Prevention, Early Detection, and Screening in Diabetes - Term Paper Example

DIABETES RESEARCH Student’s Name: Code + Course name Professor’s name University City, State Date Introduction Pre-diabetic conditions and type 2 diabetes mellitus (T2DM) have exhibited a rapid increase in their prevalence. Some of the pre-diabetic conditions include impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG). Individuals that portray insufficient levels of physical inactivity are more likely to develop T2DM. Certain lifestyle strategies in conjunction with exercise training play a pivotal role towards averting the onset of T2DM and improving glycaemia control in individuals that present pre-diabetic conditions (Hodern et al. 2012). The cardiovascular risk profile of the individual exercises regularly also improves. Moreover, the cardio respiratory fitness and body composition of the individual also improves thereby resulting in better health outcomes on the part of the individual. According to the results of random controlled trials, it is evident that persons that have IFG, IGT or both have higher chances of developing diabetes. As a result, they necessitate interventions that reduce the onset of the disease. Exercise training requires that individuals prone to pre-diabetic conditions and T2DM should attain a minimum of 210 minutes every week of moderate training (Hodern et al. 2012). As an alternative, they should accumulate a minimum of 125 minutes every week of rigorous training. They should never fail to exercise for two consecutive days. Considering the time efficiency of vigorous high-intensity training, it is appropriate to recommend the training to individuals since it yields better health outcomes bearing in mind the contraindications and complications associated with the exercise training. The persons should also undergo at least two resistance training sessions per week that consist of 2-4 sets of 8-10 repetitions. The paper develops the proper strategies for health promotion and the primary prevention of T2DM. Moreover, the paper presents the understanding of the community regarding its attitudes and knowledge towards diabetes. Finally, the paper demonstrates an awareness of the sources of evidence in prevention, early detection and screening in diabetes. Importance of Evaluation, Research and Measurements The concern emanating from the increasing prevalence of pre-diabetic conditions and T2DM has necessitated the evaluation, research and measurement of the diseases with the objective of reducing the prevalence and enhancing the health outcomes of the affected individuals. For instance, the research would play a pivotal role towards increasing the proportion of the individuals under the optimal management of diabetes initiative (Redmont et al. 2014). Being a chronic disease, diabetes requires continuous education on patient self-management and medical care to avert possible acute complications arising from the disease. Continuous education also enables the identification of effective life strategies and exercise training that reduces long-term complications. The complexity associated with diabetes care also provides the other reason for conducting evaluations, research and measurements on diabetes. Therefore, the research will also enable the understanding of the effects of the screening tests on the society, health systems and individuals (WHO 2003). There are several issues that diabetes care entails such as glycaemia control. Therefore, continuous research on the topic ascertains the development of sufficient intervention measures to improve the health outcomes of diabetic patients (ADA 2010). Continuous research on diabetes will enable the identification of the standards of care that will provide patients, researchers, clinicians, and other interested stakeholders with the critical aspects involved in diabetes care such as the tools of evaluating the quality of patient care and treatment goals. However, prior to understanding the standards of care and treatment, the evaluation and research will enable the understanding of the various classes of diagnosis including the recommended diagnosis tests (ADA 2014). The research also enables the modification of the treatment goals based on certain patient factors such as individual preferences to ascertain the attainment of goals and targets that are desirable for most diabetic patients. The setting of the standards does not intend to preclude extensive patient evaluation and management. On the other hand, the standards provide a pathway for the development of recommendations for screening, therapeutic actions and diagnosis of the patients. The recommendations will play a pivotal role towards impacting favourably on the health outcomes of diabetic patients. Towards meeting the objective, the American Diabetes Association (ADA) developed a grading system that codifies and clarifies the evidence that forms the guideline for the basis of the standard recommendations. The system uses letters A, B, C or E to list each recommendation against the level of evidence that supports the recommendation (ADA 2010). Classification and Diagnosis There are four clinical classes of diabetes. Type -1diabetes is the first class that results from the destruction of the beta (β) cells of an individual thereby resulting in absolute insulin deficiency (American Diabetes Association 2010). Type 2 diabetes emanates from a continuous defect in insulin secretion on top of insulin resistance. There are other types of diabetes that emanate from different causes such as genetic defects in the action of insulin, genetic defects in the functioning of beta cells and exocrine pancreas diseases such as cystic fibrosis and chemical and drug-induced diseases. There are three ways of diagnosing diabetes that necessitate a confirmatory diagnosis on the subsequent day unless the individual presents unequivocal symptoms of hyperglycaemia. It is evident that the 75-g OGTT (Oral Glucose Tolerance Test) is more specific and sensitive as compared to the fasting plasma glucose (FPG) in the diagnosis of diabetes, performing it in practice is difficult besides its poor reproducibility. As a result, the FPG stands out as the most preferred diagnosis test due to its lower cost, accessibility to patients and ease to use. However, patients that present normal FPG or IFG have to undergo the OGTT test for further evaluation. The Impaired Glucose Tolerance (IGT) test and the Impaired Fasting Glucose (IFG) are the diagnosis tests applicable to testing pre-diabetes. The presentation of both types of pre-diabetes indicates risk factors for future cardiovascular disease and diabetes. The test is applicable to adults of any age that are either obese or overweight or both that present a Body Mass Index (BMI) that is greater or equal to 25kg/m2. The test is also more applicable to individuals that present one or more risk factors. However, in the case of individuals that do not present any risk factors, they should undergo the diagnosis after having attained the age of 45 years. In case the results are normal, the individuals should repeat the tests at intervals of three years. In a bid to better define the diabetes risk in individuals that present IFG, it is proper to conduct an OGTT test. The individuals that present positive pre-diabetes results should undergo treatment for other risk factors associated with cardiovascular diseases. Description The increasing prevalence of pre-diabetes and T2DM among the individuals in the community was the major problem in the study. As a result, the research targeted to determine the causes of the increasing prevalence by evaluating the current lifestyle strategies exhibited by the members of the target population. At the end of the study, the team targeted to implement the recommended solutions such as the adoption of healthy lifestyles consisting of proper diets and exercising so as to reduce the prevalence of the condition. The team used to develop the guideline comprised of the expert committee, the executive committee and the steering committee that had substantial geographical representation and expertise in diabetes issues. The study consisted of 1,079 participants that encompassed 45% ethnic and racial minorities (DPP Research Group 2002). There were two major study objectives that targeted to attain a 7% reduction in the weight of the participants and a minimum of 150 minutes of exercise training. The research team considered the goals to be effective, safe and feasible with reference to past researches conducted in other countries. They key attributes of the research methodology encompassed the use of individual “lifestyle coaches”, maintaining frequent contact with the participants, and the development of a well-structured co-curriculum 16 session strategies for behavioural self management. The lifestyle coaches would also supervise the exercise training sessions of the individuals. The maintenance intervention programme used in the research comprised of “restarts”, motivational campaign and both individual and combined group approaches. The “toolbox” of adherence strategies also enabled the individualisation of the interventions. The research team also tailored the strategies and materials to cater for the prevailing ethnic diversity. Finally, the research team offered feedback responses, training and clinical support to the participants (DPP Research Group 2002). According to the Centre for Disease Control (CDC), type 2 diabetes that has a connection with physical inactivity and obesity as the primary causes accounts for 90%-95% of diabetes cases in the USA. The disease is prevalent among individuals aged at least 40 years. As a result, it has an association with old age, family history of diabetes and gestational diabetes, physical inactivity, ethnicity, race and impaired glucose metabolism. However, there is an increase in the prevalence of diagnosed cases of T2DM among young American Indians, Hispano/Latino Americans, Asian/Pacific Islanders and African Americans. The research conducted on pre-diabetes revealed that the condition arises when the glucose levels in an individual surpass the normal levels but are not high enough to warrant diabetes classification. A research on the American population conducted by CDC in 2007 revealed that there were approximately 57 million adult Americans that had pre-diabetes. It is evident from research that pre-diabetic individuals are more likely to develop T2DM, stroke and heart attacks in the future. Knowledge and Information The research conducted on the American population by CDC and the Canada-based panel that aimed at developing guidelines for the prevention, treatment and behavioural changes of T2DM and pre-diabetes revealed similar screening results that indicate whether an individual is diabetic or not. It is evident that at least 2.8% of the adult population may have undiagnosed T2DM. In fact, the figure increases to 10% in some populations that exhibit high risk factors. Hyperglycaemia tests are effective in identifying individuals that have T2DM. Majority of the persons will either present diabetes or be at a high risk of developing diabetes-related complications. In a population-based screening endeavour, the primary goals of the screening include identifying and intervening to minimize mortality and morbidity that may arise from the disease. The screening strategies for T2DM entail multiple stages. The ADDITION-Europe Study is a good example of T2DM screening conducted in Europe. The first blood glucose test of the study covered between 20% and 94% of valid participants in primary care practices. The results of the screening exercise revealed that between 0.33% and 1.09% of the individuals presented diabetes. In a similar study conducted in Cambridge, 3% of the population had diabetes. Based on the lower than anticipated results realized from the screening exercises, it turned out that screening target populations that presented high-risk factors was more appropriate than screening the general population. Some of the high-risk factors include individuals that present diabetes-associated conditions for T2DM. Therefore, 40 years suffices to be the minimum age of screening for T2DM in an individual. The recommended screening tests for T2DM are the glycated haemoglobin (A1C) and the fasting plasma glucose (FPG) tests. However, in the event that the FPG ranges between 6.1 and 6.9 mmol/L, or where the A1C results vary between 6.0% and 6.4%, a 75g OGTT is appropriate. OGTT is also recommended in cases whereby there is suspicion for T2DM and the FPG and A1C results vary from 5.6 to 6.0 mmol/L and 5.5% to 5.9% respectively. Moreover, an OGTT screening is appropriate in cases where there is a high impaired glucose tolerance (IGT). In regard to pre-diabetic individuals, it is evident that a high number of such individuals present IGT or have an A1C that varies from 6.0% to 6.4%. Rather than being at a high risk of developing macro-vascular complications, such pre-diabetic individuals are also at a greater risk of developing T2DM especially when they present the metabolic syndrome. As a result, it is proper to recommend such individuals to the strategies for cardiovascular risk factor reduction. Persons that emanate from ethnic populations that exhibit a high history of T2DM require screening for both T2DM and pre-diabetes. As mentioned before, the screening tests applicable to such individuals are OGTT, A1C and FPG. The accuracy of the A1C screening tool reduces due to the increased prevalence of the haemoglo-binopathies among the populations. As a result, the A1C tool is not reliable in screening T2DM and pre-diabetes among such populations. Moreover, holding the glycaemia levels constant, it is certain that individuals emanating from high-risk groups may present A1C results that are slightly higher than other population groups such as the Caucasians. Therefore, A1C threshold levels for pre-diabetes and T2DM are different among ethnic groups. Based on the recommendations for screening pre-diabetes and T2DM, it is proper to screen all individuals on an annual basis for the conditions. FPG and A1C screening are appropriate for all individuals after every three years provided that the individual has attained 40 years. Higher scores on the risk calculator may also necessitate the screening of an individual even if the individual has not attained the threshold age. The 75g OGTT is appropriate in cases where the individual scores highly on the risk calculator. Some of the risk factors include the existence of a first-degree relative that has T2DM. Moreover, individuals that emanate from a high-risk ethnic group or have a history of gestational diabetes also stand at a high chance of developing T2DM. The history of delivering a macrosomic infant and the history of pre-diabetes also increases the chances of developing T2DM. The existence of damage complications of the end organ as a result of diabetes complications also increases the chances that the individual will develop T2DM. Vascular risk factors such as hypertension, HDI cholesterol, triglycerides, overweight and abdominal obesity also increase the chances of developing T2DM. Other risk factors include the presence associated diseases such as polycystic ovary syndrome, obstructive sleep apnea, acanthosis nigricans, psychiatric disorders and HIV infection. Finally, the other risk factors entail the use of certain drugs such as Glucocorticoids, Atypical antipsychotics, and HAART. Rational and Context The selection of the program emanated from the need of developing lifestyle recommendations and guidelines and implementing them to reduce the prevalence of pre-diabetes and T2DM in the community thereby enhancing the health outcomes of the individuals. Some of the lifestyle changes include the adoption of a low-calorie diet that has low saturated fat, moderate intensity physical activity, and high-fibre diet (Ransom et al. 2013). The moderate-intensity physical activity should take at least 150 minutes every week to yield a moderate weight loss of about 5% of the initial weight of the body. The Diabetes Prevention Program (DPP) revealed a reduction of the risks by 58% over a period of four years. The studies entailed sustained and comprehensive programs that were pertinent towards achieving the set targets. The lifestyle intervention measures provided by the DPP program to the target individuals for a median period of 5.7 years yielded sustained benefits for 10 years. In order to achieve the outcomes, the availability of lifestyle coaches to offer training to the target population regarding the effective lifestyle strategies is imperative. The coaches should also contact the target individuals on a regular basis to ascertain the proper implementation of the recommended lifestyle strategies. Apparently, self-management is a critical component of the success of the program. The members of the program should be able to manage themselves and adhere to the recommended lifestyle guidelines so as to realize the set targets. Self-management is important in the achievement of the desired weight loss and physical activity. However, it is important that the lifestyle coaches should devote some time towards supervising the training and exercise sessions. The maintenance intervention should also be flexible by utilizing both individual and group approaches. Through the intervention programs, the coaches should motivate the target population to adopt proper lifestyle behaviours. Apparently, ethnic diversity has an influence on the training and implementation of the strategies. Consequently, it is proper to tailor the strategies and materials used in the program. Learning Objectives The main objectives of the programme include Understanding the prevalence of pre-diabetes and T2DM among the high-risk populations. Understanding the screening tools among other pertinent resources necessary in the management of the condition. Understanding the effective lifestyle strategies necessary in the prevention of the conditions. Comparing the utility of the different intervention measures in different studies. Interpreting the research associated with the prevention of T2DM. Understanding the relevant approaches to health promotion that include proper diets, behaviour change and medical, client-centred, educational and societal change. Using data from previous research to justify the performance of the intervention strategies. Increase the proportion of high-risk individuals in the community under the optimal management program for T2DM. Decrease the percentage of high-risk individuals initially diagnosed with T2DM that present cardiovascular risk factors and poorly controlled glucose by 58%. Increase the number of individuals that present diabetes on the first time during the research under new therapy and lifestyle modification. Attain a minimum of 7% weight reduction and 150 minutes physical exercise (DPP Research Group 2002). Measures and Evaluation The evaluation strategy commences with the current state of diabetes prevention at the population level. As a result, the program should evaluate the existing legislation and policies within the community to determine whether they provide a favourable environment that prevents the continued prevalence of diabetes. The existence of a diabetes prevention plan at the national level that trickles down to the community level is a positive indicator of a favourable environment. Following the implementation of the program, the target individuals should attain a weight loss of between 5% and 10% of their excess body weight. Some of the evaluation indicators encompass the attainment of the recommended body weight, the body mass index (BMI) and the waist circumference over the designated period. The other indicators encompass 2h OGTT glucose and fasting, hbA1C, fasting insulin, total intake of energy, fat intake, saturated fat intake, fibre intake, physical activity and fasting total LDL and HDL cholesterol. The other indicators include fasting triglycerides, diastolic and systolic blood pressure, smoking habits, drug treatments, cost, quality of life and treatment satisfaction (Pajunen et al. 2010). The evaluation indicators should meet the recommended levels to ascertain the success of the program. Ethical Consideration The project design should be appropriate to meet the target objectives. The protection or concealing of patient information during the program is imperative. The lifestyle coaches and other health professionals should be truthful and be able to offer an honest appraisal of the condition, prognosis and options of the patients under the program. Confidentiality is the other critical aspect of the health professionals that assist in managing diabetic patients to help them handle their situation properly. The professionals should only share what they know with the individuals that they regard as being fit to have the information for the benefit of the patient. Digitalization of medical records has impacted negatively on the confidentiality of patient information. There have been issues associated with the sharing of patient information by concerned organizations since there are cases where the information lands in wrong hands. Health professionals in the program also have to be discreet in order to absorb the additional information that they understand regarding their patients without impacting negatively on their relationships with their patients. The health professionals have the privilege of knowing patient preferences, personal circumstances and disposition. However, they should only use the knowledge to make decisions about improving the health outcomes of the patients rather than sharing the information with wrong individuals. In essence, the health professionals should ensure that the project does not yield any social, psychological, economic or physical harm to their patients. The differences in rank and expertise among patients also require trust on the part of the health professionals. For the patients that have limited information about the effective ways of handling their conditions, it is the responsibility of the health professionals to make decisions for them; a requirement that necessitates trust (Williams, 2011). Limitation The fact it is difficult to extrapolate studies involving small samples like the above research to represent a generalised population is the main limitation of the study. Even though many individuals suffering from T2DM agreed to participate in the program, not all of the expected individuals responded to the demands of the study thereby yielding inconclusive results. Moreover, realising a longer-term follow-up of the performance of the target individuals regarding the implementation of the recommended lifestyle strategies was difficult. The difficulty emanated from the fact that the study targeted to create awareness and sensitise different populations to a greater extent as compared to making follow-ups. Some of the subjects also expressed reluctance to avail themselves to the testing centres to undergo subsequent screening aimed at determining their level of progress. Consequently, only a small percentage of the initial population consented to undergoing subsequent screening. The availability of limited studies covering the effectiveness of intervention programs also hampered the evaluation of the program due to the absence of benchmark results for comparison purposes. Conclusion The study intended to develop a diabetes intervention program to evaluate the awareness, create more awareness, treat patients and develop recommendations for preventing T2DM and pre-diabetes among older individuals aged at least 40 years. The selection of the age group reclined on the fact that pre-diabetes and T2DM are more common among older individuals as compared to the other age cohorts of individuals. Based on the findings of the study, FPG and A1C are the recommended screening tools for pre-diabetes and T2DM. However, the 75g OGTT tool is applicable in situations whereby the individual presents risk factors for diabetes and scores highly on the risk calculator. Lifestyle changes suffice to be the major strategy of managing T2DM. It entails adopting proper diets comprising of low levels of caloric and saturated fat as well as exercising regularly. Part B: REFLECTION Description The increasing prevalence of pre-diabetes and type-2 diabetes mellitus (T2DM) in the community necessitated the evaluation, research and measurement of the conditions to improve the health outcomes of the individuals in the community. As a result, I intend to reflect on the prior scenario regarding the prevalence of pre-diabetes and T2DM in the community with reference to similar extended studies conducted in the USA, Canada and the United Kingdom. Moreover, I intend to reflect on the strategies for health promotion that existed before the research and the recommended modifications on the strategies following the research. The reflection also extends to the attitudes and knowledge of the community towards the management of T2DM. I understood that the self-management was pertinent towards the success of the intervention measures developed by the research. Moreover, I intend to reflect on the understanding of the community regarding the early detection, prevention and screening of diabetes. It dawned on me that in the absence of such knowledge, it would be difficult to implement the recommended modifications to the lifestyle strategies of the members of the target population to realize better health outcomes. Finally, the reflection also includes the risk factors observed among the individuals of the population. Feelings Prior to the experience, I had the feeling that individuals that presented pre-diabetes and T2DM had implemented sufficient measures to combat the situation. However, it was evident that despite the fact that some of the members of the population had developed diabetes-related complications, a good number were unaware that they had the conditions. Consequently, it dawned on me that the individuals were unaware of the symptoms of the conditions. During the research, I felt and thought that the members of the target population would exhibit moderate understanding of the recommended lifestyle strategies that are appropriate for handling T2DM and pre-diabetes. However, the members noted that they had not witnessed such an experience before. As a result, they presented extreme levels of unfamiliarity with the contents of the research. During the research, I felt that it was necessary to encourage the implementation of the recommended lifestyle changes in the community with immediate effect as a result of the increasing cases of morbidity and mortality arising from T2DM and its associated complications. I felt so discouraged following the realization that made me resort to making follow-up exercises as an individual initiative to ascertain that the individuals adhered to the recommended lifestyle strategies. Evaluation I noted a number of things that went well in the experience. To begin with, the cooperation of most of the individuals in providing confidential medical information was one of the most significant milestones to the research. Without the information, it would have been difficult to determine the recommended lifestyle strategies and treatment of the individuals that presented pre-diabetes and T2DM. The trust and confidence exhibited by the members of the targeted group on the health professionals of the research enabled the individuals to assess the existing strategies and develop modifications that would improve the health outcomes of the population. However, it was difficult for the research team to convince the target participants that had already presented diabetes-related complications that they stood a chance of attaining better health outcomes. The individuals that had succumbed to the conditions found it difficult to implement the recommended lifestyle strategies that would reduce their weights to the recommended levels. In an effort to deal with the setback, we had to educate the most affected members of the community about the performance, efficiency and significance of adopting the recommended changes as a means of achieving the desired outcomes. The most important thing is that at the end, majority of the participants were optimistic towards the program and vowed to manage themselves in order to meet the desired health outcomes. Analysis Considering the setback that the research team encountered towards convincing the participants to undertake the recommended changes, it was evident that there had never been such an initiative before. As a result, the community did not have an in-depth understanding of the causes, prevention, and treatment and lifestyle strategies necessary in the management of T2DM and pre-diabetes. Due to the lack of prior knowledge regarding the aspects of pre-diabetes and T2DM, it turned out that that provided the explanation for the pessimistic attitudes held by some of the participants. The manifested unpreparedness of the community members to manage the effects of the conditions effectively emanates from inadequate education on the part of the participants regarding the proper ways of handling the conditions. I believe that educating the individuals on all aspects of the conditions; starting from the risk factors, causes, treatment, management and lifestyle strategies would have played a pivotal role towards alleviating the negative consequences observed in the research experience. I also believe that cultivating a positive mindset among the individuals also encourages them to embrace the lifestyle approaches recommended in the research. Conclusion At the end of the research, I realized that there were several things that I could have done differently if I had adequate expertise and experience to deal with pre-diabetes and T2DM. I understand that the research is an ongoing program that targets to sensitize individuals from different communities regarding the proper lifestyle strategies of dealing with diabetes. As a result, the follow-up initiatives are inadequate. I would endeavour to make individual follow-up to evaluate the performance of the participants following the termination of a research initiative conducted on them. At the moment, I cannot accomplish the objective to its fullest since I do not have adequate experience and knowledge to handle the condition. However, I learnt that I have the required motivation to enable me gain the necessary knowledge and attain my objective. Most importantly, the experience accomplished all my learning objectives since I learnt the types of diabetes, its causes, risk factors, screening tools, treatment, medication and recommended lifestyle strategies such as proper dieting and exercising. Action Plan From the experience, I identified the essence of acquiring in-depth information regarding the issue. Having the knowledge at hand, I believe that I will be in a favourable position to meet the educational needs of the affected individuals in relation to treatment, motivation and the adoption of lifestyle approaches that improve the health of an individual. I would also recommend and lobby for the establishment of a healthcare facility in our community to deal with patients suffering from diabetes and other chronic illnesses so as to reduce the mortality and morbidity caused by the diseases and their associated complications. Having adequate knowledge, I am confident that I will be in a better position to handle such a research endeavour in the future. Reference List American Diabetes Association, 2010. Standards of medical care in diabetes—2010. Diabetes care, 33(Supplement 1), pp.S11-S61. American Diabetes Association, 2014. 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