Managing Type 2 Diabetes Aetiology, Epidemiology, Pathology

Introduction

Type 2 diabetes has become one of the major health concerns in the UK that contribute to the increasing number of morbidity and mortality (Chaudhury et al. 2017.). In the UK this health condition develops mainly in people above age 45 years. In England, 1 in every 10 people belonging to the age group 45-54 years is living with type 2 diabetes [NICE, 2018]. This health condition is a chronic health condition, in which the body has a mechanism of resisting the activity of insulin that is secreted from the beta cells of the Islets of the Langerhans of the pancreas. In the UK, the majority of the people with type 2 diabetes suffer from severe mental and emotional distress that adversely impacts the activities of their daily living. This assignment will discuss the aetiology, epidemiology, pathology and management of the patient with type 2 diabetes in the case study. Here the assignment will also demonstrate how this health condition impacts the physical, socio-cultural and psycho-social aspect of the patient in the given case study. For maintaining privacy and confidentiality the real identify of the patients is not disclosed (NMC, 2018)

Epidemiology:

In modern healthcare, type 2 diabetes poses a severe burden of healthcare cost on NHS due to the increasing rate of morbidity and mortality (Foretz et al. 2019). Type 2 diabetes is associated with different factors such as unhealthy habits, poor feeding habits, poor financial condition and irregular lifestyle. This health condition is associated with the reduced quality of living and lack of activities of daily living in affected people which pose an adverse impact on the mental, emotional and spiritual wellbeing of patients [NICE 2018]. In the UK 1 in every 4 people aged above 75 years living with type 2 diabetes. PHE (2019) reports that in the UK more than 3000 children are diagnosed with type 2 diabetes every year (Kato et al. 2019). Recent WHO data shows that in the UK more than 1 million people live with type 2 diabetes that is undiagnosed (WHO, 2018). In the case of children and young people of the UK, the vulnerability of type 2 diabetes increases day by day due to sedentary lifestyles and unhealthy habits (Okemah et al. 2018). NHS has effective health implications on the people who suffer from type 2 diabetes (NHS, 2018). NHS provides the necessary treatment clinical support, health education and self-management training to the diabetic patients thereby empowering them by improving the mental and physical wellbeing

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Global epidemiology of type 2 diabetes shows that the Global Burden of Disease (GBD) has been increased at faster rates in which a major percentage of the global population is diagnosed with type 2 diabetes (Thrasher, 2017). The GBD datable shows that, in 2019, more than 470 million people across the globe have been diagnosed with type 2 diabetes corresponding to the 6.28% of the entire global population [NHS, 2019]. The prevalence rate of type 2 diabetes is 6060 per 100,000 people globally (Bellou et al. 2018). The recent database of the World Health Organisation shows that the global prevalence of type 2 diabetes is predicted to be 7079 by 2030 per 100,000 people [WHO, 2019]. Global epidemiology of type 2 diabetes shows that the prevalence of this chronic health condition increases day by day which impacts adversely on the living standard of people. Diabetes UK reports that more than 7% of the population live with type 2 diabetes in the UK out of which more than 1 million people have undiagnosed type 2 diabetes [PHE, 2019]. The data also shows that despite the diabetes-prevention initiatives are taken by the UK government, the majority of the people residing in the interior areas and deprived community are unable to get proper health education, health information and proper self-management training. The WHO database shows that only 7.6 people with type 2 diabetes are provided with health education out of which the majority reside in the city and urban areas. PHE (2019) mentioned that NHS spends more than £10 billion in 2019 for providing effective clinical support to people with type 2 diabetes [PHE, 2019].

Aetiology:

Different factors are associated with type 2 diabetes such as generic, biological, environmental economic, obesity and lifestyle behaviours (Kato et al. 2019). The clinical intervention of type 2 diabetes shows that people who have a genetic history of this health condition have higher chances of developing type 2 diabetes than people who do not have the genetic history. In the case study of Mrs S.H, the environmental factors that can be associated with developing type 2 diabetes are long term exposure to the unhealthy and unhygienic environment and infections. Evidence suggests people who are highly exposed to the infection and unhygienic environment are more likely to have a poor immune system that can pose adverse impacts on insulin production thereby raising the blood sugar level (Kenny and Abel, 2019). Biological factors are also associated with type 2 diabetes such as the immunity power of the person, comorbidity, complex health condition (presence of other chronic health condition) and poor body homeostasis capability. Obesity is also considered as the big reason for raising the risk of type 2 diabetes, in which body fat is accumulated into the tissues and muscles cells thereby reducing the glucose absorption by muscles as well as tissues as the form of glycogen.

As mentioned by Henning (2018), the development of type 2 diabetes is strongly associated with the genetic factors that contribute to insulin resistance inside the body. Clinical intervention shows the activity of insulin is controlled and monitored by specific genes on the chromosome. Any structural or functional changes in these genes cause mutation which leads to a reduced capability of the body system to utilise insulin to bring the normal glucose level back into the bloodstream. As argued by Okemah et al. (2018), although some clinical interventions prioritise genetic cause of type 2 diabetes, there are other factors such as obesity, overweight, poor lifestyle habit, lower quality of living and deprivation which are strongly associated with developing type 2 diabetes in people. In the case study, Mrs S.H has a lack of physical activity due to arthritis which can be one of the potential reasons behind insulin resistance in his body which contribute to uncontrolled type 2 diabetes.

Critics argued that biological and genetic factor is most potential factors over the other social, behavioural and psychological factors that contribute to the changes in the internal variables inside the body that are associated with maintaining glucose homeostasis (Hemmingsen et al. 2017). As a result, a resistance system against the insulin hormone is developed inside the body that makes the body unable to perform the glucose homeostasis function effectively thereby leading to the increased blood glucose level. As argued by Sacerdote et al. (2019), along with genetic, socio-cultural, psychological and physical factors, some biological factors contribute to type 2 diabetes such as comorbidity, cardiovascular disease, coronary arterial disease and dysfunction of the autoimmune system of the body. The clinical intervention of type 2 diabetes suggests that insulin resistance pose adverse impacts on adipocytes, muscles and liver. In the case study, Mrs S. H suffers from a complex health condition (presence of more than one health condition) such as chronic kidney disease, arthritis and obesity which are the potential facilitators in developing insulin resistance system inside the body thereby reducing the body's ability to carry out the glucose homeostasis mechanism. Obesity in Mrs S.H is the major reason which reduces the ability of the intracellular receptors that are involved in the glucose homeostasis mechanism. As mentioned by Mazidi et al. (2017), insulin resistance is associated with several biological changes such as derangement of the cellular receptors, dysfunction of the intracellular metabolic process and reduced function of the intracellular glucose kinases. These changes interfere with the body's ability to utilise a sufficient amount of insulin to carry out glucose homeostasis.

Pathology of type 2 diabetes:

Type 2 diabetes is a chronic health condition in which the pancreas secrete insulin hormone that cannot be properly utilised by the body cells for maintaining the normal range of blood glucose (Oguntibeju, 2019). Insulin is secreted from the beta cells of the Islets of Langerhans of the pancreas. In normal people, while there is an increase in the blood sugar level, insulin is secreted from beta cells and then is transformed into additional glucose in the bloodstream to the glycogen which then absorbed by the muscle cells and tissues (Tumminia et al. 2018). Liver also plays crucial roles in changing glucose into glycogen (Okemah et al. 2018)

In the case study of Mrs S.H with type 2 diabetes, there are some changes inside the body, there develops a resistance system against insulin hormone which restricts the activity of this hormone on transforming additional glues into glycogen thereby raising tote amount of blood glucose (Oguntibeju, 2019).

Management and treatment of type 2 diabetes:

The type 2 diabetes condition in the case of Mrs S.H, cannot be cured permanently but its symptoms can be managed through following the prescribed medical regimen and systematic lifestyles such as healthy habits, healthy diet and regular exercise (Verma et al. 2019.). Through the following process care professionals can carry out effective management and prevention of type 2 diabetes in Mrs S.H.

Initial assessment as well as monitoring:

Initial assessment, as well as monitoring, is important to check the blood glucose level and other biological variables such as BP, oxygen saturation, BMI, height, weight, heart rate, pulse rate and presence of complex health condition in the patient (Ruanpeng et al 2017.). In the case of Mrs S.H, care providers must determine as well as assess the following variables

Cardiovascular risk factors: determine creatinine, electrolytes, hypertension, and hyperlipidaemia (Jehan et al. 2018.)

Nephropathy: detect the urine albumin and creatinine ratio, glomerular filtration rate, creatinine, ACE inhibitor and amount of urine albumen) (Frydrych et al. 2018)

Neurotherapy: carry out the foot examination to check the visuality, monofilament, and pulse (Pan et al. 2018).

Retinopathy; carry out the dilated retinal examination

Blood test: perform different types of blood test such as random blood test (RBT), Fasting Blood Sugar Test [FBT], Post Prandial Blood Sugar Test [PPT] and glycated haemoglobin test and oral glucose tolerance test (Palomer et al. 2018).

All the above-mentioned test and examination of Mrs S.H, which enable doctor and nursing professionals to determine the current level of glucose in the blood and biological factors that are associated with uncontrolled elevation of blood glucose level (Furtado et al. 2019). In the case of Mrs S.H, as she has arthritis and chronic kidney disease, these nephropathy examinations will help doctors to detect GFR, creatinine and urine albumen that are strongly associated with the ability of the body system to maintain glucose homeostasis by utilising insulin hormone. These physical assessment and monitoring system will also assist care providers to detect if there is any dysfunction in the cardiovascular system, pathological system, nervous system, lung function and metabolic function that may contribute to developing peripheral insulin resistance in Mrs S.H.

Lifestyle changes:

People with diabetes need to perform a systematic lifestyle such as sufficient sleep, taking a healthy meal with low carbs and high protein, quitting smoking and alcohol, managing body weight to avoid obesity and regular exercise (Radholm et al. 2018). Moreover, type 2 diabetes patients must go through regular health check-up that is necessary to get the consistent clinical advice (Oguntibeju, 2019). In the case study, Mrs S.H must follow below mentioned clinical regimen and diet to manage and prevent the impacts of type 2 diabetes on her health and wellbeing.

Dietary advise:

People with type 2 diabetes must follow the prescribed diet that will resist the further increase in the blood glucose thereby assisting the body system to bring the blood glucose back to the normal range (Madsen et al. 2019.). In the case study, Mrs S.H must avoid skipping the three times meals (breakfast, lunch and diner), which are important for enabling the body system to maintain a proper glucose homeostasis system.

Mrs S.H must be served meals that are low in carbohydrates and enriched in protein. For example, Mrs S.H can make bread, pasta, egg, fish, chicken, a low number of potatoes and brown rice. Evidence suggests that in the case of people with diabetes they must not take carbohydrate-free foods because it will raise their vulnerability to the risk of sugar fault which can cause severe damage to heart and lung function (Qaseem et al. 2018). As Mrs S.H, is aged (above 70 years) and has uncontrolled type 2 diabetes she must be provided with low-fat foods that will maintain her BMI and weight at the normal range.

Mrs S.H must be served with seasonal fruits and vegetable that are rich in protein and minerals along with low sugar contents. As mentioned by Naito. and Miyauchi (2017), diabetic patients must take the 5 portions a day that will improve their immune system thereby reducing the insulin resistance inside the body.

Mrs S.H must not take food that is enriched in saturated and trans fatty acids. She must include a limited amount of sucrose-containing food along with a low amount of glucose-containing foods in her regular meal that will provide the required energy to her body for performing the regular functions to maintain a normal blood glucose level.

Regular exercise:

As mentioned by Zang et al. (2017), regular physical activities are crucial for maintaining a good hormonal balance inside the body and good coordination among all body systems. Mrs S.H must perform regular exercises that will improve the activity of insulin on the excess glucose in the bloodstream thereby transforming additional glucose into glycogen. The psychotherapist must help Mrs S.H, regarding doing such exercises that are appropriate to her age and physical ability. NICE (2018), recommend that aerobic exercise is proved to be highly effective in the case of diabetic patients that improve the oxygen supply to the body thereby providing proper oxygen to the cells and tissues that are involved in utilising insulin to transform additional glucose into glycogen [NICE, 2018].

Healthy habits:

According to Hoseini et al. (2019), management and prevention of the symptom of type 2 diabetes are strongly associated with how effectively a person can implement healthy habits into his or her regular practices. In the case study, Mrs S.H must develop healthy habits such as early sleeping, sufficient sleep, early rising, no skipping of meals, taking regular medicines, perform regular exercise, wash hand properly, quit smoking and alcohol (Figtree et al. 2019). Evidence suggests that through developing healthy habits and following a systematic lifestyle, people can achieve a good immunes system that will assist the body to reduce insulin resistance thereby increasing the activity of insulin on maintaining glucose homeostasis.

Patient education:

Care providers must provide health information to Mrs S.H regarding what is type 2 diabetes, how it develops, what are possible causative factors and how the condition can be managed and prevented.

Nurses must provide training to Mrs S.H to develop effective self-management skill and stress management ability in her. On developing self-management skill in Mrs S.H, nurses will provide advice on how to check blood glucose at home, what precaution needs to be taken to control the blood glucose and what resources need to arrange at home for gaining immediate medical support such as medicines, medical instruments and blood sugar checking machines (Pinti et al. 2019).

Medicine:

As Mrs S.H suffers from uncontrolled type 2 diabetes, antihyperglycemic agents can be used to reduce the blood glucose level. Antihyperglycemic agents such as Glyburide, glimepiride, glipizide, tolbutamide and tolazamide will reduce the peripheral resistance of insulin thereby maintaining the normal blood sugar level (Rehman et al. 2017).

On the other hand, an insulin regime can be used in the case of Mrs S H based on her current blood glucose level. There are three types of insulin regimen such as short-acting, intermediate-acting and long-acting insulin. Doctors must determine the glucose tolerance of the body and the current insulin production in the body of Mrs SH before prescribing any insulin regimen.

Roles of the interprofessional team in the management of patients suffering from diabetes:

Doctors working, in the interprofessional team play different functions in the treatment and management of type 2 diabetes in the case of Mrs S H.

Specialist endocrinologists check the glucose tolerance, fasting and postprandial glucose level and insulin secretion inside the body by performing different blood tests such as Random Blood Test (RBT), Fasting Blood Sugar Test [FBT], Post Prandial Blood Sugar Test [PPT] and glycated haemoglobin test and oral glucose tolerance test (Furtado et al. 2019). These tests will assist the endocrinologist to determine the dysfunctions in the glucose homeostasis system inside the body of Mrs S.H

Diabetes specialist nurse plays crucial roles in providing proper health education to Mrs S.H by providing her with the health information regarding type 2 diabetes, its occurrence, cause and management (Palomer et al. 2018). Nurses will also empower Mrs S.H by improving her lifestyle behaviours and healthy habits.

Pharmacists play crucial roles in providing appropriate medicines to Mrs S.H based on her physical assessment reports (Oguntibeju, 2019). For example, Mrs S.H needs a long term insulin regimen and antihyperglycemic agents that will improve the activity of insulin by reducing the peripheral insulin resistance thereby reducing the blood glucose level.

Renal specialists will examine the kidney function of Mrs S.H by carrying out neuropathological tests such as checking Glomerular Filtration Rate [GFR], creatinine percentage, the ratio of creatinine and urine albumen and ACE inhibitor (Tumminia et al. 2018). Renal specialists will provide valuable advice to Mrs S.H about her daily water intake and fluid intake regarding maintaining the normal creatinine and electrolyte balance inside the body which is important to have a healthy insulin system.

The ophthalmologist will check the visions, thereby determining whether type 2 diabetes have impacted eyesight of Mrs S.H

General practitioners will work in association with the local statutory and voluntary healthcare organisations to promote public awareness about the impacts of type 2 diabetes (Mazidi et al. 2017). GPs are involving in the health promotion of Mrs S.H by providing her with the right clinical support and effective healthcare advice regarding lifestyle, diet and medication.

Psychosocial, physical, cultural impacts of diabetes on family and patients:

Physical:

Type 2 diabetes can affect the physical health of Mrs S.H in the following ways:

Long terms complication: damages of kidney function, heart function, poor lung function and poor vision (Verma et al. 2019)

Short terms complication: sleep disturbance, nausea, skin infection, vomiting, abdominal pain, exhaustion and weight gain (Ruanpeng et al 2017).

Psychological:

Depression, anxiety, loneliness, frustration, sadness, exhaustion, helplessness, persistent fatigue.

Social:

The uncontrolled type 2 diabetes reduces the activities daily living of Mrs S.H, which will make her unable to take part in any social function or occasions (Jehan et al. 2018). On the other hand, due to poor physical health such as frequent urination, lack of mobility and poor vision, Mrs S.H may feel embarrassed and ashamed to interact and meet with neighbours and society members.

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Conclusion:

From the above-mentioned discussion, it can be concluded that type 2 diabetes is a chronic health condition, in which insulin cannot act properly on the excess blood glucose due to peripheral insulin resistance. Although this health condition cannot be cured permanently, it can be managing and treated by following a systematic lifestyle, quitting smoking, developing healthy habits and following a prescribed clinical regimen. Type 2 diabetes pose adverse impacts on the physical, psychological, emotional and social wellbeing of patients thereby interacting with activities of daily living. Therefore, the healthcare authority must implement effective health promotion initiatives to provides the proper clinal guidance, health education and support to the patients with this health condition to empower patient in terms of managing their health condition.

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