Introduction to Diabetes Type 2
Type 2 diabetes mellitus is a lifelong or chronic disease. This is characterized by high level of sugar in the blood. It is also called as non insulin dependent diabetes (Type 2 Diabetes Overview, 2014). This disease consists of a wide range of dysfunctions related to hyperglycemia. These happen as a result of inadequate secretion of insulin, resistance to insulin action and inappropriate secretion of glucagon (Practice Essentials, 2014). Management of diabetes mellitus type includes treatment with the goal of lowering the high glucose blood levels at first. Long term goals in the management of diabetes type two is to prevent complications of diabetes. The most important way of managing this disease is with healthy eating and physical activity (Type 2 Diabetes, 2014). In this regard, the present essay focuses on the effects of lifestyle for the management of patient with Diabetes Mellitus type 2.
Rationale behind choosing the topic is that diabetes mellitus type two is a disease which is spread around the world and contributes significantly towards mortality and death in an early age. Becoming more common in the young adults, type 2 diabetes roughly accounts for 90 per cent of all diabetes cases. In the UK, there are more than 2.7 million people suffering from diabetes type 2 (Type 2 diabetes statistics, 2014). The health care professionals are increasingly concerned about this chronic disease. Moreover, it has risen rapidly due to obesity, stress and inactive lifestyle of the people. Additionally, if not managed properly, type 2 diabetes may lead to several life threatening complications such as disorders of heart and kidney (Urowitz and et.al., 2012). This was the reason for choice of the topic.
Several health care initiatives have been undertaken by the government (Boström and et.al., 2014). However, there is a need to explore their effectiveness with relation to management of type 2 diabetes. Moreover, there is a requirement of analyzing the current practice and evaluating its effectiveness. The present essay will explore these areas. An attempt has been made to present the information in an organized and logical manner.
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Effects of lifestyle
Diabetes type 2 is a chronic condition. However, people with this disease can lead a full normal life by keeping their diabetes in control. There are significant effects of lifestyle modifications on the management of diabetes (Younis, Soren and Farook, 2004). These include certain changes in the day – to – day habits which are very effective at keeping diabetes in control. Multiple small changes in the lifestyle even decrease the need for medication. Drinking a moderate amount of alcohol along with food does not raise the level so blood sugar considerably. Exercise proves to be beneficial for all the individuals who are suffering from diabetes or at risk of it (Carman and et.al. 2013). This also helps in managing diabetes in people with long standing diabetic complications. Exercise has positive effects on diabetic persons as it promotes cardiovascular fitness and weight loss. It also helps in lowering high blood pressure. It significantly affects the diabetic person by improving his lipid profiles and blood sugar control thus leading to an overall sense of well being.
One of the most important things that can be done by diabetic patient is to quit smoking. This has positive effects on the health of the person (White and et.al., 2003). Diabetic people who smoke have increased risk of death from heart attacks and strokes. They are also at risk of worsened sugar control and nerve damage. Quitting smoking has the potential to decrease the risk for these complications (Hornick and Aron, 2008). Diet is another aspect which is to be considered in the lifestyle for management of type 2 diabetes mellitus. There are substantial positive effects of changing the amount and type of food taken by a diabetic person. Proper diet helps in improving blood sugar control and lowering cholesterol levels in the blood.
INITIATIVES UNDERTAKEN IN THE MANAGEMENT OF DIABETES TYPE 2
There are several initiatives that have been adopted for managing type 2 diabetes and improving the health outcome general public. Their effectiveness has been evaluated as follows.
National Service Framework (NSF) for Diabetes
Department of health performs the work of assisting the people to live better for longer period of time. It has the responsibility of leading and funding health care in England (Department of Health, 2014). It initiated the National Service Framework (NSF) for Diabetes. This framework provides certain standards, key interventions, rationales and implications for planning services. This framework improves the services by setting national standards for improving the service quality. Moreover, this initiative identifies the interventions and actions for better management of diabetes type 2 according to the standards. This framework is effective at enabling people to take more control of their care. It has been able to empower the people beyond individual level so that the patient with type 2 diabetes is able to develop better relationships with the health care team. Moreover, this framework has been effective at ensuring that people have a strong voice in determining their priorities. A number of areas were identified by the NSF for diabetes, where better care can be supported by appropriate protocols. It covered the aspects such as assessment of people with diabetes and follow up of those who do not attend. It also transferred the young people to adult services. Diabetic emergencies are initially managed by frontline emergency staff as per this framework.
Guidance for the management of medicines in long term conditions such as diabetes has been developed by Department of Health. However, according to Evans (2010), despite some very good practice and effective interventions brought by the framework in the areas of diabetes management, this condition is still a concern in UK (Evans, 2010). Carnethon and et.al. (2012) claim that there are a significant number of people in UK who still do not access to best possible care for management of diabetes (Carnethon and et.al., 2012). This suggests that National Service Framework for diabetes has not been completely successful in achieving its targets. This initiative is not effective at ensuring that every person with type two diabetes benefits from high quality care. The NSF has not been efficient enough at the prevention of diabetes. The inequalities in the risk of developing type 2 diabetes have not been tackled properly (Diabetes UK, 2008). Type 2 diabetes is a condition which is more common in Black African Caribbean and South Asian communities. Work stills needs to be done in the area of early identification of diabetes as this could not be effectively handled by NSF. Also, there have been certain loopholes in the area of empowering people. There are many people who are not getting the support that they should.
NHS health check program
The NHS Health Check Program was launched by the Department of Health in England. This was intended to detect people with diabetes. It is also responsible for identifying the people who are at high risk and providing them support and lifestyle interventions so that the onset of condition could be prevented and risk could be reduced (Aschner, Horton and Skyler, 2010). NHS health check is a face – to – face risk assessment which is carried out by a practitioner who is fully trained. With it a person’s level of risk to diabetes type 2 can be identified. Moreover, people could be allowed to reduce the risks of type 2 diabetes by empowering and informing them. This was implemented in England from April 2009. According to this program, there are around 15 million people who are eligible for getting a check every five years. Another aim of this program is to reduce health inequalities resulting from diabetes type two. Health checks by NHS can identify the people at risk and early diagnosis can be facilitated accordingly. However, according to Chatterton and et.al., (2012), the program has not been successful in realizing its potential to the fullest (Chatterton and et.al., 2012). With poor implementation, the program has not been effective at identifying and supporting people with diabetes type 2 in United Kingdom.
There were a number of primary health care trusts (PCT) that could not offer even a single person a health check in the year 2011. Only 36 PCTs could achieve their target and provided NHS health check to 18 per cent of their eligible population (THE NHS HEALTH CHECK PROGRAMME, 2012). Lifestyle interventions are essential to the effectiveness of this program. However, these are not being effectively commissioned. According to Buijsse and et.al., (2011), NHS Health Check Program has not been able to manage diabetes type two in the way in which it was intended to (Buijsse and et.al., 2011). Moreover, the program is not effective at properly utilizing the opportunities of prevent type 2 diabetes. As a result of this, thousands of opportunities where diabetes could be prevented were missed. However, for the people who underwent a NHS health check, it proved to be beneficial. As recommended by the NICE guidelines, a two stage process is followed for early diagnosis of people who suffer from or are at risk of developing type 2 diabetes. Moreover, this program was effective at providing an opportunity to reduce pre mature mortality and health inequalities.
Another way in which the effectiveness of the program can be judged is the cost that it incurs. According to Price, the cost of the exclusive NHS health check program can be twice as compared to the costs of the opportunistic approach to diagnosing people with long term conditions such as diabetes. Age based screening approach, as is adopted in the NHS health check for diabetes, is less cost effective. The evidence base for approach adopted by the program has been criticized by academicians and clinicians. As per the study conducted by Smith, Waterall and Burden, (2013), the NHS health check program for diabetes failed o identify one third of people who were actually at risk of developing diabetes. It has not been effective at identifying a group of patients who were with normal body weight but were at high risk from diabetes. The health check program uses a filter as screening tool to identify people who should receive a test of blood glucose.
“Your health, your way”
“Your health, your way” is a NHS guide to long term conditions and self care. This initiative by National Health Service provides support to the people with long term conditions such as diabetes. This is effective at teaching them steps to self care. Every long term condition, including diabetes, brings certain challenges with itself. For facing and overcoming those challenges, it is extremely important for the people to have confidence and information so as to take control of their condition. This guide, by NHS, is effective at providing healthy lifestyle support and assists the people suffering from diabetes to improve upon their diet and exercise regime (Gillies and et.al., 2007). By providing information about diabetes and its treatment, this initiative is effective in making people understand the importance of adopting a healthy lifestyle in their lives.
Certain guidelines are provided by the National Institute for Health and Clinical Excellence which are known as NICE. These are formulated to provide recommendations for good practice. These recommendations are on the basis of best available evidence of cost and clinical effectiveness. These guidelines are effective at supporting the implementation of NSF in the aspects of care related to type 2 diabetes. Guidelines provided by National Institute for Health and Clinical Excellence efficiently cover the care of type 2 diabetes in primary, secondary and tertiary sectors (Abbasi and et.al., 2012). By providing recommendations in the areas of clinical and self monitoring of blood pressure, glucose and lipid levels, NICE guidelines help in proper assessment of type 2 diabetes. It also widely explores the areas related to pharmacological and non pharmacological management of this chronic condition.
According to Aschner, Horton and Skyler (2010), conditions like type two diabetes require the individuals to adopt healthy lifestyle (Aschner, Horton and Skyler,2010). For this, positive behavior is required, which can only result if diabetic person is informed about his condition and various aspects related to it. This is essential for proper management of type 2 diabetes. NICE guidelines are effective in encouraging the people to adopt healthy life style. These guidelines focus on self management education and empowerment. It strives to use care plans and teach emergency self management to the diabetic persons. Information is provided by the NICE guidelines on the diet and its importance. This elicits the effectiveness of this initiative in the management of diabetes type two. Diet has significant effects on the condition of diabetic patient. Proper diet decreases the risk of various diabetes complications. It also helps in improving the control of blood sugar. In this way, information about these aspects prove to be efficient in managing the health of people with type two diabetes.
COLLABORATION AND TEAMWORK AND USER INVOLVEMENT
By evaluating the effectiveness of various health care initiatives, it can be analyzed that collaboration and teamwork is extremely important for the management of type 2 diabetes. Equally important is the involvement of the user (Chary, Greiner, Bowers and Rohloff, 2012). Lifestyle interventions are focused on improving the lifestyle of people living with or at risk of diabetes. This requires involvement of the individual at every step. Collaboration in health care helps in providing continuous and effective support to the people. This makes the diabetes care cost effective. Considering the prevalence of diabetes type 2 in UK, it is important to broaden the delivery of care by expanding healthcare team and include several types of health care professionals. With team care, the patient’s health risks are effectively minimized. It leads to better assessment of the condition and behavior of the patient in adopting healthy lifestyle interventions for better management of diabetes. It also leads to better surveillance for proper identification of the problems at an early stage so that timely treatment can be initiated (Farmer and et.al., 2007). Participation of the patient in treatment decisions helps in fostering better outcome of various interventions. It is only with the involvement of the individual, that the intervention of adopting a healthy lifestyle can be successful. However, these only provide theoretical information. Hence, these are not effective when practical implementation of guidelines if required.
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RECOMMENDATIONS FOR CURRENT PRACTICE
Drawing from the information gained, the following recommendations can be made for the future practice:
- There is a requirement for every primary care trust to maintain a strategy for prevention of diabetes. This strategy should be inclusive of delivering information and education regarding healthy eating and increased physical activity. Moreover, there should be appropriate therapy which can be tailored to individual needs. Health care professionals should be proactive in providing support to those individuals who are at an increased risk of diabetes (Bahouth, Esposito-Herr and Babineau, 2007). This is important so that they can reduce the likelihood of developing the disease by making relevant lifestyle changes.
- Programs for management of diabetes should be established and initiatives should be taken to screen those that are at an increased risk of diabetes type 2. Also, emotional and psychological support should be provided to adults with diabetes. This should become an integral part of the diabetes care package. It is only then that individuals will be motivated to bring changes in their lifestyle that could help in better management of diabetes type two (Goldstein and Wieland, 2008).
- People with diabetes are required to have checkups at least once a year (Hill-Briggs and Gemmell, 2012). However, it is not happening so. For this, it can be recommended that people with this condition can be involved in the planning of their care. This will make them committed towards taking care of their health.
- Health care initiatives for management of diabetes type 2 should focus on a team approach. This can be effective in helping people to cope with a wide array of problems that they face related to diabetes. There is a need to encourage some people to adopt healthy behavior while there are others who do not have complete information about diabetes and its management (Macdonald and et.al., 2013.). In this regard, a team approach is required in which health care professionals and counselors work in collaboration. For the people who are not much aware of diabetes, they need to be educated and provided counseling for the same. In other people, nurse should take up the role of motivating them and their families for the adoption of a healthy lifestyle. This can only be possible if the initiative for diabetes management works on a team approach.
Diabetes type 2 is a chronic disease which is characterized by high level of sugar in the blood. Its management is mainly concerned with the treatment by lowering the level of blood glucose. Long term goals are focused on preventing the complications of the condition. Healthy eating and physical activity are the most important ways of managing this disease. This is because; its main reasons have been found to be obesity, stress and inactive lifestyle of people. These can only be tackled by introducing certain changes in the day – to – day habits of a person. Lifestyle changes have significant effects on the management of type 2 diabetes. This includes drinking a moderate amount of alcohol and quitting smoking. There will be positive effects of including exercise in the daily routine of a person. Lastly, consumption of balanced and nutritious diet helps in better management of diabetes type 2. Several health care initiatives have been undertaken in the area of management of diabetes type 2. National Service Framework (NSF ) for diabetes is effective at providing certain standards, key interventions rationales and implications for planning services. However, it has not been completely successful in achieving its targets as there are a significant number of people in UK who still do not access to best possible care for type 2 diabetes.
The NHS Health Check Program is another initiative that is effective at identifying people at risk of developing diabetes. This results in early treatment. However, there are cases where the program has not been efficient at detecting people with a low body mass who could be at high risk of diabetes (Anderson and Kendall, 2003). “Your health, your way” is a NHS guide that effectively provides educations regarding long term conditions and self care. Guidelines provided by the National Institute for Health and Clinical Excellence, known as NICE, also help in educating the people regarding self care and management of diabetes type 2. Collaboration and team work is extremely important for effectively managing lifelong conditions such as diabetes. Equally important is involvement of the users.
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- Abbasi, A. and et.al., 2012. Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study. BMJ. 345.
- Anderson, J. W., and Kendall, C. W. C. 2003. Importance of weight management in type 2 diabetes. Review with meta analysis of clinical studies. American journal of clinical nutrition.
- Aschner, P., Horton, E., and Skyler, J. S., 2010. Practical steps to improving the management of type 1 diabetes: recommendations from the Global Partnership for Effective Diabetes Management. International Journal of Clinical Practice.
- Bahouth, M., Esposito-Herr, B. M. and Babineau, J. T., 2007. The Expanding Role of the Nurse Practitioner in an Academic Medical Center and its Impact on Graduate Medical Education. Journal of Surgical Education.