Health Care: Diabetes and its Management - Essay Example

? HEALTH CARE PART A BACKGROUND OF THE PROBLEM Diabetes in the recent ages has emerged more of a social problem rather a scientific one. America is ahub where diabetes has emerged as an epidemic, since 1980 where this disease has almost doubled and is rising at a very rapid pace. As per the statistics floated by the ‘Centers for Disease Control and Prevention’ almost 21m people in the country are suffering from the ailment and also 54 m population are afflicted with blood sugar levels and are endanger of developing the syndrome in near future. The disease is more prevalent in specific categories namely American Indians, African-Americans and Latinos (Hu & Wallace, 2006). For the past 2,000 years, diabetes has been regarded as one of the most fatal diseases. Many eminent physicians such as Aretaeus explored the ill effects of the disease revealing that diabetes leads to drain of essential body fluids and liquefaction of body flesh through urine. Unfortunately, the physicians couldn’t develop effective treatment for the same. Moving ahead in century’s various recommendations were suggested for diabetes’s cure such as oil of roses, broken red coral etc but all in vain. Then in later 17th century, Dr. Thomas Willis monitored blood sugar level through urine which till 20th century and later remain unchanged and successful method to identify the presence of Diabetes (Sattley, 2008). However in the year 1935, Roger Hinsworth explored the two types of diabetes, one called as "insulin sensitive" or Type I and the other named "insulin insensitive" or Type II. In USA specifically, a marginal amount of people percentage acquires Type 1 disease which arises genetically. Type 2 on the other hand is generally referred to as adult-onset diabetes which is rapidly infusing not only in adults but also among children as well (The Economist, 2007). The cause of rapid rise of Diabetes specifically in regard to America is the rise in obesity levels. Gradually, down the years much new experimentation were carried on in 1995, Metformin which is an oral medication for Type II diabetic patients was finally discovered and approved by FDA for use in US, after which many more successful medications were floated. Even after numerous researches and drug inventions, the problems still remains chronic and increasing at a higher rate than ever before. Educational, psychological, physical, external, psychosocial etc are few of the personal barriers that have constrained the prevention and cure of the menace (Simmons, 2001). Surprising but facts clearly state that USA stands seventh in the list where it is regarded to be one of the worst hit diabetic nation responsible for thousands of death every year due to the widely spreading disease (Online US diabetes magazine, 2007). As of the current status in America, almost 16,600 health care practitioners are certified diabetes educator and the population suffering from the illness is approximately over 24 million people (Brenson, 2010). This clearly reveals that on every 1500 diabetic patients, one CDE is appointed. This is more than just disappointing and situation itself unveils the extent of fissure that exists between the disease and its management. PART B HEALTH PROBLEM AND ITS EVALUATION After analyzing the past statistics of the American people in the last twenty years, it has been found that diabetes has steadily risen to almost 8 percent of the entire population (Wilson, 2010). In few parts of America in specific, almost double the increase in the diabetic patients has been witnessed. Future estimates were forecasted in the year 2004 by the ‘the Centers for Disease Control and Prevention’, according to which out of every seven people, one would be suffering from diabetes, especially in the regions like Alabama and Mississippi (Wilson, 2010). In a research conducted by Venkat Narayan, Edward Gregg, it was found that almost 135 million people in the world were suffering from this lethal disease in the year 1995 and this count is now expected to multiply by approximately 300 million by the coming year 2025. The research particularly pointed out towards the industrialized nations, US being the leader that such countries marked a significant increase in the diabetic patients by almost 42 percent. The causes of such rapid increase were identified such as obesity, physical inactiveness, dietary issues etc. All such factors are quite prominent in US lifestyle and routine pattern. Researches have also pointed out that Diabetes is slowly and steadily becoming a major health concern in US and other parts of the world and transforming into an endemic (McGlynn, Asch, Adams, Keesey, Hicks, DeCristofaro, 2003 : Narayan& Gregg ,2000). In this very study, the overall quality of care imparted to US public was examined thoroughly based on predefined standards of quality. On the whole the study revealed that just half of the suggested and duly advised processes from the practitioners involved care aspects. The large amount of deficits which are been observed in the health care of the massive American public is actually emerging as a situation of distress and disappointment on the whole. In a study conducted amongst 17,937 eligible adults from twelve different cities of the country, only 24 percent of the total diabetic patients confirmed that they actually receive proper health care. This percentage of patients carrying Diabetic history received three or more glycosylated hemoglobin tests over a span of last two years. In a similar study conducted by Saaddine and his peers, also stated the same fact that just 29 percent of the adults who were actually suffering from diabetes and agreed to be an active participant of the ‘Behavioral Risk Factor Surveillance System’ actually got their blood sugar levels tested. There is a huge gap or deficiency in rendering of proper medical aid to people at right time. Routine monitoring processes have to be aggravated as it would certainly help in assessing the effectiveness and efficiency of the treatment advised to the patients. Such kind of discrepancy in the US health system poses immense threats and menace to the U.S public and is an alarming call for both the federal and the private health care systems. Hence, to overcome this problem, abundant information must be floated among the general public with a further implementation of well defined monitoring and control system for quality enhancement. PART C IMPLICATIONS OF THE PROBLEM (SOCIAL, POLITICAL AND ECONOMIC) Diabetes mellitus was once considered to be disease that was casual and considered minor in nature when compared with other chronic diseases that existed, but gradually with the changing times and specifically related with the advent of the 21st century, this disease suddenly transformed itself into a threat not only to the human life but involving other social, political and economic concerns as well. In the last two years, the numbers of cases who have acquired diabetes have suddenly soared; the causes may be due to the changing lifestyle patterns, attitude of people, eating habits, environmental degradation etc. In America, many cities have adopted unique strategies to combat the social threat created by the changing needs of people. For instance, the kind of strategy designed by the government authorities in the region though may not be 100 percent successful, yet are quite beneficial as a creative resolve for the grave problem. The city is considered to be one of the fastest one in the US to perambulate the streets with abundant weighing machines just in order to urge and compel people to watch out their weight and loosen up if necessary. Certainly there is a dire need for countries to address the social and political implications in respect of type 2 diabetes which can be prevented if timely addressed. From economic point of view, changes may be practiced in form of increased taxes on products which are non advantageous for a healthy body. There is a common myth in this dynamic world, where health is considered to be more dependent on individual choices. This myth gets even more inflated when type 2 diabetes is taken into consideration. There have been numerous changes in the society in terms of the work life patterns that is from heavy labor to deskbound computing environment, intense mechanization etc all having serious implication on human health. Such concerns need immediate attention along with an effort to make people aware regarding the ill effects of fast food , absence of physical exercise. Diabetes is a disease that involves long term care which involves mush more than just medication, involvement of caregivers and other practitioners plays an important role. There exist socio-structural factors that generate a large amount of uncertainty and risk especially for the minority sections of the industrialized nation such as US. Proper access to diabetes care, low standard medical interventions, low socio economic status has a deep impact on the behavior and psychological makeup of people that further hinder the prevention and cure of the disease. Another dark perspective of the disease is often reflected on women in specific, who have another lfe within them. This is a threat not only to the individual but also on the unborn child. In us the minorities populations are generally at a high risk of diabetes due to the ever expanding nature of its complexities on account of non availability of proper health conditions and care. Such conditions complicate the worsened conditions as exorbitant cost burdens are added to the existing expenditures. Social and economic issues rise in case of older women who suffer with diabetes and who live alone and are poor as well. Poverty is a concern that aggravates the problem for such people. Diabetes give rise to other chronic diseases which further adds to the economic costs of the country. For instance, diabetes can lead to heart disease, nerve damage, kidney failure, amputation, gradual weakness of eyes turning into permanent blindness a death in few of the cases where proper diagnose and treatment is not imparted. Such implications create economic and social problems for the nation as more Medicare burden is added along with complexities in increased disabilities with low life state and health condition. Social implications involve a difficult situation in terms of following s diabetic diet. Family, care takers and friends may feel offended by the eating habits of the diabetic people. Diabetes restrain and constrain people from participating from social activities and group activities due to a constant need for monitoring and control for blood sugar levels that further leads to stagnation or group isolation. Diabetes further leads to brain impairment and serious memory problems. According to the data revealed by the Mayo Clinic, people suffering from diabetes are more prone to contract Alzheimer’s disease, depression and cognitive impairment. Diabetes is one of the most costly health issues in the country. If the estimated rise in diabetes is actually realized, then by the year 2025, the costs will soar up to 303–559 billion dollars approximately. Statistics reveal that 25 Latin American countries suffer lost production costs which are almost five times more than the direct costs involved in the prevention and cure of diabetes. Families have to bear the brunt as well due to the absence or lack of significant family earnings. Diabetes deteriorates the quality and standard of life of people. In developed in rich countries like USA, insured diabetic people bear 10 – 15 percent of the total medical costs while other 20 percent of the people still have no insurance cover whether private or government, this also gives rise to creation of economic strategies and future cost plans. Political implication is another main hurdle in itself. The race or classes in which the diabetic suffers are found to be the highest is generally the minority group, which generates political disturbances on account their neglect and inferiority treatment. The failure of economic developments projects on ground of racial discriminations give birth to political inequalities. Still there remains a wide scope for developing integrated policies for diabetes education and timely intrusions. Spreading of awareness and education is the key that could lead to a healthy living by introducing government interactions or actions which themselves are grounded with political biasness and vulnerability. PART D CURRENT SOLUTION OF CONTROLLING THE PROBLEM The epidemic in US in form of diabetes which is expected to triple itself by the coming year 2050 needs appropriate solutions through which its rapid growth can be curbed and restricted. The major reason behind its intensification is the ageing of a large amount of US population. A significant number of American people are obese and because the demographic status of the American population, the cultural and lifestyle of people is changing which requires swift and consistent actions for the problem. It is a reason that is responsible for millions of death in the United States that adds up almost $170 billion to the total health care costs of the country. To avoid the same, the first and foremost solution that can be emphasized upon is: Self –Management Every individual needs to be aware about the menace that hovers around and the correct action that one needs to take. Personal barriers in all respects related to diabetic care and management need to be overcome (Coonrod A B, 2001). A healthy lifestyle and self management can certainly raise awareness levels and help in reducing the extent of the problem even if it is a very small percentage of the larger sum. On the other hand diabetic patients who take the onus and responsibility of self management have seriously reported lower HbA1c levels and better health care (Heisler et.al, 2003). Past researches have proven that patient evaluations and personalized health management are not only useful but also facilitate in better understanding and reducing glycemic levels. Promoting Lifestyle and Diabetic Knowledge With the consistent rise of people getting afflicted with diabetes, it becomes essential for the federal authorities as well as private practitioners and NGO’s to create as much awareness as possible among the masses regarding a healthy lifestyle including eating habits, intake of nutritious and low calorie food regular physical activity etc. (Chilton ,2006) To lead a balanced and unstressful life can certainly help in reducing the advent of the chronic illness or can facilitate in increasing the gestation gap to when an individual can acquire such disease gradually with the aging process. People need to be more aware about the consequences through which such illness can be acquired along with its unpleasant consequences in the latter stages of life (Chilton ,2006). Diabetes can be well prevented if proper measures are adopted well in time for which people need to be made watchful and more responsible. Team Diabetes Care Nothing can be achieved in solitude. Past researches have verified and clearly stated that all those people who are supported by a team comprising of primary care physicians, nurses and other specialists are in a better state to overcome and control the illness in comparison to those who are up to themselves only. More participation, active involvement of patients along with non practitioners is a better healing medicine and apt ‘Chronic Care Model’ then just prescription of medication (Rubin, Peyrot, Siminerio, 2006). This is more of an evidence focused practice to control diabetes illness. FEDERAL AND PRIVATE INTERVENTION The US federal and state governments along with the collaborative efforts of private health care experts have been actively involved to develop effective means to control diabetes. The government has taken effective steps in form of running programs such as ‘NDEP - The Federal National Diabetes Education Program (NDEP)’ which is conducted by ‘The National Institutes of Health (NIH) and CDC together (UnitedHealth Group 2010). The primary objective of conducting such program is to extend valuable media support and informative tools and equipment for the effective diabetic care. The federal government tries to render complete support to many states within the nation who take initiatives to promote their creative and result oriented actions and programs against diabetes control and prevention against the onset of the epidemic. The State based program for instance , ‘The Diabetes Prevention and Control Programs (DPCP)’ help in extending all possible support to organizations at national, community and state level in form of required resources and technical guidance. In Utah, special programs were designed to focus upon curbing the lipid and blood glucose level among diabetic patients (UnitedHealth Group 2010).In Texas, a program was organized to educate public, give them proper counseling on self management and control of diabetes (UnitedHealth Group 2010). Other measures which have been implemented include intensification of resources for creating more public awareness, use of predictive analysis that helps in achieving high patient outreach, emphasize on evidence based diabetes care and control, developing effective and new reimbursements policies and models especially for the community based providers, developing attractive incentive programs to encourage voluntary customer participation in health care programs. Organizing network based models targeted for management of complicated and difficult cases (UnitedHealth Group 2010). Health care departments are also making all possible efforts to inducing lifestyle interventions that help in plummeting the probable risks for intensifying diabetes complications and improving overall health of employees. Despite of the numerous plans and action programs organized with the health system for improving and control the current alarming status of the disease, not much success is realized. The major cause for such disappointment is probably due to the fact that most of the health care and prospective cost-saving intrusion strategies rely on deliberate involvement of individuals or people who are likely to get benefitted from it directly or indirectly. However, the irony is the lack of support of people who are hesitant to take responsibility and onus of the same. To some extent social and environmental factors also prove to be one of the most probable hindrances in reducing the ill effects of the scourge. Another major constraint that is faced while implementing the health programs is the exorbitant costs which keep on accelerating, with the rise in the level of complexity. The programs couldn’t achieve 100 percent success due to the costs that keep multiplying and exceed beyond the planned costs including social, economic and other expenditures. What is required at this point of time is a broader action plan with revised health system grounded policies and strategies that focus on controlling pre onset diabetes and diabetes both. PART E PLAN TO REDUCE THE PROBLEM IN OUR SOCIETY/ COSTS ANALYSIS As analyzed above, all the necessary steps for curbing and controlling diabetes have already been initiated by the health experts in collaboration with other organizations, however few of the measures mentioned below can be added to the existing programs for better results. The plan consists of few identified steps that must be carried on for accomplishing broader objectives: Firstly awareness about self management must be spread widely. Generally awareness and self management are handled separately but they need to run parallel. People need to be educated and encouraged for developing interest in self management against the inception of the disease or adopting all possible ways to control it. To achieve the objective, individuals need to know about the healthy diet intake, additional supplements for maintaining high blood sugar levels, increased physical activities such as brisk walks etc. Hence effective counseling need to be made available to extend behavioral support in areas such as weight loss, enhanced glucose metabolism, reduced lipid levels, and maintaining blood pressure. Secondly, before curing the existing illness it is important to curb its growth. Hence Reversing Prediabetes is an essential element to control menace right at the point of its inception thus priority must be given to those plans that aim to control the growth of diabetes right at its introductory stage. Statistics reveal that 7 percent of the American population is at the verge of contradicting diabetes which can be well controlled. This is a significant portion that can really change the worsened scenario into something constructive. Thirdly Incentive Plans must be given due consideration at all levels as people awareness and their willingness to come forward and fight against the health peril is of vital importance. People need to be urged to actively participate in the wellness programs. For this employers can play an imperative role by offering a series of incentives comprising of cash vouchers, gifts, insurance, health savings account, and rewards etc to their employees for active involvement in wellness programs for their individual health betterment and of others as well. Participation in health campaigns, theatre education etc can be some creative ways where general public can be involved in overcoming a huge health concern. Fourthly, intervention becomes important to help avert the succession from prediabetes to diabetes stage. When public becomes more responsible, at least people endangering prediabetes can be helped curing it before it reaches the incurable phase. Past researches have proved that Type 2 diabetes can be cured and prevented if proper diet is followed along with a well balanced lifestyle (The New England Journal of Medicine 2002). Similar facts were proven in a study conducted by The Finnish Diabetes Prevention Group in the year 2001 which confirmed that transformation of prediabetes into diabetes was reduced by a massive extent of 58 percent due to the intrusion of ‘lifestyle intervention group’. Fifthly are the proper and timely diagnosed diabetes and its constant monitoring and control. It is seen that people suffering from the acute problem often visit the doctor and spend a huge amount of money on hospitalization and medicines when compared with people who are non sufferers. Thus, timely detection of the disease is important to avoid the unnecessary costs which certainly can be reduced if not completely avoided. Personalized counseling to patients regarding self management, diet, self monitoring can further reduce the hospital expenditures incurred by individuals and help in better disease management. Both clinical and economic gains can be derived if such approach is undertaken. For instance, a well designed plan or strategy including measures for proper glucose or blood sugar control, even a marginal drop in A1c blood levels can actually reduce the other organ failure risks by almost 40 percent. Similarly a reduction of 10 mm Hg in the blood pressure level can further help in mitigating the complication levels by at least 12 percent (Steven, 2010). The economic costs that was incurred almost a decade back in curing the critical illness was almost $132 billion, but looking ahead in the coming years the costs would certain multiply manifolds and authorities need to make necessary arrangements for them (Steven, 2010).. If human costs and social costs are considered, then lots of human lives are at stake. Diabetes give rise to further critical ailments such as heart strokes, blindness, kidney failure etc. the statistics revealed by the ‘ National Institute for Mental Health’ revealed that diabetic patients are more prone to depression when compared with others. It is seen that in a commercially secured percentage of people, the total yearly cost for diabetes management arises between $8,000 and $12,000 that excludes the prescription cost. In the past year 2009, a patient who approached and took advice from health experts and proper health care system incurred roughly $11,700 to the person who did not benefit from the above facility and spent $4,400. Moreover, a diabetic history patient involving too many complications spent another $20,700 per year when compared to a non-complicated diabetic history case $7,800 as the annual charge for disease management (Steven, 2010). Such costs would certainly tend to grow in coming years due to increased cost of living as well as treatment as well. Generating human awareness, uplifting the standard of living of poor and underprivileged people, holding campaigns and other means to support people at large, all requires heavy social and economic cost. CONCLUSION USA to combat the peril of diabetes needs to put into action a proper disease management strategy and policy which is future oriented and that mainly aims to extend help to the those sections of society who are under privileged or lack adequate knowledge to fight the problem. Not only government intervention, but collaboration of private practitioners, NGO’s , volunteers are also required. REFERENCES Brenson, G. (2010). The Role of Disease Management in Diabetes Care. Diabetes Spectrum Volume 23, Number 2, 2010. Retrieved from http://spectrum.diabetesjournals.org/content/23/2/116.full.pdf Centers for Disease Control and Prevention. (2007) National Diabetes Fact Sheet, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. [Assessed on 2nd Dec, 2011]. Retrieved from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf Coonrod ,A. B. ( 2001). 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