Challenges of Diabetes Mellitus: Empowerment, Health and Wellbeing

---

Introduction

The World Health Organization (WHO) has attributed 35 million deaths totalling to about 60% every year to non communicable diseases such as cardiovascular diseases, chronic respiratory diseases, cancer and diabetes. Diabetes is one of those dubbed as the world's leading killer diseases today, having caused about 1.3 million deaths with global prevalence of 10% among adults aged 25 years and above in 2008 (World Health Organization, 2008). "Diabetes is a chronic, debilitating and costly disease associated with severe complications, which poses severe risks for families, Member States and the entire world and serious challenges to the achievement of internationally agreed development goals, including the Millennium Development Goals."(UN Resolution 61/225).

So global is the diabetes epidemic that November 14th is celebrated annually as the World's Diabetes Day. An International Diabetes Federation was also founded, with memberships from over 160 countries with an aim of uniting to advocate for better policies for diabetic patients in one voice. During the last diabetes day, celebrated on November 14, 2012, the Federation estimated that about 371 million people have diabetes globally (Lorenzo, 2012). The figures have been projected to increase by 2015 if proper measures will not be fully implemented to avert the rate of these increasing Non-Communicable Diseases, diabetes included.

Diabetes, portrayed by high levels of sugar in the blood, has also been cited as a leading cause of heart attacks and strokes among adults. The World Health Organization categorizes diabetes into two groups; type diabetes that is prevalent among adolescent and children and the type II diabetes that is highly prevalent among adults and the most common affecting a higher population globally (World Health Organization, 2008). The Centre for Disease Control (CDC) established that as of 2010 8.3% equivalent to 25.8 million of the global population had diabetes. Among this population, 1.9 million cases were for those aged 20 years and above Centre for Disease Control (2010). Diabetes type 2 is rapidly wide spreading and a cause for alarm due to the increased number of people affected and the mortality rates Gerstein and Hayness (2010). A research done by the Diabetes Mellitus Interagency Coordinating Committee within the United States in 2010 revealed that the marginal groups characterized by race and ethnicity, who also fall in the category of lower socioeconomically group, were at higher risks of developing diabetes type 2 compared to their non-Hispanic counterparts Taylor, M. C. (2008).

Diabetes patients are dealt with using an incorporated activity of primary care teams offered by both clinical and non-clinical. Researchers have developed proper guidelines for Evidence-based practice for to enable organizations curb and manage. Documentation highlighting the advantages of conducting certain activities like controlling cardiovascular and glucose risk factors indicate that by adopting the multi-factorial approach in care, the mortality in type II diabetes will decrease by about half. The globally recognized signs and symptoms of diabetes include: frequent urination intervals, massive weight loss and increased hunger/appetite leading to kidney failures, blindness, impotence, strokes or even heart attacks. It is unfortunate that the epidemic is rarely detected at the initial stages of development among those who suffer from it, until at a later stage when it has caused damages within the body organs (International Diabetes Federation, 2008). This paper will focus on the challenges of diabetes mellitus in terms of empowerment, wellness and health management.

Management of diabetes

Diabetic patients are faced with various health and psychological challenges. It causes damages to patients and for some; it can ruin their lives and totally paralyze their daily operations at the work place and the family. The World Health Organization stipulates the major reasons for an urgent need of diabetes management as; to relieve off the symptoms, to rectify other health complications and costs incurred in treatment of diabetes, to prevent long term complications that could emerge and for the overall improvement of life’s quality and levels of productivity in the society (Alwan 1994). Among the bio psychosocial impacts that are caused by diabetes include the; Diabetic Ketoacidosis (DKA), retinopathy, erectile dysfunction and hyperosmolar. DKA condition occurs when the amount of insulin in the body has reduced. This condition is dangerous to the life of a patient because it causes excess ketones in the body that eventually lead to metabolic acidosis. Retinopathy destroys the blood vessels of the eye and may cause blindness. Erectile dysfunction mostly affects the male diabetic patients and can destabilize their relationships. Hyperosmolar may cause increased mortality (Niswender 2009). Another condition that comes along is hypoglycaemia, following imbalances between the insulin and carbohydrate in the body, causing mixed feelings of weakness, faintness and tiredness (Samreen 2009).

The cost of diabetes treatment is almost catastrophic in that it can drain an individual's resources and financial savings hence affecting even the family members. The household incomes become strained as very little or no financial securities maybe left for investment. Townsend et al (2005, p.16) have observed that the costs needed to take care of diabetes patients keep varying and type II treatment accounts for about 3% to 6% of the overall expenditures used in the health care sectors of eight developed countries in Europe. For instance, 10 million diabetic patients in these countries of Europe spend 20 billion Euros. Another challenge is the lack of proper documentation for the indirect costs incurred during diabetes treatment. Diabetes also affects a productive age group in a country's population thus stifling economic growth and development, as people's production at the workplace is affected. Healthcare stakeholders have strived to develop measures that could be used to curb the rising cases of diabetes. Diabetes treatment objectives are meant to avert further health complications and challenges that come with the disease. These treatment measures are also meant to prevent minor complications that may develop at later stages in the life of the patient, prevent death rates and help those affected lead health lifestyles. Striving to have hypoglycaemia under control is likely to reduce the occurrence chances of other complications related to micro vascular. Other healthcare arrangements can also be made to enhance the management of wounds, eye and foot care and the pain that is neuropathic in nature (McIntosh 2007). Steve et al (2003) notes that diabetes management measures hence be implemented to ensure the conditions are manageable. The components of diabetes management could be in the form of; well maintained body weight, a monitored intake of carbohydrate foods, proper nutrition and diet analysis

.Body weight control

Research has indicated that most diabetic cases are correlated with obesity. About 80%-90% of diabetic patients who have type II are considered to be overweight. This calls for a static plan of losing the extra fat that forms the body weight because this could be a pointer of uncontrolled glycaemia. Weight loss promotes great levels of glucose control in the body. Diabetic patients should seek the services of a dietician. Monitoring the glucose in blood prevents further complications. Although most diabetic patients fail to take into serious consideration of the monitoring process, self monitoring remains a very critical aspect of control especially for those who use insulin. There are other situations or conditions that may provoke urgent monitoring such as; the increased hypoglycaemia levels, during acute illnesses, fasting periods when no food is consumed, during unstable periods of glucose control and pregnancy period. For older people with glycaemia, symptoms of hypoglycaemia may start manifesting as early as when the blood glucose level is above 4.0mmol/L. Frequent snacks intake may help curb the situation (Rayman and Morton 2010).

Effective body exercise conducted regularly is also another important component of diabetes management. Continued exercises help diabetic patients to cut down excess weight and increase the sensitivity of the tissues in insulin. Regular check-ups to detect any other risks involved in the foot that may result to foot ulcers, commonly associated with diabetic patient, should also be done for early risk detection. These foot examinations must be frequently done by highly trained medical professions like doctors and podiatrists.

Medical treatment of diabetes

Manton and Boogaerts (2005) conducted a case study to analyse the role of nurses in the provision of holistic care management in diabetes affected patients. The study involved a close scrutiny of one of the indigenous male patients that had suffered during the surgery process, from pressure injury and after being discharged fro the hospital where he had been admitted, the community hospital nurses collaborated with the family members of the management to give and support him with home care, that eventually led to his total healing of the wound, despite being diabetic. This is already a strong indication that diabetic patients have the hope of better outcomes in their medical conditions if a holistic approach in primary care can be adapted. The medical case is about an Aboriginal man who was aged 65 years old that suffered from pressure injury thus rushed to a nearby community hospital. His historical medical information indicated that he had Type II diabetes mellitus, kidney disease that was at the end stage level, retinopathy, cerebro vascular accident, peripheral neuropathy and hypertension combined with ischaemic disease of the heart. He had been on medication by taking prescribed medicines like insulin, digoxin, pantoprazole, and aspirin among others. Some supplements of calcium (Caltrate) and paracetamol also been given to him plus other inhibitors of ACE like Coversyl and Carvedilol that serves as a beta blocker. After a period of two weeks, there was feedback that his blood level of glucose had been controlled and he was released from hospital. Nonetheless, the wife collaborated with the nurse who had been assigned to him while at the hospital to consistently administer and monitor his blood levels. By the time the first home visit was conducted, the nurse worked with the patient and family to develop a care management plan. First, a comprehensive assessment that was holistic in nature was carried out holistic through nurse-family collaborations. An assessment of the injury and risks involved was also analysed, and he was supplied with a mattress that relieves pressure, a sheepskin and gel cushion. Through the plan, the nurse and family agreed that preventive protocols will be implemented to maintain the integrity of the wounded skin, he will be protected against forces and friction that may worsen the scenario, he will uphold the tolerance of tissue to pressure, and implement the strategy on managing the wound as prescribed, sustain the balance of moisture, manage bacteria, enhance nutritional foods that promote repairmen of tissues among many others. His family remained supportive by monitoring his daily condition. The roles performed by the nurse in the case study is similar to the findings of Cowley (2005) who notes that the dynamic changing needs of patients have made nurses take on several other roles like finding cases, educating the newly diagnosed diabetes patients, conducting biomedical tests and measuring on going progress. They now have full participation in the prevention, detection, insulin conversion and the overall management of diabetes.

Medications are the most appropriate solutions to the global diabetes challenge and must be used for addressing the following conditions in a diabetic patient; control of glycaemia, hypertension, and dyslipidaemia among others. Worth noting is that too much medication may prove overwhelming to these patients hence the need for effective patients’ drug consumption education. Most patients have also expressed various concerns in this process including possible prescription errors by medical health workers, the high costs incurred in medication and the possible side effects brought about by these drugs (Triplitt 2006). Diabetes patients should embark on consistent medication to prevent further complications. The use of insulin is the most famous medical form of treatment and hence has been used by medical experts to curb the complications in patients. Insulin was initially produced for type I diabetes but has also proved effective in type II management and containment. It has proved beyond a reasonable doubt that it is effective in reducing the glycaemia levels in the body. Basic insulin therapy increases its supply. What makes it different from the other forms of medication is that it has no limit of the expected maximum dose that may result into a therapeutic condition. More doses of this substance, about 1 unit may be required to avoid insulin resistance that mostly occurs in type II diabetes. The only side effect as research has indicated is that insulin is correlates to increase in weight which may again pose a threat to cardiovascular diseases. Insulin has different characteristics regarding the time they take to bring about the effect and in the onset. Some patients may need two injections per day to minimize the production of insulin. Using metformin is another medical prevention of diabetes and research indicate that it is the biguanide that is only found across the globe that lowers the production of glucose that is considered hepatic in insulin. It also reduces hyperglycaemia and weight gain. Research indicates that by consuming metformin, the AIC levels are slightly reduced by about 1 to 2%. It can be used along changes in lifestyles. Certain precautions must hence be taken while using metformin. These include;

1. Terminating its use in times of acute illness that is most likely to cause dehydration.
2. Terminating its consumption when acidosis of the respiratory system is most likely.
3. Avoiding its use for the elderly such as those with over 80 years old.
4. Refrain from using it for about 48 hours both before and after operations involving surgery.

Using Sulfonylureas (SUs) is the third medical alternative of controlling diabetic conditions. It prompts the secretion of insulin and works best in those affected by type II diabetes that are non-obese. During prescription, they can either be given through mono therapy or together with other medical agents. Actual treatment by taking medicines is crucial for diabetes management. Patients must be involved in the management process actively. Lack of information and empowerment of diabetes has also been a challenge towards the management of diabetes because it results to a poor understanding of the patient. Another obstacle to managing the diabetic epidemic has been the level of drugs intake by the affected patients. It is impossible for their health to improve without medication.

Other Interventions

In addition to the above mentioned methods, diabetes could also be curbed using both primary and secondary intervention measures. These measures are developed using evidence based research approaches that inform the policy formulation processes. Professionals in the health sector are gradually adapting to the Evidence Based Practice (EBP) as one of the best approaches to deal with their patients. The Evidence Based Practice in simple terms means the use of current available best evidence to inform the decision making process of health patients (Mary and Hellen McCutcheon 2010). Another health researcher, Montori argues that the EBP is not only a convenience but has become a necessary tool in the process of refining clinical information to the patient Montori, V. M. (2007). This approach has previously been used in diabetes treatment, which is a globally increasing Non Communicable Disease (NCD). A research done by the Diabetes Mellitus Interagency Coordinating Committee within the United States in 2010 revealed that the marginal groups characterized by race and ethnicity, who also fall in the category of lower socioeconomically group, were at higher risks of developing diabetes type 2 compared to their non-Hispanic counterparts Taylor, M. C. (2008). Diabetes patients are dealt with using an incorporated activity of primary care teams offered by both clinical and non-clinical. Researchers have developed proper guidelines for Evidence-based practice for to enable organizations curb and manage. Documentation highlighting the advantages of conducting certain activities like controlling cardiovascular and glucose risk factors indicate that by adopting the multi-factorial approach in care, the mortality in type II diabetes will decrease by about half. Primary interventions are for those already having the disease while secondary are for those who are not infected. To begin with, laboratory screening and diagnosis is very vital to estimate the disease severity and analyze the appropriate measure response (Hofmann and Del 2009). Countries have adopted national medical screening of citizens to promote early diabetes detections. Other nations like the USA, Russia among others have adopted the Federal Laws on Diabetes that have outlines the rights and protections of all those with diabetes. Research and development have been the key strategies used by countries to combat the spread of diabetes. Scientists and other researchers have invested in conducting research on the development of the diabetes control and preventive measures (Kelly 2001). These have included research analysis on health policies that have helped the government to make evidence based policy formulations. Australia has adopted strong systems for diabetes surveillance. This involves a continuous process of gathering, analyzing and evaluating diabetes data among the Australian population than disseminating the research findings to the government, who are the policy makers and other health development partners to help inform their decision making processes.

Other nursing interventions being implemented by governments include the training, capacity building and development of community health workers on diabetes, who then use the knowledge and skills acquired on the epidemic to enlighten the other citizens in local communities, especially in rural areas. Countries may also work hand in hand with the Commonwealth communities to develop global accreditations standards of providing education and information on diabetes to empower the masses. Actions points outlining diabetes preventive measures were developed and adopted as the UN resolutions on World Diabetes Day in 2006 on December 20th during the 61st session of the United Nations' General. These included but not limited to: early diabetes detection strategies, promoting healthy lifestyles through improving diets to balanced diets, regular physical exercises to combat obesity, guaranteed medical care for diabetic patients, improvement to quality and affordable healthcare, creation of regional diabetic centres and strengthening the exiting legislation on non communicable disease management and treatment. The United Nations called on governments across the globe to work with healthcare stakeholders in their countries to create more awareness of the diabetes epidemic (DMICC 2010).

Diabetes health promotion

Healthcare professionals have observed that the best way to promote health messages is through mobilizing people to spread by word of mouth on the good health practices to promote health education. Warning diabetic patients on the possible effects of unhealthy lifestyles may also help in curbing the disease prevalence rate. Nurses have been very effective as health promoters due to their daily interactions and the trust bestowed upon them by their patients. Nurses using theories of psychology and working closely with the family members of the diabetic patient increases the levels of adherence and encourages the patient giving them a form of inward satisfaction (NHS Scotland 2010). Nurses could use polite approaches to advocate for behaviour change among patients by advising them to; quit smoking, make efforts to reduce their weights, do more physical exercises, reduce the drinking rates, and improve their diets by consuming more vegetables and fruits. Such health messages could be shared to clients in the form of light jokes, sympathetic messages or through discussions with the patients involving the questions and answer system. (Delamater 2006) challenges the health workers to lead by example in effecting behaviour change in patients. It is dangerous to assume that patients will bear the responsibilities regarding their decision making processes as most of them look up to medical workers as role models, who are expected to give direction through their actions in line with the health requirements.

Patient-Centred Approach in Diabetes management

Having a patient centred approach is the best strategy to achieve behaviour change as it promotes collaborative efforts in diabetes medical interventions. It is worth noting that the health sector is gradually transforming its mode of operation. Today, a patient is a significant stakeholder and a consumer of the healthcare products and services thus his/her involvement in the decision making process is critical. The situation is different from the previous years where a doctor or a medical professional was the only expert, who knew it all and whose decision was final without any resentment or challenges from the patient. Being health consumers, diabetic patients have an equal say and rights just like commercial consumers of manufactured goods and make conscious choices on their desired health providers. This system of designing health programs with patients in mind is the patient-centred approach. The Institute of medicine defines a patient centred approach as an overall healthcare system that seeks to involve, and enhance partnership among all medical practitioners including; the actual patients and their family members in decision making to capture the needs of the patients. It also supports the empowerment of these patients towards knowing their rights and roles in making health oriented decisions (Common Wealth Health Fund 2012).

Health workers should have the goal of improving supportive diabetic patient centred care and healthcare decision-making regarding their modes of treatment and the way of life. A patient-centred approach improves the safety and quality of the diabetic medication management. This involves redesigning diabetic health promotions and wellness programs to be a patient-centred health programs and adapt to both the internal and external factors. Implementation at the organizational and system levels will determine the diabetic patient approach success (Mary Courtney & Hellen McCutcheon 2010). At the organizational level, the capacity of the program is increased to enhance internal factors such as developing the effective leadership through trainings in methods and importance of quality diabetic health improvement. Changes at the system include creating public awareness by using education and engaging with the diabetic patients to get them empowered (Shaller 2007). Other internal and external factors that determine the transformation process towards a diabetic patient centred approach include effective leadership from the health workers who must get committed towards achieving the approach. Involvement and consultations with diabetic patients and their families should occur at various levels. Feedback monitoring and evaluation to improve and analyze the impact of the intervention is also critical in the process (Shaller 2007).

Redesigning the program to be patient centred is an uphill task as several challenges suffice. The first issue is in regards to the health workers’ motivation towards adapting the idea. Most health workers believe that due to their academic qualifications and working experiences, they are better informed than the diabetic patients and are in better positions to make the best decisions on their behalf. These health workers strive to maintain the medical status quo by dominating and representing the interests of the diabetic patients. Medical paternalism then takes centre stage at the expense of the diabetic patients’ interests. Time is also another barrier in this process as initial research must be done for sufficient data collection, consultations with all stakeholders involved, data analysis, decision making and agreements (Dun 2013). Despite the fact that a diabetic patient centred approach mostly involves face-face interactions among the providers and patients, the impact of technology in implementing this approach cannot be undermined. Health organizations must strive to invest in technological processes that will further propel the approach initiatives. Technology plays a significant role because it enhances communication activities among diabetic patients, their family members and medical health workers. If well applied in hospitals, technology has the potential of increasing the diabetic patients’ family members support and their continuity of care through sending to patients electronic messages of encouragement, storage and transfer of medical records via the internet (Plantree and Picker Institute 2008). This patient approach method according to (Marwan 2011) should seek to remind diabetic patients on the most critical steps they should take like:

1. Getting empowered through public education on their choice of drug and self monitoring.
2. Taking note of the signs and symptoms of complications related to diabetes.
3. Taking note on instructions given on drugs and medication processes.
4. The most appropriate lifestyle that will prevent more complications.
5. The need for frequent check-ups to detect any dangers

Self management initiatives have proved very effective in diabetes management. This include adapting those types of interventions that strongly advocates for diabetic patients to lead healthy lifestyles and eventually avert further development of the disease from one stage to another. Such self management initiatives help in curbing glycaemia. The high levels of depression suffered more by diabetic patients have been a barrier to the implementation of these self management initiatives. Researchers note that the situation is even worse for minority groups who have the rates of depression at least two times more than the normal people (Gerstein 2001).

Conclusion

Diabetes remains to be a global epidemic as the prevalence rates have been projected to increase even further in the near future. Countries, especially those that are developing have faced various challenges in curbing this disease due to lack of enough resources to carter for the high costs of treatment, lack of proper documented information and evidence based research findings to inform policy making by governments. The lack of poor leadership also prevents the effective implementations of diabetes healthcare services. This has resulted into a global disease burden as health expenditures have increased tremendously because more money is invested in treatment. This calls for the efforts to prevent the prevalence rates of the disease by every person. The earlier the interventions are made, the better as risks are minimized. The various challenges that are currently faced by health workers and diabetic patients include; making maximum use of existing initiatives and therapies to maintain a constant flow of blood and liquids. Creating and increasing patient awareness on their rights and role in diabetes management has also been a great barrier (Victorian, Government 2007). Developing concrete adherence of patients to healthy lifestyles and other required interventions, and finally improving how health care services are delivered by community health workers especially to those with non communicable diseases like diabetes. (Delamater 2006) advices that it is critical to have an understanding on the reasons that promote non-adherence. It is important to put in mind several factors like the demographics, social factors and the medical systems of medical providers. The overall management calls for the collaboration of all stake holders involved to control the spread of diabetes through the various means discussed in this essay.