The Treatment and Management of Diabetes Essay

Introduction

For centuries, medical scientists have been developing various interventions in a bid to treat and manage diabetes among the population. Nutrition and lifestyle interventions are part of interventions that have proved to be effective in the treatment and management of diabetes. According to Delahanty (2010), nutrition and lifestyle interventions are current therapies for diabetes because they “have been a critical component in three of the four largest clinical trials that focused on diabetes in the past two decades” (p. 360).

The three major clinical trials involving diabetes are Diabetes Control and Complications Trial 1983-1993 (DCCT), Diabetes Prevention Program 1996-2001 (DPP), and Action for Health in Diabetes 2001-2012 (Look AHEAD Trial). These clinical trials confirmed that nutrition and lifestyle interventions play a central role in the treatment and management of diabetes; type I and type II diabetes mellitus. Therefore, this essay examines the findings of the three clinical trials that are relevant in the treatment and management of diabetes, as nursing practice.

Diabetes Control and Complication Trial

The DCCT trial entailed diabetic patients with type I diabetes who volunteered for the study. The clinical trial randomly assigned participants who volunteered for the study to conventional and intensive therapies. Conventional therapy is aimed at helping diabetic patients to measure their glucose levels in blood and urine while attending their clinics after every three months. Comparatively, the intensive therapy required the diabetic patients to measure their glucose levels in the blood and urine regularly while attending their clinics monthly. Both patients under conventional and intensive therapies received similar dietary counseling.

When planning a diet for diabetic patients, “insulin doses were first matched with a consistent diet, and the dieticians taught participants how to adjust insulin for variations in food intake and activity level” (Delahanty, 2010, p. 362). During the progress of the clinical trial, it was evident that intensive therapy with nutrition has a significant impact on the treatment and management of diabetes.

The findings of the DCCT show that there is a marked difference between conventional and intensive therapy. Delahanty (2010) states that “intensive therapy achieved a stable HbA1c by approximately 7.2% versus 9.1% with conventional treatment” (p. 362). Such reduction in HbA1c has significant benefits because it reduced the risk of developing retinopathy by 76% and progression of diabetes by 54%. Moreover, the reduction in HbA1c decreased the risk of developing microalbuminuria by about 30-60%. In this view, the DCCT proved that medical nutrition therapy is important in maintaining blood glucose levels, achieving HbA1c targets, and minimizing weight gain.

Diabetes Prevention Program

DPP intervention focused on patients with diabetes type II. The clinical trial aimed at determining whether 150 minutes of physical activity would help diabetic patients reduce their weights by 7%, and thus prevent or delay the occurrence of type II diabetes (Delahanty, 2010). To achieve this, DPP randomly assigned 3000 patients to three groups, namely, metformin, placebo, and lifestyle intervention groups.

Patients in the three groups underwent regular assessment after every three months, where they received their respective counseling about treatments. As case managers, the dietitians “scheduled quarterly outcome assessment visits within the appropriate time windows, reported and documented adverse events, reviewed their participants’ progress with lifestyle goals at weekly team meetings” (Delahanty, 2010, p.366). Throughout the clinical trial, dietitians assessed the impact of physical activity on the prevention, treatment, and management of diabetes type II.

The findings of DPP intervention indicate that modification of diet and physical activity are critical in preventing the development of type II diabetes among the predisposed population, or in delaying its progression among the diabetic population. According to Delahanty (2010), “the lifestyle intervention decreased the development of diabetes by 58% compared to placebo,” while metformin decreased its development by 31% (p. 366).

Moreover, the findings indicate that lifestyle intervention is very effective among older patients and the ones with low body mass index when compared to metformin intervention. Overall, lifestyle intervention of physical activity led to weight reduction, which ultimately reduced the risk of diabetes by 71% among older patients.

Look AHEAD Trial

Look AHEAD trial focused on the impact of intensive lifestyle intervention on patients with diabetes type II. The objective of the Look AHEAD was to “determine the long-term effects of a lifestyle intervention compared to conventional ‘diabetes support and education’ treatment” (Delahanty, 2010, p. 367). The Look AHEAD intervention entailed modification of diet and incorporation of physical exercise in the management of diabetes among patients.

The evidence obtained indicates that the Look AHEAD intervention is the most effective intervention when compared to the DCCT and DPP interventions. The Look AHEAD intervention has a two-fold effect in the treatment and management of diabetes because it reduced HbA1c levels and enhances weight loss. The findings of the study are relevant in nursing, because, nurses can utilize them in aiding diabetic patients to make informed decisions regarding the nature of the diet and physical activity, which are appropriate in the management of diabetes.

Conclusion

The DCCT, the DPP, and the Look AHEAD are three interventions, which have proved that nutrition and physical activity are central in the treatment and management of diabetes among the population. The DCCT intervention aims at aiding a diabetic patient to understand how to manage body weight and blood glucose levels. Moreover, the aim of DPP and Look AHEAD interventions is to help a diabetic patient manage own body weight and maintain normal glucose levels in the blood. Overall, the three interventions show that dietitians have a noble role in offering lifestyle and nutritional interventions, which prevent the development and progression of diabetes in the population.

Reference

Delahanty, L. M. (2010). Research charting a course for evidence-based clinical diabetic practice in diabetes. Journal of Human Nutrition and Dietetics, 23(4), 360-370.