Type 2 Diabetes Mellitus - Disease Prevalence and Therapeutic Strategies - Case Study Example

Critical Analysis: Type 2 Diabetes Mellitus (T2DM) Student’s Name Institutional Affiliation Introduction According to IDF (the International Diabetes Federation) statistics, the prevalence of type 2 diabetes mellitus, also written as T2DM, epidemic is a worldwide concern. Currently, the disease has affected approximately 246 million people across the globe, with nearly 46% of the total number of affected people persons lying within the age brackets of 40-59 years (Jain & Saraf, 2010). Further, the statistics show that the number of individuals living with the condition will rise to 380 million for the next 20 years if appropriate measures to prevent the disease will not be implemented. Presently, T2DM affects around 5.9% of the adult population in the world with nearly 80% of the entire population in the developing countries. The most affected regions in the world include the Eastern Mediterranean region and Arab countries with 9.2%, as well as the North America with 8.4% of the adult population. However, the disease is more prevalence in the Western Pacific with approximately 67 million people suffering from the T2DM, followed closely by Europe with around 53 million affected persons. (Jain & Saraf, 2010). The objective of the study is to critically analyze type 2 diabetes mellitus, through cross-examination of the underlying concepts, definition of the disease, its prevalence and intervention programs such as physical activity, education, and glucose monitoring programs. Definition of the Type 2 diabetes Mellitus (T2DM) The Type 2 diabetes mellitus (T2DM) is among the widely known chronic diseases that are linked with co-morbidities such as cardiovascular disease, hypertension, obesity and hyperlipidemia which when combined encompass ‘Metabolic Syndrome.' T2DM results from relative insulin deficiency and due to fasting, as well as postprandial hyperglycemia. Hence, if medical attention is not given to the patient, the hyperglycemia may result to macro-vascular, as well as micro-vascular complications that include atherosclerosis, neuropathy, nephropathy and retinopathy. The overall effect of this disease is high morbidity and mortality rates with undesirable effects on the patients, community and families of the affected. Sedentary lifestyles, obesity and diets containing a high percentage of fat content have been identified as some of the risk issues that occurrence of T2DM. Diets with high fat content and obesity stimulate insulin resistance that results to hyperinsulinemia compensatory response towards insulin resistance. Hyperinsulinemia is usually connected with extra gain in weight, which aggravates hyperglycemia and results to continual insulin over-production. Prospective researchers have indicated that insulin action defects at target tissues and secretion of insulin are autonomous Type 2 diabetes mellitus risk factors. However, insulin resistance is usually the earliest identified characteristic of the disease. Disease Prevalence According to the World Health Organization (WHO), 347 million people worldwide currently have diabetes, and more than 80% of diabetes deaths occur in low and middle income countries (Davidson 2000). In 2004, for example, an estimated 3.4 million people died from the consequences of high levels of fasting blood sugar, a statistic that was repeated in 2010 (WHO, 2013). According to the International Diabetes Federation (IDF), there were 382 million people living with diabetes worldwide in 2013, of whom 35 million were from the Middle East and North Africa, 56 million from Europe and 138 million from the Western Pacific countries (IDF, 2013). The IDF also indicated that the prevalence of diabetes is increasing on a daily basis and the number of people living with diabetes worldwide is expected to reach 592 million by 2035. In addition, diabetes in the Middle East and North Africa is expected to undergo an increase of 96.2 % by 2035 compared to Europe, where the incidence of the disease is set to increase by 22.4%, and the Western Pacific, where it will supposedly increase by 46% (IDF, 2013). Thus, the Middle East and North Africa (MENA) are facing significant challenges in the next 22 years as the prevalence of diabetes increases. This increase is driven by a range of factors including rapid economic development and urbanization; changes in lifestyle that have led to reduced levels of physical activity; increased intake of refined carbohydrates; and a rise in obesity (Majeed et al., 2014). For example, in Saudi Arabia, the majority of people have their own maids who prepare their daily meals and carry out all other house-related duties (cleaning, babysitting). In addition, women cannot access outdoor sport activities since they are prohibited from doing so by the local culture. Lastly, there have been changes in the types of food being consumed. So not only will diabetes become more prevalent, the burden of the disease is also expected to increase. To combat the problem, the Gulf Cooperation Council (GCC) is attempting to implement a number of treatment strategies that will minimize the high rate of diabetes and control its prevalence. For example, Saudi Arabia’s Ministry of Health implemented a national plan to combat diabetes. It is accepted that the core problem in relation to diabetes is mainly a lifestyle in GCC countries, but the goal of implementing effective glycaemia control cannot be achieved without competent self-management on the part of patients. In this paper, diabetes always refers to type 2 diabetes mellitus (DMT2), which accounts for 90% of all diabetes cases worldwide (WHO, 2013). The prevalence of type 2 diabetes has increased dramatically in Arabic-speaking countries over the last three decades, a trend that is happening in parallel with increased industrial development. The riches created by oil resources in GCC countries have led to upgraded standards of living, along with accelerated urbanization, extreme changes in nutrition, reduced physical activity and greater reliance on technology. The countries in question are Kuwait, Qatar, Saudi Arabia, Bahrain, Oman and the United Arab Emirates (UAE) (reference 3). There are a number of major risk factors for the onset of diabetes, and also for poor clinical outcomes in diabetes patients after its commencement, namely, genetic predisposition, family history, obesity, hyperglycaemia, hypertension, dyslipidaemia, physical inactivity, ethnicity and environmental factors (Majees, 2014, p. 1). Therapeutic Strategies Education In the majority of included studies, the intervention group received significantly more contact time than the control group, but in only seven studies was contact time reported for both the intervention and control groups. Because contact time was shown to be an important predictor of effect for the intervention group, it is unfortunate that there were not sufficient data to provide adequate power to examine the relationship between the difference in contact time between the control and intervention groups and GHb. This important issue should be addressed in future evaluation studies, either by equalizing contact time between groups (e.g., with a sham counseling intervention), or by reporting contact time for the control and intervention groups and exploring the relationship with outcomes (Susan et al 2002). Further research is needed to better define effective interventions for reducing GHb in persons with diabetes, particularly interventions aimed at long-term maintenance of initial behavior change. This work needs to focus on identifying the predictors and correlates of glycemic control (particularly psychosocial attributes such as depression, social support, and problem-solving skills) and on improving the quality of performance and reporting of DSME intervention studies. This research must provide adequate descriptive information, including demographic data, detailed descriptions of interventions (particularly contact time for both the intervention and control groups), and details of the health care delivery system. Measures of variance should be reported for all outcome measures and DCCT traceable GHb measures used. Allocation must be concealed when randomization is performed, and attention must be paid to minimizing attrition. Target populations must be described and scientifically sampled so that results are generalizable to specific populations (Gary et al. 2003). While considering the current the therapeutic strategies for T2DM, there is a need for scientists involved in developing treatments to consider the environmental, as well as the genetic factors that lead to the prevalence of the disease. There is four setting through which evidence of DSME effectiveness can be of much importance. The four setting include community gathering locations, recreational camps, the worksite, and the home. There is a need review the effectiveness of educating school personnel and co-workers to raise awareness of the diabetes (Christina et al., 2013). The education of adults is much different from the education of children as diabetes is usually of type 2 and type respectively. Therefore, there is a difference in managing of diabetes in children and adults (Gary et al. 2003). There is evidence of self-management strategies where community interventions provides with cultural relevancy benefit, as diverse cultures have diverse learning techniques as addressed in a better way in the community context, and the use of apposite educational styles may incline the acceptance and relevance of the diabetes education. There is a convenience in intervening community gathering locations especially in people living in rural areas so as to promote attendance (Susan et al 2002). The DPP (Diabetes Prevention Programs) have displayed strong evidence that a lifestyle intervention lead weight reduction by 7 percent and increase in physical exercises, in individuals at a higher risk of succumbing to diabetes may prevent the occurrence of obesity and very cost-effective method. Current research in the US have indicated that the Diabetes Prevention Programs as applied in public health have resulted into weight reduction and general improvement in CVD (cardiovascular disease ) risk factors (Susan et al 2002). Physical Activity Physical activity and diet help in the management of the disease at initial stages. However, it becomes challenging to implement lifestyle changes thereby making initial management of T2DM ineffective. However, to overcome these challenges, new strategies to treat the disease are being developed. Individuals living with diabetes have a great role to play in the daily management of their chronic condition. Monitoring of the blood glucose, medication intake, physical activity and diet forms the daily management practices that are aimed at maintaining normal levels of blood glucose. However, in many people the glycaemia levels usually goes beyond the recommended (Aguir et al 2010) Patients with diabetes, their families, as well as the clinicians are progressively becoming more aware of the significance behavior of managing the metabolic control. Failure of individuals to put emphasis on self-care may result to a serious crisis and long-term severe complications. Hence, the diabetes educators have stressed on the inclusion of ‘behavioral’ element in programs involved with T2DM treatment (Sigal et al (2009). Hence, reinforcing the conventional diabetes treatment with individualized attention particularly on areas related to insulin administration, self-care-diet, oral medication and foot care. Moreover, supporters of assorted psychological approaches, such as counseling, social education and relaxation maintain that their methods seem to be the best in facilitating behavioral changes (Sigal et al (2009). However, for self-management strategies to be effective there is a need for individuals to get involved in physical activities, maintain intake of proper diet and follow the physicians medical instructions in their daily self-management of this chronic condition (Sigal et al (2009).). Diet control and physical exercise help in achieving the recommended levels of blood glucose. Similarly, individuals living with this condition need to use physiological strategies, as well monitoring of the blood glucose to minimize the effects of T2DM when faced with stress, illness or other daily complexities. Studies indicated that, those people who were involved in physical activities and diet control had a higher probability of maintaining normal levels of blood glucose (Aguir et al 2010). Therefore, diabetes is a chronic disease that calls for patients’ input in self-care behaviors and the ability to sustain them for a prolonged period of time and make them their daily routine in the management of diabetes. Whereas programs on DSME (diabetes self-management education) results to the positive outcome in prevention of diabetes in the short-run, failure to do a follow up, as well as supporting such programs renders them helpless (Sigal, 2009). Despite the call for the current DSMS (diabetes self-management support), the systems on health care have been reluctant in allocating funds in support of such programs. Consequently, there is growing interest in the implementation of programs on ‘peer support’ that aims at providing guidance on management of diabetes and other chronic diseases. Through the use of peer support involvement, peers may be charged with different roles, responsibilities, as well as different involvement levels. For example, based to the nature of intervention and aim for involvement, peer supporters can act as mentors, educators, cultural translators or case managers (Sigal et al (2009). Glucose Monitoring During the initial stages of the T2DM, resistance of insulin in peripheral tissues comprising of fat and muscle is connected with a compensatory rise in the secretion of insulin by pancreatic b-cells. Thus, the secreted insulin encourages utilization of glucose in peripheral tissues reducing hepatic gluconeogenesis. Additionally, fasting levels of insulin gradually rise in a step-wise manner up to the point the b-cells are no longer capable of compensating for the rising insulin resistance. Ensuing pancreatic b-cells’ loss and secretion of insulin results in hyperglycemia levels defined as type 2 diabetes mellitus (T2DM). Low intake of high fat content diets, sufficient carbohydrates and fiber intake, as well physical activities can enhance action and secretion of insulin thus facilitating the disposal of glucose. (Sabin Allemann 2009). For instance, islet cell transplantation, as well as glucagon such as peptide -1 (GLP-1) analogues has been applied in proliferation and replacement of islet cells. Although islet cells plantation is most appropriate for type 1 diabetes whereas GLP-1 is best suited for T2DM. Other identified current therapeutic strategies include I kappa kinase beta, dipeptidyl peptidase IV, as well as acetyl-CoAcarboxylase 2. These current strategies have the capacity to promote target tissues’ insulin action, reduce production of endogenous glucose, and encourage catabolism of fat and carbohydrates. (Sabin Allemann 2009) There is a need to expound the pathogenesis that forms an important link between type-2 diabetes and obesity. An understanding of mechanisms involved in associating insulin resistance, obesity, and type-2 diabetes may eventually lead to an exceptionally individualized treatment. One of the areas of future research is the identification of gene variations and their impacts on fatty acid, glucose, and energy metabolic mechanism at the cellular and organism levels. Instead of searching for an individual factor in expounding on the predispositions to decompensation of b-cell in obese persons, a synergistic justification corresponds more with the underlying knowledge (Malanda 2012). The findings indicate that the DSME monitoring programs undertaken in Montana are capable of proving additional education programs to the diagnosed diabetic patients. Rural and urban DSME programs provide lifestyle tips to the patients with higher chances of becoming obese. Therefore, most of the DSME programs have implemented the lifestyle intervention tips similar to those offered in DDP and receiving training out of their own will. In general, most of the reported possible barriers to the implementation of a diabetes deterrence program were due to inadequate reimbursement and inadequate staff to offer the service (Malanda 2012). Worth noting, the DSME program proved to be most efficient and effective if presented by a team with multidiscipline status and comprehensive plan of patient care. In such a team, the members do their jobs independently, share objectives and consult with each other. Therefore, a referral system should be established to make sure that a diabetic person received the appropriate education from trainers with higher credentials and training (Malanda 2012). It is imperative to understand that this integrated and collaborative team approach diabetic individuals are seen as leaders in their groups with an active role of designing their experience in educational programs.( Sabin Allemann 2009) Conclusion Although it is several years since we marked the beginning of a new millennium, the world is still encountering the prevailing diabetes issue and other disorders associated with it. The Anti-hyper glycaemia agents are becoming of great importance as new methods of attaining an air-tight control in the prevention of anticipated micro-vascular conditions. The new methods of diabetes treatment concentrate on promoting insulin sensitivity and supplementing insulin secretion that is dependent on glucose. The additional investigation of the targets may lead to efficacious and safe drugs that will be the mainstays of the coming generation therapy treatment for diabetes. Therefore, the providers of the healthcare services should in the forefront in helping the patients with T2DM to benefit from the low-cost treatments and health facilities. Additionally, providers of the healthcare services may offer assistance through providing credible directions to the T2DM patients in the validation of appropriate medical information so as to assist the patient to feel well in control of the situation. The struggle involved in controlling diabetes should not be aggravated by the factors such as prejudice and stigma. Therefore, healthcare provider assists the individuals in overcoming these challenges. References Aguir et al (2010). A journal on Efficacy of interventions that include diet, aerobic and resistance training components for type 2 diabetes prevention: a systematic review with meta-analysis. Ahola. J & Groop.H (2012).Barriers to Self-management of Diabetes. Department of Medicine, Australia. Allemann, S. (2009). 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