Introduction
According to CDC s’ statistics, more than 25.8 million Americans had diabetes in 2010 (Centers for Disease Control and Prevention, 2014). This number represented 8.3% of the country’s population (Centers 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. The government estimated that the economic cost of diabetes was approximately $174 billion in 2007 (Centers 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 (Centers 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- 20 years and above
According to statistics from the Center 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 (Centers 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 (Centers for Disease Control and Prevention, 2014). Statistics show that diabetes caused an estimated, 71,382 deaths in the year 2007 alone (Centers 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.
Literature Review
Diabetes management measures and approaches include controlled diets, patient education, ability to influence perceptions of patients, participation in physical activities, and self-management. According to Barnard, Katcher, Jenkins, Cohen, & Turner-McGrievy (2009), vegan and vegetarian diets are effective in the management of type II diabetes. These diets control the concentration levels of plasma and glucose in the body. They contain high fiber content, zero cholesterol, and small amounts of saturated fat.
The Chronic Care Model (CCM) applies effectively in the management of diabetes. According to Stelfson, Dipnarine, &Stopka (2013), CCM has two main goals. First, it aims to equip patients with self-management skills. Second, it monitors their progress in order to ensure steady progress toward the improvement of health outcomes.
Factors that affect effective management of diabetes include the perceptions of patients regarding the disease, 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 when patients 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
Dietary regulation is one of the most effective measures used to manage diabetes. According to Barnardet et al (2009), vegetarian and vegan diets are effective in managing diabetes particularly type II diabetes. Low-fat vegan diets are more effective than conventional diabetes diets in glycerin 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). Consumption of diets with low quantities of saturated fat, high amounts of vegetable protein, low amounts of iron, and concentrated intramyocellular lipids aids in glycerin control (Barnard et. al, 2009).
Glycerin 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 glaucoma. On the other hand, HHS’s symptoms include uncontrolled glaucoma 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 (CCM)
CCM applies 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, it equips patients with self-management skills. Second, it monitors the progress of patients in order 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, as well as 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.
CCM model applies a self-management support system. 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. Clinicians make follow-up calls to determine whether patients progress in achieving their goals. 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 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 the 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 example, a study involving 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. 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).
Studies have shown that some patients perceive 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. Eventually, most of them avoided taking part in management practices. 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).
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). It is important to ensure that patients have the right psychological preparation and emotional strength before they engage in 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).
Other hindrances to effective management of diabetes include financial challenges and time limitations. Experts advise that in order to improve the management of diabetes, it is important to educate patients on effective management practices.
Patient education as a management strategy
Patient education is an important aspect of improving diabetes management. According to Tidy (2014), teaching patients about diabetes is imperative for effective management. 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).
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.
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 by nurses.
Conclusion
Diabetes is a serious illness in the United States and its prevalence among adults is very high. The prevalence of diabetes is much higher among older people aged 65 and above. More than 10.9 million people in this age category 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.
Center 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). 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 inAdult Patients with Diabetes.Diabetes Care, 32(7), 1335-1343.
Tidy, D. C. (2013).Management of Type 2 Diabetes. Web.