These reports clearly show of a possibility of getting diabetes even at an early age, albeit these incidents are paired with other risk factors such as ethnic ancestry.
It has been shown that the genetic link for Type 2 diabetes is stronger than that of Type 1 diabetes. Family also puts a person at risk of having this disease. If a family member has type 2 diabetes then the other members of the family also run this risk especially if their relation is that of the first degree such as a parent to his/her child or among siblings. These run greater risks than that between an uncle or aunt and his nephew or niece.
Many of those of the African and of the Asian race have higher risks of having Type 2 diabetes than those that are Caucasians or the white race. In the UK particularly, those of the African-Caribbean and South Asian racial origins have higher risk of at least 5 times than the white population of getting diabetes. Other ethnic groups such as the Aborigines of Canada, Latin Americans, and Native American also have a high risk of having the disease.
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Increase in the risk of having diabetes also comes with a drastic increase in body weight or obesity. Statistics shows that over 80 percent of people who have Type 2 diabetes are obese. Overweight people usually tend to be inactive and thus have greater risks for diabetes. The BMI or Body Mass Index is one widely used method of determining if one is overweight. A Body Mass Index of above 27 is an indication of a risk for type 2 diabetes. Obesity not only leads to diabetes but other diseases as well such as hypertension and heart problems. Even other risk factors, when coupled with obesity increase chances of having diabetes.
Persons who have an apple shaped figure or those who carry their weight in the trunk of their bodies have a really high risk for diabetes in contrast to those who have their fat mostly concentrated around the hips and thighs.
Constant physical activity could lessen obesity and therefore lessen a risk of having Type 2 diabetes. This also improves blood sugar control of persons who already have this disease. So, living a sedentary lifestyle or one with less physical activity is highly disadvantageous for those who already have the risks of diabetes or those that already have the disease.
Drinking too much alcohol can cause pancreatitis which is a chronic inflammation of the pancreas. This, in turn, leads to the impairment of its ability to secrete insulin which then leads to the person ending up with diabetes. Tobacco use can lead to insulin resistance because it causes an increase in blood sugar levels. Chemicals in tobacco, one being nornicotine, may increase the risk of having diabetes. Heavy smokers (people who
smoke more than 20 cigarettes a day) are shown to at least triple the risk of acquiring
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this disease.
People with high blood pressure or those with hypertension also have a high risk of getting Type 2 diabetes. Hypertension also has obesity as one of its factors, and thus it follows that those who are hypertensive also have high risks of being diabetics. It is shown that up to 60 percent of those diagnosed with diabetes are also diagnosed with hypertension.
Type 2 diabetes can also develop due to impaired glucose tolerance (IGT) or Impaired Fasting Glucose (IFG). Blood tests can determine if these to conditions are present in a person. Although having these conditions doesn’t mean that the person has diabetes right away, they have abnormal sugar blood sugar control and abnormal reactions to sugar loads. This provides them with a higher risk, not just for Type 2 diabetes but they also have risks of developing cardio vascular ailments. People with these conditions should undergo preventive strategies such as changing their lifestyle and undergoing regular screenings for diabetes.
Incidence and Prevalence Rate in East Sussex and in the United Kingdom
Let us first differentiate Incidence rate from Prevalence rate. As indicated by answers.com, incidence refers to the rate at which a particular event happens, as the number of new cases of a certain disease occurring during a certain period. On the other hand, prevalence pertains to the total number of cases of a disease in a particular population at a certain time.
In the United Kingdom, the incidence rate for diabetes as of January 2007 is 1.3% per
100,000 per year. While the prevalence rate as of 2006 is 3.54% per 100,000 from
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2005-2006.
In East Sussex, the prevalence of the disease is 36.5 per 1,000 population from 2006-2007.
Sociological, Ethical, and Environmental Perspectives
Being a disease that claims millions of lives each year, people cannot help but be very concerned with the gradual uprise of the number of individuals who are diagnosed with diabetes. The loss of loved ones and dear friends due to the silent killer has made people very much aware of the existence of diabetes. These people have formed organizations that support, motivate, and help individuals cope and live with the condition. One very famous organization that deals with the charity, as well as the funding of research, for people with diabetes is Diabetes UK. They are very proactive in guiding persons who are newly diagnosed with the disease and aids them in their struggle to adjust with their condition. By promoting information about the management of diabetes, they also conduct activities to gather all the people to go out there and participate in the usual doings of everyday living and not letting the condition get in the way of happiness. With the proper treatment regimen and being very responsible to take care of the self, diabetics can surely manage their situation with less difficulty than they could ever have. In fact, they will be holding a fund-raising activity entitled Run 10K for Diabetes UK on July 6, 2008 starting on Picadilly at Hyde Park Corner that would finish in Whitehall near Downing Street. You can always visit and browse their website
at http://www.diabetes.org.uk/.
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Moving on to the ethical perspective, one principle that is very important in the management of diabetes is the principle of informed consent. A general practitioner is obliged to tell his patient all about his condition with proper disclosures. The patient has every right to know about the goings-on of his situation and all the other information that he ought to know, like the cause of his illness, the management of diabetes, and the alternative solutions that would help the patient cope with his state. The general practitioner and the patient, together with the latter’s family has the freedom to choose the management they all is best for the betterment of the patient. It doesn’t mean that the patient will have to strictly follow every instruction and recommendation of the general practitioner so as to hasten the alleviation of diabetes. It is all up to their sound reasoning to decide whether or not to precisely adhere to the general practitioner’s treatment regimen.
Multisectoral linkages are also very essential in helping individuals manage their condition. Not only private organizations are capable of reaching out a hand to those in need, but also various agencies from the local or national government could lend an ear to those who ask for help. Multiagency approach includes the Department of Health, the Community Diabetes Specialist Nurse (community DSN), the local community groups, and practice nurses (Allard, 2007). This collaborative teaming up will certainly come up with interventions and activities for diabetic patients to deal with and survive their situation.
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Short and Long Term Effects of Diabetes Mellitus Short Term Effects
For a person who is diagnosed with such a serious condition, he will be going through a lot of changes and major adjustments in his life. The consequence of having such a disease entails responsibilities that the patient will be able to handle. The short-term effects include the changes it would make to your normal life, and the effect of the disease towards the patient’s capacity to earn. Almost immediately, when one knows that he has diabetes, he will deny the existence of his condition. He will experience strong emotions and go through mood swings (Carruthers, 2007). As a defense mechanism, he will feel anger towards the people around him, and ambivalence between denial and acceptance. Through internalization and managing his emotions, one can gradually acknowledge the disease within him. With regard to his capacity to earn, it would depend on which career he is into. If he is involved with dangerous and risk-taking jobs, he would have to resign and look for another job that would require him to do much less activity and with minimal harmful outcome.
Long Term Effects
What is the NHS role in the long-term treatment of diabetes? Being publicly involved and patient focused, their aims are to serve people and treat them as individuals involved in their own care, and include groups and communities in improving the quality of care, influencing priorities and planning services. Approximately 5% of total NHS resources, and up to 10% of hospital inpatient resources are used to care for people with diabetes. It is costly indeed, the management of diabetes, but it is the responsibility
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of the national government to take care of their people so as to make them more productive citizens of the country. The general practitioner’s role, who is within the NHS, is that he should be able to handle, at least to an initial extent, with any medical problem that the patient presents. This generalist approach not only benefits the patient, but the general practitioner himself. It helps him in such a way that the enthusiasm for a unique interest is greatly beneficial to morale, retention and recruitment, and most significantly, to the care of the patient (Hadley-Brown, 2004).
Social Policy
The social policy that is applicable to this kind of situation is the Health Care Policy. This pertains to the attention given by the national government about the wellbeing of an individual. There are a number of factors that health depends on, like biological and environmental factors, nutrition, and the standard of living. Issues in the health care are dealt with by health services, which is also called medical services. Every individual or family must be registered, together with a general practitioner, to the NHS. When they register, they should be well aware that they are paying for social protection. This practically means that whenever they call their general practitioner or any other physician for that matter, the general practitioner must by all means visit their client who made the request. The NHS was created to safeguard all citizens. There is also a downside to this free service, like the long waiting lists that the physicians already have with regard to their clients who need medical attention. In some cases, people who have serious conditions may die because of treatment cost is more than what NHS is willing to bear.
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The effect of these social policies that have been mentioned create an impact on the quality of care the patient receives because depending on the status of the patient in society, there will always be inequalities with regard to the delivery of health care. It may be because if the patient is deprived of the prosperity in life, she will have lesser options with regard to the treatment of her condition. With this patient, he has diabetes mellitus, which limits his actions and options. He needs special attention, care, and support from his immediate family. But without the advantage of being well off, his medication and treatment may be delayed or not given at all. The long-term care for this patient may be affected by this social policy.
Actions done to Address Diabetes Mellitus Role of the Nurse
The main roles of a nurse in a diabetes case are an educator and a caregiver. First of all, an educator because she informs and teaches the patient about the right management of care and the proper ways of coping with the consequences of diabetes. Diet and nutrition, foot care, physical activity, administration of medication, name it. It is the duty of the nurse but, to care. There goes as well the role as a caregiver. With the best qualities like much knowledge and superb skills, a nurse can hardly go wrong with her work. It is also her role to educate those people who don’t have diabetes so as to prevent the occurrence of the mentioned disease.
Health Promotion at the National and Local Level
From the joint Department of Health and Diabetes UK Care Planning Working Group,
they have set a guide on the care planning process for diabetes services. This care
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planning process aims to help diabetics achieve optimum health through a partnership
approach with health care professionals in order to learn about diabetes, manage it, and related conditions better and to cope with it in their everyday lives.
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