Assignment: Type II Diabetes Mellitus

Assignment: Type II Diabetes Mellitus

Assignment: Type II Diabetes Mellitus

Construct a background and significance on a specific disorder (your choice) within the adult body system that has been discussed this semester.
Select and define a specific adult disorder that has been discussed this semester.
Analyze a statistical description of the disorder’s effects on the adult patient population (eg. prevalence, incidence, etc. in your responses)

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Review how the disorder affects the United States healthcare.
Formulate strategies adapted by the nurse practitioner (NP) to design, coordinate and evaluate adult patients with the chosen disorder to improve healthcare outcomes.
Must be 6 pages, including the title page and reference page. Must use 5 peer-reviewed current scholarly references within the last 5 years.

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Type II Diabetes Mellitus

            Diabetes is a chronic condition caused by a deficiency of insulin or poor response of tissues to the presence of insulin (what is called insulin resistance). Type II diabetes mellitus is the variety of the condition that normally affects people in later life as opposed to when they are still children. Type II DM is basically a lifestyle disease or condition that one gets predisposed to by having lifestyle factors present in a context of genetic predisposition. These lifestyle factors include poor diet and a sedentary lifestyle with no exercise leading to overweight and obesity (Hammer & McPhee, 2018). To definitively diagnose type II DM the clinician orders for the HbA1c or glycated hemoglobin test. The test measures the percentage of erythrocytes that are coated with glucose within the past two to three months. Around the world including in the United States (US), type II DM is a major lifestyle disease responsible for major complications such as kidney failure that eventually lead to premature death. The purpose of this paper is to discuss type II DM in terms of its significance and implications especially in the US.

Background and Significance

            A sedentary lifestyle that leads to overweight and obesity are the perfect setting that encourages the development of insulin resistance and type II DM. Usually, the patient is a person that eats very little if any fresh fruits and vegetables. Often, they consume a lot of junk foods and carbohydrates with a lot of calories in them. Unfortunately, since they do not engage in any form of exercise the calories are stored in the body leading to overweight and obesity. Insulin resistance and obesity occur together with other pathological ingredients in a condition known as metabolic syndrome. The World Health Organization (WHO) states that a sedentary lifestyle (lack of exercise) is a single most important cause of disability and mortality worldwide. The lack of physical activity and its resultant obesity are therefore responsible for the increasing incidence of type II DM in the US and around the world (Najafipour et al., 2017).

Incidence and Prevalence of Type II DM Globally

            The global prevalence of type II DM is 6059 cases per 100,000 persons. According to the 2017 global epidemiology statistics, this translates to 6.28% of the total global population. In other words, about 462 million people in the world have type II diabetes across all age groups beginning in adolescence (Khan et al., 2020). When split in terms of age groups, the above prevalence turns out as follows: 15-49 years (4.4%), 50-69 years (15%), and 70 years and above (22%). These are sobering statistics according to Khan et al. (2020). As a matter of fact, an annual mortality of a million people is attributable to DM according to the authors. They also project that the global prevalence of type II DM is set to rise to 7079 persons per 100,000 people by the year 2030. The incidence of type II DM in 2018 was 6.9 adults per 1,000 persons.

Complications of Type II DM   

            Type II diabetes mellitus has some very serious complications that will increase the disease burden and the rate of mortality. These complications can be classified as short-term and long-term. The short-term complications are low blood glucose levels or hypoglycemia; and hyperosmolar hyperglycemic non-ketotic syndrome. On the other hand, the long-term complications are diabetic nephropathy or kidney disease, diabetic neuropathy, diabetic retinopathy, and macrovascular complications (Hammer & McPhee, 2018). All these complications happen quicker if the diabetes is poorly controlled and the patient continues with a sedentary lifestyle and poor dietary choices.

            The damage to the small blood vessels by consistently high blood sugar levels is referred to as microvascular complications and it is what encompasses retinopathy, nephropathy, and neuropathy (Hammer & McPhee, 2018). Retinopathy is the effect that the chronic high blood glucose has on the retina. This leads to problems with eyesight later on in life, with a possibility of cataracts and even complete loss of sight. Nephropathy is the damage to the small blood vessels in the glomerulus and parenchyma of the kidneys. If the DM is not well controlled, eventually the person develops irreversible kidney failure and will require dialysis or kidney transplantation. Then there is diabetic neuropathy that refers to the effect the chronic high blood sugar has on the nerves. The nerves get affected over the long term such that the person cannot feel pain anymore in the extremities. This especially happens with the feet and that is why they do not notice when they get hurt there and end up developing diabetic foot.  

            The most important macrovascular complication of diabetes is its effect on the large blood vessels. What happens is that diabetes normally coexists together with high blood pressure. With their combined effects, they encourage the formation of atheromatous plaques in the arteries including those of the heart (coronary arteries). With time and with no exercise and a poor diet, these arteries get occluded and angina develops. If nothing is done the occlusion of the coronary arteries worsens and leads to myocardial infarction or heart attack (Hammer & McPhee, 2018). When the plaques are formed in the arteries of the brain, the result is stroke and can affect any part or side of the brain.

How the Disorder Affects the US Healthcare System

            The main effect on the US healthcare system of type II diabetes is that the chronic nature makes access and affordability of healthcare difficult for many. The healthcare system in the US is arguably the most expensive in the developed world (Sultz & Kroth, 2018). This is partly because it is run on a capitalistic basis like a business by the private sector. The other reason is that the US does not really have Universal Health Coverage (UHC) comparable to the National Health Service (NHS) of the United Kingdom. The Patient Protection and Affordable Health Act (ACA 2010) has made some progress in achieving affordability and cost-effectiveness for the poor and vulnerable but a lot still needs to be done (Kominski et al., 2017). The Centers for Medicare and Medicaid Services (CMS) is also helping but this is still not enough leading to a significant disease burden and mortality of type II diabetes in the US. What is needed is a single-payer system that will actualize the dream of UHC in the United States (Cai et al., 2020).

Design: Applicable Care Plan Design for Type II Diabetes Mellitus

1. Nurse Practitioner Guidelines

            The guidelines by the United States Preventive Services Task Force (USPSTF) on type II diabetes for the nurse practitioner (NP) are that every adult between the ages of 35 to 70 years should be screened for diabetes. This is especially true if they are overweight or obese (USPSTF, 2021). The rationale is that overweight and obesity are the leading risk factors for the development of type II diabetes mellitus. The other recommendation by the USPSTF is that the NP should start those that have been found with type II DM on lifestyle measures first (Rao et al., 2020). That means exercise and diet alone without medications. It is only after these on their own fail to bring the desired results that oral hypoglycemics can be added to the regime.  

1. Overview of the Plan of Care by the Nurse Practitioner

            The plan of care by the nurse practitioner will be about prevention basically. Screening is one of the most important elements of secondary prevention and that is what the NP will focus on doing. A community diagnosis of overweight and obesity will be a good starting punt from where initiatives for mass screening within the community will be planned. For those that will be found in pre-diabetes or with type I diabetes already, they will be put on lifestyle strategies that include exercise (aerobic and resistive) as well as dietary control. 

• Sample Plan of Care by the NP for a Patient with Type II DM

A sample plan for a patient with type II DM involves:

• Daily aerobic exercise (such as walking) for 30 minutes for six days in a week.
• Daily consumption of fresh fruits and vegetables
• Avoidance of fatty and oily foods
• Avoidance of sugary sweetened beverages and snacks
• Avoidance of junk foods
• Daily monitoring of blood glucose by a self-monitoring home device.

Coordination: Interprofessional Collaboration and Stakeholders

1. Interprofessional Collaboration

            As the clinician, the NP is well aware that the proper and successful management of a patient with type II DM can only be accomplished through the effort of many disciplines and professionals. There will therefore be need for interprofessional collaboration. The NP will thus encourage this by consulting the physical therapist and the dietician when it comes to the implementation of the lifestyle measures.

1. The Other Healthcare Providers in the Interprofessional Multidisciplinary Team

            The other healthcare professional that will assist the NP in managing the patient with type II DM as stated above will include the dietician and the physical therapist. The other very important professional here will be the social worker. The PT will help with titrating the type of exercise to the patient’s physical condition. The dietician will prescribe the correct calories and diets, while the social worker will visit the patient at home and evaluate what may be the social determinants of health preventing compliance.

Evaluation

            With reference to the USPSTF guidelines, evaluation of progress for these patients with type II diabetes by the NP will involve a number of things or measures. These will include:

1. Continuous monitoring of the blood sugar, preferably by a home device that the patient can use on their own.
2. Continuous monitoring of the body mass index (BMI) to make sure it remains below 25 kg/m². This is the cut-off for overweight with anything above it being overweight or obesity.

            These two outcome measures will be the determinants of evaluation and decision as to whether the lifestyle interventions are being efficacious or not. If not efficacious, the decision will be made to add oral antidiabetic medications to complement the lifestyle measures (Chaudhury et al., 2017). This is what the recommendations of the clinical guidelines advocates for. The lab investigations that will be very useful also in monitoring progress are the HbA1c and fasting blood sugar. There will be need to continue the interprofessional collaboration even as the patient gets controlled and continues to be followed up. This will involve the social worker, the physical therapist, the dietician, and the NP. The reason for this continued collaboration is that if the patient is left to their own devices, they will relax and lapse back into overweight/ obesity with disastrous consequences.

Conclusion

            The condition that is type II diabetes is a global public health concern that requires proper guidelines and planning for it to be managed properly. One of the main elements of proper management is screening that is recommended by the USPSTF. This enables secondary preventive measures to be put in place before complications such as nephropathy, retinopathy, neuropathy, and macrovascular ones arise. The most important leader in this effort is the nurse practitioner. However, they do not work alone and have to be assisted in an interprofessional collaborative arrangement by other disciplines such as the dietician, the physical therapist, and the social worker.

References

Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M., Bertozzi, S., White, J.S., & Kahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLOS Medicine, 17(1), 1-18. https://doi.og/10.1371/journal.pmed.1003013

Chaudhury, A., Duvoor, C., Dendi, V.S.R., Kraleti, S., Chada, A., Ravilla, R., Marco, A., Shekhawat, N.S., Montales, M.T., Kuriakose, K., Sasapu, A., Beebe, A., Patil, N., Musham, C.K., Lohani, G.P., & Mirza, W. (2017). Clinical review of antidiabetic drugs: Implications for type II diabetes mellitus management. Frontiers in Endocrinology, 8(6), 1-12. https://doi.org/10.3389/fendo.2017.00006

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Khan, M.A.B., Hashim, M.J., King, J.K., Govender, R.D., Mustafa, H., & Al Kaabi, J. (2020).  Epidemiology of type 2 diabetes – Global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1), 107-111. https://doi.org/10.2991/jegh.k.191028.001

Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555

Najafipour, F., Mobasseri, M., Yavari, A., Nadrian, H., Aliasgarzadeh, A., Abbasi, N.M, Niafar, M., Gharamaleki, J.H., & Sadra, V. (2017). Effect of regular exercise training on changes in HbA1c, BMI and VO₂ max among patients with type 2 diabetes mellitus: An 8-year trial. BMJ Open Diabetes Research & Care, 5(1), 1-8. http://dx.doi.org/10.1136/bmjdrc-2017-000414 

Rao, A.S., Hegde, S., Pacioretty, L.M., DeBenedetto, J., & Babish, J.G. (2020). Nigella sativa and Trigonella foenum-graecum supplemented chapatis safely improve HbA1c, body weight, waist circumference, blood lipids, and fatty liver in overweight and diabetic subjects: A twelve-week safety and efficacy study. Journal of Medicinal Food. 1-15. https://doi.org/10.1089/jmf.2020.0075 

Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9^th ed. Jones & Bartlett Learning.

United States Preventive Services Task Force [USPSTF] (August 24, 2021). Pre-diabetes and type II diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes