Type 2 Diabetes Prevention and Risks - Essay Example

Type 2 diabetes prevention Name Institution Date Type 2 diabetes prevention Introduction Type 2 diabetes is a chronic condition affecting the way the body metabolizes sugar. When suffering from this condition, the human body will resist effects of insulin or fail to produce enough of the sugar regulation hormone so that the body will not be able to maintain the required glucose level. Although no cure has been found for this condition, the condition can be managed by observing several physical and health conditions to help the body maintain a sustainable sugar level. Recent developments in the health sector have focused on prevention and several strategies and frameworks have been developed to contain this condition and minimize cases for the condition. This is has been the approach due to the common understanding that prevention is better than cure, especially so when the condition is chronic and not easily curable. This paper critically examines various frameworks, strategies and approaches that have been developed for prevention of this condition. It also compares these approaches as carried out in different countries with a recommendation of the best way to carry out prevention for the most desirable results. Risk factors for type 2 diabetes There has not been identified any specific cause for the type 2 diabetes. Nevertheless, several risk factors associated with the condition exist. While most of these are genetic and little could be done to control them, some factors could be minimized. One is at a high risk when he/she: Has a family history of diabetes Is aged 45 years and above Has metabolic syndrome Has high blood pressure Is overweight Has known history of gestational diabetes Has developed impaired glucose tolerance Is from certain ethic and racial groups like Non-Hispanic blacks, American Indians, Asian Americans (American Diabetes Association, 2013; ). The National Diabetes Education program (2013) also says that one is at risk when cholesterol levels go high and when one is a woman who has suffered gestational diabetes. Lifestyle changes for prevention of type 2 diabetes Approaches towards prevention are usually aimed at lifestyle modification programs that help participants to regulate their sugar levels. Recommendations to effective prevention of diabetes type 2 incorporate self management efforts by those at risk. The following are the precautionary measures that should be adopted in order to minimize the chances of developing this chronic condition: Maintaining a Healthy Body Type 2 diabetes will most likely develop when one has excess weight and obesity. Medical intervention to obese conditions has been to undertake bariatric surgery that greatly reduces the stomach size. Reducing the stomach size has been known to reduces obesity and almost completely eliminate Type 2 diabetes. Study has shown that losing just about 5 kgs over 10 years can reduce the risk by about 50%. Weight gain has been more common in the recent years contribution to the rising cases of diabetes. Reducing high-sugar foods intake It is important pay attention to the type and amount of carbohydrates taken. Ingestion of high glycemic load food like corn flakes results to rapid increase in blood glucose level which causes massive secretion of insulin in an effort to absorb all the sugar. If too much insulin is secreted, too much sugar is absorbed from the blood raising the craving for more food to again raise blood sugar level. Repetition of this process wears out the pancreas and promotes obesity since more sugars will be converted to fats. Consumption of complex carbohydrates containing foods like whole grain products produces less glucose and insulin, avoiding blood glucose fluctuations, reduces insulin production and prevents pancreas overloading. These forms of carbohydrates are therefore recommended to minimize diabetes. Mayo clinic staff (2013) recommends use of high fibre foods to help contain the sugar level. Choosing the right fats Certain fats indirectly cause insulin resistance by promoting inflammation. Oleic acid from olive oil, on the other hand, has an anti-inflammatory action that reduces the risk of insulin resistance. It is important therefore to use olive oil combined with intake of omega- 3 as a strategy for prevention of diabetes type 2. Exercising Evidence has shown decrease in risk for physically active adults and those maintaining a normal body mass index (Steyn et al, 2004). In response to insulin, muscles are the main absorbers of glucose. Sensitivity to insulin can therefore be increased by involving in regular physical exercise that helps in maintain optimal muscular function. In this way, the body can easily moderate its blood glucose levels. A study of pre-diabetics who suffered high blood pressure and hyperglycemia showed considerable reduction of glycemia through regular exercise over three years more than if they had taken metformin to reduce the blood glucose. Regular exercise also improves blood pressure that is vital for heart disease prevention. Food spices Certain food spices are instrumental in diabetes Type-2 prevention. Cinnamon is an example. It is known to improve glucose tolerance and can interfere with creation of glycation products that damage blood vessels. Turmeric also reduces blood glucose levels and its powerful anti-inflammatory activity is vital for reducing cardiovascular system damage caused by excess sugar (Béliveau et al, 2009). Framework, strategies and approaches for Type 2 diabetes. Type 2 diabetes prevention in the U.S. Dansinger (2012) says that type 2 diabetes could easily be prevented by adopting healthy lifestyle habits. In the USA, prevention measures have been focused on lifestyle modifications and findings have indicated that calorific reduction as well as increased physical activity that lead to weight loss greatly reduces the risk of the Type 2 diabetes in grownups. A research trial named the Diabetes Prevention Program led by the National Institute of Health (NIH) was set up to assess the effectiveness of different approaches to prevention of Type 2 diabetes. The DPP has provided foundation for the understanding of lifestyle changes in prevention of this condition (LeRoith, 2012). The study reported a 58% reduction in incident rates of the condition after carrying out lifestyle intervention program aimed at achieving 7% weight loss with a minimum 150 minutes of physical activity. The DPP (LeRoith D., 2012) Among the approaches employed to achieve the lifestyle goals were use of individual case managers, maintained contact with all participants, structured 16- session core-curriculum teaching on behavioural self management strategies, supervised physical activities involvement as well as training, feedback and clinical support. Randomized Control Trials have also shown that pharmacotherapy could be very effective for primary prevention in high-risk adults. The DPP also showed that metformin was another safe and effective way for primary prevention. It found out that this approach produced about 31% reduction in diabetes risk (Dansinger, 2012). High risk adults found with impaired glucose tolerance also use acarbose and orlistat with positive results. These oral agents prevent absorption of carbohydrates and fats. Other oral agents with strong effects in the US market are troglitazone, the first of the TZDs, insulin sensitizing agents. New TZDs with low hepatotoxicity have however been introduced although these have not been tested for the primary prevention (American Diabetes Association, 2002). The DREAM study which was conducted using rosiglitazone, another type of thiazolidinedione showed great response. When combined with lifestyle changes, there was a decrease in progression from IGT by 60%. The study recorded 14 cases of non-fatal heart failure while the placebo group recorded 2 cases. Mortality rates were however same in the two groups. It was also found that ramipil treatment did not lower risk but improved glucose profiles after meals (Joshi & Joshi, 2008). Although many interventions in the USA use high risk approach, Satterfield et al (2003) report their findings on evidence of population approach. They however point out that population approach mainly involved targeted populations that are known to be prone to the development of the condition. These populations include the Ho-Chunk, Zuni Pueblo and Akimel O’odham peoples as well as African Americans, Mexican Americans and Native Hawaiians. Their search revealed such approaches not only in USA but also in Canada, New Zealand, Australia and Sweden. Most of the studies, as found by Satterfield et al (2003), used a quasi-experimental design as well as a pre-/posttest methodology. Sample sizes varied widely from 24 on a U.S. Indian Reservation to everyone living in municipalities in Sweden. The program lengths also varied widely from just half day workshop to 10 year interventions across multiple countries. All interventions except one combined exercise and diet strategies but majority offered education on nutrition, including food preparation and cooking demonstrations, recipe exchange and grocery store tours. Among the exercise programs were residential walking programs, gentle exercise classes, running clubs and creation of exercise facilities. Various programs were designed to involve the target groups in the development, promotion and implementation of the interventions. Most of them include cultural symbols messages and strategies in the form of traditional activities, foods and knowledge while others were based on a holistic view of health, touching on spiritual, emotional, physical and mental dimensions (Satterfield et al, 2003). Challenges of population approach The studies reviewed reported several challenges. Only one intervention used an experimental design, most likely due to cultural unacceptability of the approach. Other common limitations included large number of nonresponders, short intervention periods, and inability to much pre- and post test information and to match self-reported changes in lifestyle to health outcomes. Only few of the studies could demonstrate positive outcomes in the intermediate outcomes of interest. It was also difficult to assess the extent to which the interventions reduced plasma glucose levels or other risk factors among the target populations. PEN-3 framework in the U.S.A In addressing prevention in African American communities, a community-campus partnership employed a community-based research principle and the PEN-3 cultural framework to put in place a culturally specific and locally relevant intervention program to prevent Diabetes in this group of Americans. The framework included a comprehensive needs assessment that covered 13 elicitation interviews, 217 surveys and 3 focus groups which greatly assisted the survey with identification of major themes (Cowdery et al, 2010). The PEN-3 model has culture at its centre and provides guidelines that ensure culturally specific intervention. After assessment, the framework goes into intervention development that will address the findings of the assessment. Limitations of the PEN-3 approach This model requires all community members to participate. Coordination and allocation of responsibilities becomes difficult. Involving members of the community in the oversight of the project means a great deal of communication and dedication. Time frames and responsibilities must also be communicated early and team members made to understand role dependant priorities (Cowdery et al, 2010). Data collection is difficult using the traditional research methodologies forcing the group to use samples that may contribute to limited representation. Prevention of type 2 diabetes in Europe The use of goal oriented lifestyle interventions in efforts aimed at prevention of the Type 2 diabetes. A clear demonstration is the Finnish Diabetes Prevention study where 522 middle aged subjects with overweight and impaired glucose tolerance were assigned to the control group and intervention group (Ahmad & Crandall, 2010). In this case, each individual in the intervention group was subjected to individualized counseling that was aimed at weight reduction and intake of saturated and total fat. They were also encouraged to increase their intake of dietary fiber and participate in increased physical activity. Cumulatively, diabetes incidence was 11% in the intervention group after 4 years while the control group recorded 23%. The risk of diabetes was thus reduced by 58% during the trial period in the intervention group. This reduction in diabetes incidence was a direct result of the lifestyle changes. When subjects fully implemented all the five lifestyle goals, none of them developed the disease during this intervention period (Toumilehto et al, 2005). There was developed a European- level action plan in the form of the IMAGE project whose aim was to improve and unify various prevention strategies which exist in the European Union (Pajunen et al, 2010). The project was also responsible for generation of guidelines for prevention and development of a curriculum for prevention manager’s training as well as establishment of quality management standards for diabetes prevention programs. The working group believed that the quality tools as well as the IMAGE guidelines and the curriculum for prevention managers will go a long way in improving quality of prevention and make prevention approaches comparable. The project had the following proposals for population level and high risk level strategies Population level approach in Europe Since the risk factors have a close connection to those factors for other diseases, prevention measures should be integrated into population approaches so that these diseases are prevented as a group (WHO, 2013). IMAGE proposes that policies and legislation should support diabetes prevention. Each country should also have a national diabetes prevention plan that defines specific prevention targets. The legislation and policies were also required to take into account specific prevention measures targeting obesity among adolescents and small children. The national health monitoring system was required to provide information for performing efficient surveillance while the health care provider was to ensure sufficient allocation of resources for preventive work. Apart from provision of policies and legislation for population – level framework, the project also provided guidelines for high risk approach for prevention. This later approach was designed to incorporate guidelines for screening with organized pathways to handle individuals at risk for diabetes. Health care providers were supposed to employ a multidisciplinary approach during interventions. The high risk intervention strategies had to be included in healthcare professional’s education and medical record system had to support chronic disease intervention and prevention in general (Pajunen et al, 2010). Prevention of type 2 diabetes in Africa A report by the WHO on strategy for Africa indicated that the member states are urged to evaluate magnitude of the condition and identify areas of prevention and improve them in terms of tertiary, secondary and primary prevention activities. The countries are further urged to create favourable conditions for prevention, early diagnosis, guarantee of access to care, treatment and availability of drugs (WHO, 2009). The general goal of the regional strategy is to actively participate in burden reduction of morbidity and mortality of diabetes and its associated risk factors. The strategy mainly aims to: Increase advocacy and sensitization in the fight against the disease, using epidemiological data for the general public and policy makers. Promote tertiary, secondary and primary prevention interventions Strengthen healthcare quality by integrating diabetes into the primary health care so as to provide equitable and just access. Improve healthcare personnel’s capacities so that they can better deal with diabetes. Support research in population interventions. The International Diabetes Federation action plan summary for Africa proposes both community actions and primary healthcare action as well as seeking government participation in prevention and care (IDF, 2013). Strength and limitations of the high risk approach No evidence of positive benefits has been recorded in health outcomes for whole population screening for IFG, diabetes or IGT. Of known merits however is screening of high risk groups in a given population which has shown positive results for discovery of potential diabetics. This is particularly important since with early discovery comes early treatment which may reduce or prevent complications (Joshi & Joshi, 2008). A major disadvantage of the high risk approach is that potential cases of predisposed populations remain unknown until the affected individuals develop serious medical conditions. The intervention process is also involved with high costs in the form of oral drugs and employment of personal intervention managers. Of greater importance is the evidence of desirable outcomes and the accuracy provided by recorded information. Conclusion The United States employs several approaches in addressing the prevention of type 2 diabetes. Programs incorporating lifestyle changes have produced great results in prevention of this menace. Most lifestyle changes have been aimed at weight reduction through physical exercise and dietal changes that try to reduce intake of sugar. Several other interventions include use of pharmacotherapy that has shown positive results as far as prevention is concerned. This approach is also common in Europe although recent developments propose integrated healthcare guidelines that use population approach. Population approaches have the advantage of reaching out to more people and promoting both individual and communal changes that are vital for sustainability of prevention programs. The best prevention program should however, employ several approaches to address the varied individual and societal needs and should use both high risk and population strategies. In this way, the challenges encountered in a given approach could be addressed by the other. It is also paramount that appropriate guidelines be put in place to give direction and provide an environment that will encourage efforts aimed at prevention of type 2 diabetes References Stellefson M, Dipnarine K, & Stopka C, 2013. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review. Prev Chronic Dis; 10:120180. Retrieved on 23rd September 2013 from < http://www.cdc.gov/pcd/issues/2013/12_0180.htm> American Diabetes Association, 2013. 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