Introduction
In the United States of America, diabetes is a major health issue that affects many people. According to CDC s’ statistics, more than 25.8 million Americans had diabetes in 2010 (Centres for Disease Control and Prevention, 2014). This number represented 8.3% of the country’s population (Centres for Disease Control and Prevention, 2014). The prevalence and health effects of diabetes are different for various age groups. The state governments are addressing the situation because of its negative economic effects. In 2007, the government estimated that the economic cost of diabetes was approximately $174 billion (Centres for Disease Control and Prevention, 2014). $116 billion of this amount accounted for medical costs while $58 billion accounted for indirect costs related to effects of diabetes such as absence from work (Centres for Disease Control and Prevention, 2014). Several approaches are applied in the reduction, diagnosis, and treatment of diabetes. Treatment of diabetes in primary care is based on patient-focused approaches and personalized care. Individuals are encouraged to participate in physical exercise and reduce their intake of high-calorie foods.
Diabetes among adults (people above 20 years of age)
According to statistics from the Centers for Disease Control and Prevention (CDC), the rate of diabetes prevalence is higher among people above the age of 20 years than among people below 20 years. According to statistics, more than 25.6 million Americans have diabetes. This number accounts for 11.3% of the population (Centres for Disease Control and Prevention, 2014). Among older people (adults over the age of 65 years), prevalence is higher. More than 10.9 million people have diabetes. This accounts for 10.9% of the population. Diabetes leads to the development of illnesses that affect the vigor and day-to-day activities of patients (Centres for Disease Control and Prevention, 2014). Complications associated with diabetes in adults include heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system disease, and amputation. In 2007, statistics revealed that diabetes caused 71,382 deaths (Centres for Disease Control and Prevention, 2014).
Literature review
Diabetes management measures and approaches include controlled diets, patient education, awareness to influence patients’ perceptions, and participation in physical activities as well as self-management. According to Barnard, Katcher, Jenkins, Cohen, & Turner-McGrievy (2009), vegan and vegetarian diets are effective in the management of type 2 diabetes. These diets control the amount of plasma glucose concentration in the body because they contain high fiber content, zero cholesterol, and small amounts of saturated fat. The Chronic Care Model (CCM) has been effectively used in the management of diabetes. According to Stelfson, Dipnarine, & Stopka (2013), CCM has two main goals. It aims to equip patients with self-management skills and monitor their progress in order to ensure steady progress toward the improvement of health outcomes. Factors that affect effective management of diabetes include patients’ perceptions, financial constraints, lack of awareness regarding management approaches, and physical limitations that prevent patients from engaging in physical activities. According to Fukunaga, Uehara, & Tom (2011), it is important for patients to develop positive perceptions in order to benefit from diabetes management approaches. Treating complications that emanate from diabetes is also important. According to Kitabchi, Umpierrez, Miles, & Fisher (2009), two major metabolic complications experienced among diabetic patients include a hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA). Treating these complications aids in the management of diabetes. Teaching patients about diabetes is important for effective management (Tidy, 2014). Patients need to know about the importance of physical exercise, lifestyle changes, and regular monitoring of blood pressure well as glucose levels. Moreover, nurses should teach patients about the importance of the cessation of habits such as smoking.
Management measures
Vegan and vegetarian diets in glycemic control
Diet regulation is one of the most effective measures used to manage diabetes. According to Barnard et. al (2009), vegetarian and vegan diets are effective in the management of diabetes particularly type 2 diabetes. According to a study on the effect of vegan diets on diabetes management, the prevalence of type 2 diabetes is lower among individuals who followed vegetarian diets than among individuals who did not follow vegetarian diets. On the other hand, the study revealed that low-fat vegan diets are more effective than conventional diabetes diets in glycemic control among diabetic individuals (Barnard et. al, 2009). Vegan and vegetarian diets manage diabetes by controlling the amount of plasma glucose concentration in the body. High concentration of plasma glucose results in microvascular complications like neuropathy and nephropathy (Barnard et. al, 2009). Vegan and vegetarian diets have high fiber content, zero cholesterol, and low quantities of saturated fat.
Fiber makes individuals feel full and thus helps them to reduce the amount of food they consume. Intake of vegan foods with high fiber content helps in lowering the level of blood glucose (Barnard et. al, 2009). Patients with type 2 diabetes usually succumb to death because of macrovascular complications. Timely management of diabetes prevents the development of complications that worsen the health of patients and in some cases cause death. Consumption of diets with low quantities of saturated fat, high amounts of vegetable protein, low amounts of iron, and concentrated intramyocellular lipids aids in glycemic control (Barnard et. al, 2009). Glycemic control lowers the risk of developing vascular complications (Barnard et.al, 2009). Common metabolic complications experienced among diabetic patients include a hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA) (Kitabchi et. al, 2009). The main signs of DKA include metabolic acidosis and uncontrolled glycemia. On the other hand, HHS’s symptoms include uncontrolled glycemia and dehydration. DKA and HHS are treated by body hydration, maintenance of electrolyte balance, and patient monitoring (Kitabchi et. al, 2009). Other treatment remedies include fluid therapy, insulin therapy, bicarbonate therapy, phosphate as well as potassium replacement.
Chronic Care Model
One of the approaches applied in the management of diabetes is the Chronic Care Model (CCM). It is applied in primary care settings. The model promotes evidence-based changes in the health care system in order to cater to the needs of diabetics. The main aim of the model is to facilitate the availability of health information through community-based initiatives. CCM has two main goals. First, to equip patients with self-management skills, and second, to monitor the progress of patients to enhance the attainment of positive health outcomes (Dipnarine et. al, 2013). This is achieved by restructuring medical care and giving patients the freedom to develop personal plans for diabetes management. CCM comprises six major components. They include patient empowerment through learning, organization of health care, professional support, coordination of care processes, monitoring patient progress, and improvement and application of community resources as well as policies (Dipnarine et. al, 2013). According to the model, self-management education (DSME) is effective in improving the psychosocial and clinical outcomes of diabetic individuals.
Nurses teach individuals about important topics like compliance to medication plans, foot care, setting goals, and ways of interpreting laboratory results (Dipnarine et. al, 2013). In self-management support, clinicians make follow-up calls in order to determine whether patients progress in achieving their goals. Self-management practices include personal care, physical exercise, and regulation of metabolic process through measurement of blood pressure and levels of glucose in the body (Dipnarine et. al, 2013). One of the most important aspects of self-management support is effective communication. Effective communication between patients and nurses gives assurance that medical help is readily available when needed. The CCM approach integrates personal management practices and professional care. It gives patients the freedom to develop and implement personal plans of management with the help of nurses and medical professionals. In the CCM approach, the role of the nurse is to facilitate patient learning and empowerment, provide guidance to patients with regard to effective ways of implementing evidence-based care, track patients’ progress, and coordinate care processes to guarantee the attainment of desired health outcomes (Dipnarine et. al, 2013). In addition, nurses provide support services such as foot and medical examinations for patients who are at risk of developing complications due to errors in the implementation of the personal management program.
Perception and barriers to diabetes management
A factor that affects effective management of diabetes is the patient’s perception, which can be either positive or negative. The perception of diabetes among adults determines the effectiveness of self-management approaches and community-based initiatives. For instance, a study conducted on 198 Hawaiian adults revealed that many of them felt that diabetes was a hindrance to productive lives because of its negative effects on their lives. The study involved assignment of participants to treatment and focus groups. Each focus group comprised an average of 1 to 7 participants between the ages of 18 and 65. According to participants, the burden of controlling diet, maintaining recommended blood sugar levels and changing certain eating habits affected the quality of their lives. These were the negative effects of diabetes. On the other hand, other adults argued that diabetes had positive impacts on their lives because it made them make healthy food choices and implement lifestyle changes (Fukunaga et. al, 2011). Participants perceived diabetes as a dangerous disease that mainly led to complications such as blindness and amputations.
These perceptions were mainly based on the experiences of family members. Many participants talked about their fear of such complications. However, they did not participate in diabetes management activities. Insufficient understanding of diabetes, as well as negative emotional effects and psychological barriers, are major causes of poor management of diabetes among adults (Fukunaga et. al, 2011). The study also found out that another barrier to effective management of diabetes is health-related factors. For instance, some patients had physical conditions that prevented them from taking part in physical exercise. In addition, side effects of medication and related complications were hindrances to the physical activities of patients (Fukunaga et. al, 2011). Other hindrances to effective management of diabetes include financial challenges, psychological barriers, and time limitations. In order to improve the management of diabetes, it is important to educate patients on effective management practices. The role of nurses is to provide psychological care to patients, social and emotional support, and promote public awareness and education (Fukunaga et. al, 2011). Nurses should provide the support that caters to the physical, emotional, and social needs of patients. The study revealed that many patients were unaware of available methods with regard to diabetes management. Nurses should educate patients and emphasize the efficacy of active prevention methods (Fukunaga et. al, 2011).
Patient education
Patient education is an important aspect of improving diabetes management. According to Tidy (2014), teaching patients about diabetes is imperative for effective management. In the United Kingdom, the government developed two programs namely X-PERT and Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) in order to teach patients how to make lifestyle changes and develop healthy habits (Tidy, 2014). According to studies, many education and self-management programs are not effective. They only help patients to change their beliefs about diabetes. Patient education involves offering dietary advice to patients, encouraging them to engage in physical exercise, teaching them about the benefits of lifestyle changes as well as the importance of early diagnosis (Tidy, 2014). Initial assessment and monitoring of patients are very important. The role of nurses in patient education is to guide patients with regard to healthy lifestyle behaviors and teach them about various complications related to diabetes and ways of avoiding them. In addition, they aid patients in making important decisions that affect their health. Blood pressure management, regulation of blood lipids, eye screening, and monitoring for kidney damage are examples of activities that nurses carry out on patients in order to enhance the management of diabetes (Tidy, 2014). Other aspects of diabetes management include timely illness assessment, referrals, and dietary advice.
Conclusion
Diabetes is a serious illness in the United States. Its prevalence among adults is very high. Statistics reveal that in 2010, more than 25.8 million Americans had diabetes. This number represented 8.3% of the country’s population. Among older people (people over the age of 65 years), the prevalence of diabetes is higher. In this age group, more than 10.9 million people were diagnosed with diabetes in 2010. This number accounted for 10.9% of the population. Effective measures of diabetes management include dietary control, patient education, and physical exercise. Vegan diets have high fiber content, zero cholesterol, and low quantities of saturated fat. Fiber makes individuals feel full and thus helps them reduce the amount of food they consume. Patient education involves offering dietary advice to patients, encouraging them to engage in physical exercise, and teaching them about the benefits of lifestyle changes as well as early diagnosis. Insufficient understanding of diabetes, as well as negative emotional effects and psychological barriers, are major causes of poor management of diabetes among adults.
References
Barnard, N. D., Katcher, H. I., Jenkins, D. J., Cohen, J., & Turner-McGrievy, G. (2009). Vegetarian and Vegan Diets In Type 2 Diabetes Management. Nutrition Reviews, 67(5), 255-263.
Centres for Disease Control and Prevention: Diabetes Research and Statistics (2014). Web.
Dipnarine, K., & Stopka, C., & Stellefson, M. (2013). The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review. Web.
Fukunaga, L., Uehara, D., & Tom, T. (2011, February 15). Perceptions of Diabetes, Barriers to Disease Management and Service Needs: A Focus Group Study of Working Adults with Diabetes in Hawaii. Preventing Chronic Disease, 8(2), 32-46.
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic Crises in Adult Patients with Diabetes. Diabetes Care, 32(7), 1335-1343.
Tidy, D. C. (2013). Management of Type 2 Diabetes.Web.