Introduction
Type 2 diabetes mellitus(T2DM) is a worldwide issue with many perplexing characteristics. Various factors, including other global health issues such as obesity and heart disease, influence a person’s risk for type 2 diabetes. Since type 2 diabetes is a progressive disease, medical providers should be prepared to adjust patients’ current drug dosages and investigate the addition of second-line treatments based on each patient’s specific situation. Blood sugar levels must be strictly controlled to avoid additional vascular and neurological problems. Maintaining a nutritious diet, participating in appropriate physical activity levels, and taking prescribed medication can help slow the condition’s progression (Apovian et al., 2018). Even if all of the recommended treatments are followed, the disease will likely worsen due to genetic factors.
Statistics and Figures
Diabetes affects approximately 10.3% of men and 9.6% of women aged 25 and older in the European Region (Saeedi et al., 2019). It is the equivalent of about 60 million people living there. There has been an increase in the number of cases of diabetes reported in European countries. This is primarily attributable to the rise in overweight and obesity, unhealthy diets, and lack of physical activity. In 2019, the rate of diabetes among adults in Germany was 15.3 percent, the highest in all of Europe. In second place was Portugal, where 14.2 percent of adults had diabetes (Saeedi et al., 2019). The prevalence of diabetes was 4.4% in Ireland, making it the lowest in Europe.
Internationally, the Centers for Disease Control and Prevention (CDC) has identified type 2 diabetes as a significant public health problem due to its widespread prevalence, its enormous influence on the culture, and its associated costs on the healthcare system. Diabetes mellitus type 2 was diagnosed in about 34.2 million people in the United States alone in 2018, which is equivalent to 10.2% of the population of the United States, and the World Health Organization forecasts that the number of cases globally will quadruple by the year 2040 (Xu et al., 2018). The prevalence of diabetes mellitus type 2 is more than doubled in people aged 65 and older. Diabetes Mellitus Type 2 is significantly more prevalent in men than in women (Xu et al., 2018). The prevalence of T2DM is the highest among people of African ancestry, who are not of Hispanic descent, followed by people of Asian descent and Spanish people, and the lowest among white people, who are not of Hispanic descent.
Type 2 diabetes mellitus has been dubbed a health catastrophe in the majority of countries throughout the world; poor diets and sedentary lifestyles have contributed to an increase in obesity and BMI in adults, which has resulted in a significant rise in the prevalence of diabetes. Obesity and diabetes have become a healthcare epidemic of endemic proportions in the United States due to their meteoric rise in prevalence (Xu et al., 2018). In 2012, more than one-third of the population of the United States was judged to have some degree of obesity, most significantly abdominal obesity, which is a key cause of type 2 diabetes (Burhans et al., 2018). Insulin resistance in the obese may be mediated by several different mechanisms, but inflammation in adipose tissue may be a common underlying contributor to many of them.
Several factors, such as an aging population, rapid urbanization, and obesogenic environments, have contributed to this upward trend. To better encourage improvements in care for all people living with diabetes and to promote T2D prevention efforts, it is crucial to periodically produce prevalence estimates and future projections for diabetes, such as those presented in successive editions of the IDF Diabetes Atlas (Saeedi et al., 2019). The Atlas also highlights blanks in the epidemiological data that need to be filled in order to paint a more complete picture of diabetes’s effects.
Diabetes Prevalence by Age and Sex in 2019.
There has been a worldwide rise in the prevalence of diabetes-related complications like renal failure, cardiovascular disease, and peripheral artery disease. Diabetes-related complications like stroke, peripheral vascular disease, cardiovascular disease, neuropathy, retinopathy, amputations, and infections negatively impact life expectancy and quality of life (Xu et al., 2018). Diabetic complications can also lead to many different diseases and conditions, such as cancer, infections, and dementia, are associated with diabetes.
Pathophysiology of Diabetes Type 2
Both impaired insulin production and insulin resistance contribute to the development of pathophysiological illnesses. A decrease in glucose response is a sign of decreased insulin production, which may occur prior to the clinical manifestation of the disease. More specifically, impaired glucose tolerance (IGT) is caused by decreased glucose-responsive early-phase insulin secretion (Galicia-Garcia et al., 2020). In contrast, postprandial hyperglycemia is caused by a decrease in additional insulin secretion after meals (Shubrook, 2020). In impaired glucose tolerance (IGT) cases, an oral glucose tolerance test (OGTT) will often imply an over-response in individuals of Western and Hispanic heritage with markedly high insulin resistance.
Even when an overresponse is found in patients who are obese or have other risk factors, the early-phase secretory response is diminished. A decrease in early-phase secretion is a critical element of this disease and is critical as a fundamental pathophysiological shift throughout disease progression in all ethnic groups (Galicia-Garcia et al., 2020). Sexual interaction can pass this disease from person to person. In most cases, decreased insulin secretion worsens over time, and glucose toxicity and lipo-toxicity accompany this worsening. The progression of reduced pancreatic cell function has a considerable and detrimental impact on the body’s ability to manage blood glucose levels over time (Shubrook, 2020). Patients in the early stages after the onset of the disease primarily show an increase in postprandial blood glucose due to increased insulin resistance and decreased early-phase secretion; however, the progression of the deterioration of pancreatic cell function ultimately causes a permanent elevation in blood glucose.
Insulin resistance is when insulin within the body does not conduct an acceptable amount of activity compared to its blood concentration. One of the most prevalent pathophysiological features of type 2 diabetes is a reduction in insulin activity in major target organs such as the liver and muscles (Galicia-Garcia et al., 2020). Insulin resistance develops and worsens years before sickness arises. The research into the molecular basis for insulin action has provided light on the relationship between inherited variables and environmental factors (such as hyperglycemia, free fatty acids, and the inflammatory process, amongst others) that are connected with insulin resistance (Galicia-Garcia et al., 2020). Polymorphisms of thrifty genes, such as the adrenergic receptor gene and the uncoupling protein (UCP) gene, are connected with visceral obesity and induce insulin resistance. As important routes for decreased insulin production and signaling dysfunction, glucolipotoxicity and inflammatory mediators are also required (Shubrook, 2020). Excess glucose in the body can result in glucolipotoxicity. Adipocyte-derived bioactive chemicals, commonly known as adipokines, have recently emerged as potential contributors to insulin.
Case Study
Alice, not her real name, the pseudo name, has been used to conceal her identity for confidentiality, is a 65-year-old Hispanic female with Diabetes Mellitus and a family history of T2DM and cardiovascular disease, and is obese. Her frequent episodes of hyperglycemia had not improved despite diet and exercise. Alice comes from a family with T2DM and heart disease. All of the patient’s immunizations are up to date, and they recently received two doses of the Pfizer COVID-19 vaccine. The last flu vaccine was administered three months ago. There has been no recent international travel. The patient was previously diagnosed with type 2 diabetes mellitus and was advised to make dietary and physical activity changes.
The patient has had osteoarthritis in both knees in the past. Ibuprofen is prescribed on an as-needed basis for treating bilateral knee osteoarthritis. There are no documented food allergies and unknown allergies to seasonal changes. The patient’s father is 94 years old and has hypertension and type 2 diabetes; a mother is 89 years old and has cardiovascular disease and type 2 diabetes; a brother is 64 years old and has type 2 diabetes; a sister is 62 years old and is healthy and has no health issues; and two sons who are 62 years old and are healthy and have no health issues.
Physical Examination: T = 98.4, HR = 67, BP = 136/85, RR = 18. BMI is 29.1, height is 5’6″, and weight is 182 lbs. Pt. appears to be in good health, with no signs of sudden illness. According to diagnostic tests, the patient’s fasting blood glucose level is 130 mg/dl, and their A1C level is 7.5%. she had a fasting blood glucose level of 129 mg/dl in November 2019. A1C 7.6%. Renal function is normal. The patient’s treatment plan will combine metformin and second-generation sulfonylurea.
Diagnostic Tests
When diagnosing diabetes, there are four methods for detecting the amount of glucose in the blood. In this case, the nurse practitioner (NP) may do a Hemoglobin A1C (Hgb A1C) test to measure the average glucose level in the blood during the previous two to three months. You have prediabetes if your A1C is 6.5% or above. Another test, Fasting Plasma Glucose (FPG), determines the quantity of glucose in the blood after the person has gone eight hours without eating or drinking (Padhi et al., 2020). A fasting blood glucose level of more than 126 mg/dl is symptomatic of prediabetes or diabetes. The term RPG stands for random plasma glucose. This test evaluates the amount of glucose in the blood at any particular time. If the result was greater than 200 mg/dl, the patient was diagnosed with prediabetes or diabetes.
The Oral Glucose Tolerance Test evaluates a patient’s blood glucose levels before and two hours after consuming a special sugary drink. This test is usually given to pregnant individuals. A blood glucose level of 200 mg/dl or higher after two hours of monitoring is considered diagnostic for diabetes (Padhi et al., 2020). This examination is the process of examining both subjective and objective anatomic findings using observation, palpation, percussion, and auscultation.
Pharmacologic and Nonpharmacologic Management
The primary goal of the medication is to improve glucose regulation without increasing body weight. The medicine of choice was glyburide, a sulfonylurea that operates primarily by increasing insulin release from pancreatic islets. Nonetheless, it has been related to minor weight gain, and concerns about hypoglycemia have spurred some reconsideration of the matter (Padhi et al., 2020). Januvia, also known as Dipeptidyl Peptidase 4 Inhibitor, is a medicine that decreases glucose production while increasing the activity of incretin hormones (Padhi et al., 2020). Although Januvia is less likely to cause hypoglycemic episodes than sulfonylureas, people taking medicine may have immune-mediated dermatological side effects such as angioedema and urticaria.
Metformin emerged as the leading choice among non-insulin diabetes treatments after careful consideration. Metformin is the first-line treatment for type 2 diabetes and prediabetes, as well as the most often-used medicine. Metformin acts by suppressing glucose production in the liver (Lipscombe et al., 2018). It also operates by sensitizing insulin receptors in the target tissue and boosting glucose absorption in response to any available insulin. Metformin, unlike other non-insulin diabetic treatments, does not increase insulin levels or encourage weight gain or hypoglycemia (Lipscombe et al., 2018). However, to reduce the chance of GI side effects, this drug should be taken with food, and alcohol should be avoided.
A healthy diet and regular exercise can lessen the need for medical care in most people. When developing a meal plan for a patient like Alice, it is critical to consider the individual’s background, culture, religious views, and financial position (Lipscombe et al., 2018). Being physically active is critical in managing diabetes because it sucks up extra glucose in the blood, uses it, and reduces the total demand for insulin (Lipscombe et al., 2018). A healthier and more active lifestyle can be achieved by decreasing one’s body weight and maintaining it through regular physical exercise at a rate of two to three workouts per week.
Medical Nursing Interventions and Holistic Care Needs
People with diabetes are more likely to suffer from mental health problems. Diabetes patients are twice as likely to suffer mental health problems as individuals who do not have the disease. The findings clearly show that the patient needs the whole treatment regimen. Nurse-led diabetes intervention and care management allow for the treatment of urgent issues and the prevention of long-term complications such as cardiovascular disease, blindness, and amputations. This action is beneficial for treating the disease’s immediate symptoms and preventing potentially disastrous consequences. The patient receives assistance with medication management as part of the comprehensive nursing intervention. The patient is also advised to eat correctly, plan physical activity, and lose weight.
Cognitive-behavioral therapy is recommended as part of the intervention to enhance the patient’s mental health and raise her understanding of the issues associated with diabetes. Patients can engage in stress management activities as part of cognitive therapy, which may help them experience a prolonged decrease in discomfort and anxiety and induce behavioral changes that amplify the advantages of medical treatment. It is critical to use an approach that takes cultural variations into account. Improving self-care management outcomes may be achievable if the patient’s religious requirements are met throughout the intervention. One cause for this is the patient’s solid Christian belief. Speaking with loved ones and members of her faith community may help the patient feel more supported, raise her self-esteem, and reduce her worry and depression.
Evaluation of Intervention Effectiveness
In the short run, the degree to which a patient participated in the treatment process and cooperated with a nurse is one of the elements used to determine whether or not an intervention was beneficial. It will be possible to accurately predict the patient’s readiness for changes and improvements based on the patient’s attitude toward treatment plan implementation. The long-term criterion is the reduction of adverse psychological symptoms caused by adopting new lifestyle habits and regular involvement in stress-management activities. In addition, the patient’s physical health markers will improve, such as a normalization of their insulin level and a reduction in body weight. The intervention will eventually result in improved health conditions and changes in the patient’s psychoemotional and social functioning, which will ultimately manifest the intervention’s beneficial impacts.
Health Promotion
One of the primary goals of public health is to promote healthy lifestyles so that individuals, communities, and governments are better equipped to face and manage health issues. It can be achieved through the implementation of health-oriented public policies, the creation of conducive environments, and the enhancement of personal and collective capacities. People with type 2 diabetes, like Alice, can delay or prevent further complications by adhering to lifestyle habits that reduce their risk of developing the disease, such as eating a healthy diet, engaging in regular physical activity, keeping their weight within a healthy range, and not smoking. Repercussions of diabetes can be avoided or postponed with the help of treatment, which includes changes to one’s diet and lifestyle, frequent exercise and medication, and monitoring for complications.
Relationship Between Physical and Mental Wellbeing
Managing diabetes can be an intimidating challenge, which can have a destructive impact on Trusted Source’s physical and mental health. In addition to bringing on a wide variety of physical symptoms, periods of hyperglycemia or hypoglycemia can also affect a person’s state of mind and the way they think. It is possible that navigating these elements will be challenging and strain relationships. However, understanding these effects of diabetes can help a person living with the condition, as well as the people around them, construct stronger and healthier connections. It can induce symptoms such as extreme thirst, the urge to urinate frequently, and exhaustion. In addition, it can raise the likelihood of significant problems with the eyes, heart, or nerves.
Psychological and Social Changes
Blood sugar changes can cause rapid mood swings and other mental symptoms such as weariness, difficulty thinking correctly, and concern. Diabetes distress is a symptom that can be brought on by diabetes. Diabetes pain is similar to stress, sadness, and anxiety. Diabetes and the difficulties it can induce, according to the data, are associated with several psychological and psychiatric issues. Melancholy, poor eating habits, and anxiety about low blood sugar levels are among the symptoms. Patients with diabetes experience considerable amounts of the emotionally exhausting symptoms of diabetes.
Their physical health and immunological systems have both been damaged, making them more vulnerable to infections. Patients’ medical complaints included issues affecting the chest cavity, such as difficulty breathing at night, lower limbs, numbness in hands and legs, and generally weariness, sight, sexual, and other body regions. The patient mentioned having problems with other portions of their body, such as urinating. The patient, in this case, claims to be exhausted and unable to perform as well as before their diabetes diagnosis. Others can receive the necessary food and medicine, even though some have expressed difficulty obtaining the medicine and food required for their nutritional therapy.
Integrated Health Care for Patients with Type 2 Diabetes Mellitus
The overall purpose of integrated care is to streamline the delivery of critical health and care services to patients so that they can obtain efficient and effective treatment for each individual. The coordination of multiple service components and the construction of a suitable infrastructure to offer patients comprehensive and continuing care services is referred to as integrated health care. Alice’s six-week participation in the diabetes education program was to boost her confidence in her abilities to manage her disease while decreasing her impression of the problems she would face. Diabetes education may contribute to better diabetes control. Two two-hour meetings per week are planned. These sessions address various issues, including glucose monitoring, lifestyle changes, medication education, and foot care.
Specialists recommend a yearly diabetic foot evaluation for those at low risk, a semiannual evaluation for those at medium risk, and a biweekly evaluation for those at high risk. Looking for symptoms of protective sensory loss, identifying lesions on the foot, carefully clipping nails, always wearing clean, dry socks, and consulting a doctor if the condition persists are all part of screening for corns and calluses. This test enables the early diagnosis of diabetic foot ulcers, which helps to avert more severe complications. Alice’s capacity to control her diabetes is improved by her better awareness of the disease’s prevalent symptoms. She will describe symptoms such as severe tiredness, thirst, blurred vision, frequent infections, and slow wound healing.
Legal and Ethical Issues
Ethical and legal issues are common in today’s healthcare system. This is mainly because, unlike in the past, ongoing research and advancements in technology, pharmaceuticals, and treatment options have made it possible to provide people with treatment that is not only effective but also curative. Even if the disease cannot be cured, the management of symptoms and the provision of palliative care can slow the progression of the disease, improve the prognosis, or allow a person to live a relatively everyday life despite the condition. People dealing with their conditions for a long time may benefit the most from such medical advances, but they can also raise several moral concerns. Given the high long-term cost of care, difficult questions about the efficacy of such treatments and how they will be funded naturally arise in a publicly funded healthcare system. At the end of life, doctors, caregivers, and family members may face some of the most challenging decisions of their lives, such as deciding whether to seek assisted suicide, discontinue all treatment, or continue receiving treatment.
Conclusion
Type 2 diabetes mellitus is a challenging illness linked to numerous risk factors and comorbidities. Heart disease and stroke are more than twice as likely in patients with this syndrome. Chronic renal disease and neuropathy are common complications for people with type 2 diabetes. Many patients do not realize they have the disease until it has progressed significantly. Knowing the root of the illness is crucial for developing treatments that mitigate its adverse effects. The hallmark of type 2 diabetes, hyperglycemia, is caused by insulin resistance and an inadequate supply of insulin. It is also possible that b-cell deficits caused by the body’s immune system contribute to the development of the condition. Hyperglycemia causes more damage to blood vessel walls, which increases the risk of cardiovascular disease and death in patients with type 2 diabetes. Maintaining patient health through medical management of glucose levels and behavioral modification is of utmost importance. Tight glucose management is essential in reducing the risk factors that lead to complications and mortality.
Reference List
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Burhans, M.S. et al. (2018) ‘Contribution of adipose tissue inflammation to the development of type 2 diabetes mellitus,’ Comprehensive Physiology, pp. 1–58.
Galicia-Garcia, U. et al. (2020) ‘Pathophysiology of type 2 diabetes mellitus,’ International Journal of Molecular Sciences, 21(17), p. 6275.
Lipscombe, L. et al. (2018) ‘Pharmacologic glycemic management of type 2 diabetes in adults,’ Canadian Journal of Diabetes, 42.
Padhi, S., Nayak, A.K. and Behera, A. (2020) ‘Type II diabetes mellitus: A review on recent drug-based therapeutics,’ Biomedicine & Pharmacotherapy, 131, p. 110708.
Saeedi, P. et al. (2019) ‘Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition,’ Diabetes Research and Clinical Practice, 157, p. 107843.
Shubrook (2020) ‘Evolution of type 2 diabetes treatment,’ The Journal of Family Practice, 69(10 Suppl).
Xu, G. et al. (2018) ‘Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: Population Based Study,’ BMJ.