Diabetes: Health Promotion and Education - Article Example

Diabetes Name: Roll No: Class: Teacher: Subject: January 28, 2008 University: Health promotion and education Health promotion is termed as relatively a new subject of professional and research activity. World Health Organization has been active and dynamic in its activities for popularizing, conceptualizing and framing the global development of this area. In fact World Health Organization has now been active for a long time. It developed, in the year 1986, Ottawa Charter particularly aimed at health promotion, a project as an initiative in which governments and organizations are in a better position to establish via change in policy favorable to healthy choices and health. (Harris R, 2003) Many governments worldwide particularly in developed countries have developed a variety of national health targets and goals for the purpose of viewing to motivate and inspire practitioners of health promotion for working towards objectives of decreasing high risk elements and preventive programs. (Engelgau MM. 2001) These goals and targets emphasize programs of health promotions as a methodology of creating and developing much healthier society. (Commonwealth Department of Human Services and Health, (CDHSH), 2004) Man y authors perceive health education and health promotion as interchangeable concepts. They suggest that concept of health education is able for the usage of educational strategies to approach health related alterations while health promotion is a blend of strategies including political changes and health education aimed to develop public health. (Koopman RJ. 2004) Some of these alterations are associated with concerns regarding genetic predisposition about a variety of disease-awareness and proposition for health promotion and also regarding increasing apprehensions about globalization that is fuelling an wave of diet linked diseases around the world via development of energy-solid diets and foodstuffs. (Giles-Corti, 2004) Governments around the world have developed policies and procedures for national targets and goals for using different theories of health promotion. Some of these theories have been used for studying behavioral alterations while others have become a source of development from standards of communication theory. (Koopman RJ. 2004) Health promotion being as applied science has tend to develop its theoretical basis by borrowing from Social Psychology, Sociology, Behavioral Psychology, Anthropology, Social Marketing and communication. (Harris R, 2003) World Health Organization terms health promotion as a blend of economic, educational and political activities that are primarily formulated with consumer contribution. (Engelgau MM. 2001) Though, all health promotion theories are focused as determinants of health. All such determinants divulge different elements that interact strongly to create an impact on the health of a person or population. (Koopman RJ. 2004) Some of these elements are; Biological factors like genetics and aging; environment; lifestyle; economic and social factors; access and usage of health services. (Harris R, 2003) Diabetes Diabetes can be defined as a disorder of metabolism-the manner in which our bodies digest food for energy and growth. Majority of the food that we eat is ultimately broken into glucose, being sugar form in blood. (Edelman D, 2006) Glucose is termed as the major fuel source for body. Glucose, after digestion, bypass into bloodstream. In bloodstream it is then used by cells for energy and growth. Insulin must be present for glucose to go into cells. Insulin is in fact a hormone that is produced by pancreas which is a sizeable gland at the rear of stomach. (Harris R, 2003) When a person eats, the pancreas robotically creates the exact quantity of insulin for pushing glucose right from blood directly into cells. (Edelman D, 2006) Pancreas, in people with diabetes, either creates almost no or little insulin or their cells are not reacting to insulin being produced. (Harris R, 2003) Glucose is developed in blood then it run over in urine and ultimately passes from human body through urine. As such the body tends to loose the major source of energy and fuel though blood comprises large quantity of glucose. (Engelgau MM. 2001) Diabetes is classified into three types: Type 1 diabetes; Type 2 diabetes; and Gestational diabetes. Type 1 Diabetes: It is an autoimmune disease that results in case the system of body for fighting infection, also known as immune system, turns alongside a body part. (Koopman RJ. 2004) Immune system, in diabetes, strikes and demolishes insulin-creating beta cells that are found in pancreas which then creates no or little insulin. Person having type 1 diabetes should receive insulin every day to live. (Colquhoun, 1997) Type 2 Diabetes: is a most common shape of diabetes. Almost ninety to ninety five percent people have diabetes 2. This kind of diabetes is mostly related with obesity, older age, family history in diabetes, gestational diabetes history, physical inactivity and different other ethnicities. Almost eight percent people having type 2 diabetes are found overweight. Children and adolescents are being diagnosed increasingly with type 2 diabetes. (Peterson, M. 2000) Gestational Diabetes: During the course of pregnancy, some women ought to develop this kind of diabetes known as gestational diabetes. Women with gestational diabetes possess twenty to fifty percent possibility of developing type 2 diabetes in five to ten years. Sustaining a rational body weight and remaining physically active can support to avoid type 2 diabetes. (Engelgau MM. 2001) The fasting blood glucose test is termed as an ideal test to diagnose diabetes in non-pregnant adults and children and is reliable when performed in morning. However, based on the below-mentioned test results, diabetes diagnosis can be made verified by repeat tests on different day. Fasting blood glucose test. Oral glucose tolerance test and Random blood glucose with level of 200 mg/dl plus, together with existence of diabetes symptoms. (Koopman RJ. 2004) “In short we can say that gestational diabetes is Gestational Diabetes is a state of ailment where a person’s blood glucose level is raised above the required level. In such cases person is required to have medicines to keep glucose level in control. Some women develop diabetes during pregnancy, it is called ‘gestational diabetes’ and it often subsides after the birth of baby. Gestational diabetes can be more dangerous as it may harm baby and mother both. If a woman gets diabetic during pregnancy, she becomes more prone to get diabetes in the years to come as well.” (Edelman D, 2006) Edelman D., gives much emphasis to the value of treatment and maintenance of diabetes as he writes “If gestational diabetes is not controlled properly, the size of fetus can grow abnormally that may create complications during pregnancy. Baby of mother who had uncontrolled gestational diabetes, will not arrive with diabetes, but baby may suffer from low blood glucose at the time of birth. Such babies are kept under strict observation unless their blood glucose level is maintained.” (Edelman D, 2006) Diabetic Complication in Primary and Secondary Care The long-run management in the patients of diabetes is being supervised globally either in part of totally in primary care. It is specifically adequate for those type 2 diabetes patients having reasonable glycaemic control and without considerable diabetic complications. (Edelman D, 2006) Complexities of metabolic control and finding of complications should initiate consideration of expert advice. Different models of care are described as: Miniclinics: run during general practice although based mostly on hospital clinics. (Rush WA. 2001) Integrated and Coordinated Care Systems: Patient management is normally shared among primary and secondary segments-but domestic conditions will impact the arrangement among specific health district. (Harris R, 2003) Many of them need adjacent cooperation among primary care and hospital-based, because ready approach to hospital services along with diabetes expert nurses are preconditions. (Hillen J, 2003) An effective recall system and patient register are also vital elements. Standard audit of outcome and process is required. (Engelgau MM. 2001) Some studies made in this subject have revealed that expert aimed management of diabetes particularly in primary care can provide fine rates of satisfactory data collection, (retinal examination and blood pressure), patient attendance, and appropriate record keeping. (Hu FB, 2002) Conversely, unformatted care can result in loosing substandard glycaemic controls, follow-up, inappropriate attention towards complications and possibly increased mortality. (Hillen J, 2003) In the developed countries including United Kingdom and United States advisory groups have been formed with the objective of managing hospital services, general practice and mostly vital- patients implicated in diabetes care. Harmonized guidelines may support to ensure constant and minimum traditions of care. (Hillen J, 2003) Plans aimed for primary and secondary care has been prepared that involve implementation of protocols and guidelines of diabetes management to the domestic strategy aimed at provision of care. (Engelgau MM. 2001) Even though considerable proficiency is accessible in secondary care, four reasons are termed necessary that suggest the increasing significance of primary care or the leading function in care delivery to diabetes patients and facilitates secondary care to focus on more significant and challenging cases. The undesirable impact of diabetes on patients. Enhancing pervasiveness of diabetes and requirements on secondary care. The significance of quality in care delivery to diabetes patients. Maintainability of primary care to organize chronic diseases. (Rush WA. 2001) Diabetic Nephropathy Evaluation Diabetic nephropathy is the most common and single cause and reason of end-phase renal disease mostly in the western world and related with significantly amplified cardiovascular morbidity and mortality. With the enhance commonness of type 2 disease it poses heavy load on heath care systems globally. Investment in basic and clinical research has in fact capitulated strategies which can decrease diabetic renal disease risk and reduce speed of its progression. Stages Type 1 which is insulin reliant and type 2 as non-insulin dependent diabetes are epidemiologically and aetiologically dissimilar states that affect various sections of populations. Nevertheless, no main distinction has been discovered among nephropathies observed in such states, either pathophysiologically or in management terms. They can be easily considered together. It is pertinent to mention that type 2 diabetes patients tend to be older and hypertensive as such it is likely that they possess renovascular disease and concomitant hypertensive. (Mokdad AH. 2003) Diabetes with relationship of preteinuria was first identified in the 18th century. Later on Kimmelstiel and Wilson (1936) defined such condition by narrating the lesions of nodular glomerulosclerosis and the relation with hypertension and proteinuria in the type 2 diabetes patients. These characteristics symbolize much late stage in development of the condition. Succeeding work, mostly on type 1 diabetes, directs to the meaning of several different stages in evolution of disease. (Mognesen CE, 1999) Prior to pervasive violent treatment of yperglycaemia and blood pressure among 25% and 40% of patients of type 1 and type 2 developed diabetic nephropathy in the span of twenty years and certain risk elements that distinguish this subgroup from those patients who sustain usual renal function are glycaemic control, systemic hypertension, hyperlipidaemia, smoking and dietary protein ingestion. Blood Pressure: Hypertension is mostly common in the patients of diabetes as compared with common people and has been recognized as a main risk element not only for microvascular but in macrovascular complication comprising diabetic nephropathy. Entire cardiovascular mortality among diabetes is linked with high blood pressure specifically in type 2 disease. (Harris MI, 2005) Proteinuria: is mostly regarded as creator for level of glomerular damage: the degree of proteinuria is linked with prognosis for renal function and interference that hinder development of diabetic renal disease, decreasing proteinuria. (Mokdad AH. 2003) Genetic Elements: are likely to be significant in diabetic nephropathy. Current interest has concentrated on genes of rennin angiotensin technique that are identified to be extremely polymorphic and have been widely studied in association to cardiovascular disease. (Harris MI, 2005) Some of the researches have identified DD genotype to be linked with an enhanced risk factor of diabetic nephropathy and a swift reduction of GFR in type 1 and type 2 diabetes. (Yoshida H. 1996) Hyperlipidaemia: is found generally in type 1 and type 2 diabetes. Enhanced plasma triglycerides and low degree of highdensity liproproteins have been interrelated with the growth of diabetic nephropathy and also with cardiovascular diabetic complications. (Yoshida H. 1997) Glycaemic Control: Type 1 and type 2 diabetes possess the condition of chronic hyperglycaemia and also glucose-reliant procedures that are possibly implicated in pathogenesis of diabetic complications comprising nephropathy. Glucose-stimulated tissue damage may be mediated by the creation of higher glycated proteins or through other systems like polyol pathway implicated in nephropathy. (Cooper ME, 2004) Management Risk of cardiovascular death among diabetic patients by way of microalbuminuria is around seven to forty times with regards to agematched common population: among normoalbuminuric diabetes is two and a half. (Harris MI, 2005) Microalbuminuria can be termed as a symbol of continuous and common process of disease upsetting the entire cardiovascular system. As such for managing diabetic nephropathy patient must concentrate on entire cardiovascular risk elements plus particularly on such actions to retard the sequence of renal disease. (Mokdad AH. 2003) Hypertension The advantageous effect of reducing level of blood pressure on development of renal disease and whole cardiovascular mortality is presently so well recognized that control and monitoring of blood pressure has become significant element of diabetic care. (Tyrrell K, 2003) In a diabetes patient of type 1 and type 2 with microalbuminuria, reduction of blood pressure also stabilizes or reduces AET and also retards the progression rate to overt nephropathy. Diet with Low Protein A beneficial impact of dietary protein limitation has been revealed by two meta-investigations on the progression among diabetic nephropathy in diabetes of type 1. (Mokdad AH. 2003) It is still not clear as to what degree of protein limitation should be used, how suitable this will substantiate to patients and how it will associate to treating observance in setting up of regular primary care. Long-run studies are needed to monitor such concerns in type 1 and type 2 diabetes. (Harris MI, 2005) Aspirin It has been confirmed by some prospective trials of antiplatelet therapy about advantages of secondary prevention along with treatment through aspirin in patients with confirmed atherosclerotic disease and analogous advantages in non-diabetes and diabetes patients. (Tyrrell K, 2003) Recommendations have been made by some studies on coronary heart disease prevention suggesting aspirin treatment of about 75mg per day in persons aged fifty years and plus whose hypertension is controlled and who are considered a high risk. Higher risk of cardiovascular among patients having overt nephropathy or microalbuminuria debates strongly for using aspirin as a basic prevention strategy among some patients. (Joint British recommendations on prevention of coronary heart disease in clinical practice, British Cardiac Society, 2000) Lifestyle Increasing volume of aerobic exercise, stopping smoking and cutting down of excessive consumption of alcohol are significant lifestyle targets. Particularly aerobic exercise has been termed as enhancing insulin sensitivity and decreasing cardiovascular risk among type 2 diabetes. (Tyrrell K, 2003) Conclusion Diabetic end-phase renal disease is a distressing state that can be prevented in some cases and considerably postponed in many. (Tyrrell K, 2003) The discovery of microalbuminuria recognizes a subgroup among patients having higher degree of risk of cardiovascular morbidity and mortality along with diabetic renal disease and belligerent management for such patients can significantly improve and enhance their outlook. (Mokdad AH. 2003) Physicians caring for patients of diabetes must assume meticulous screening and apply effective long-run schedules for controlling glycaemia and hypertension. Cardiovascular risk elements like hyperlipidaemia and smoking should not be neglected. The difficulty and cost of accomplishing such aims can be significant but so are the prospective benefits. (Mokdad AH. 2003) The constant-increasing occurrence of diabetic nephropathy has significant implications for health sources and patient welfare at such time during which renal services are also striving to tackle present demand. (Engelgau MM. 2001) The portentous importance of renal involvement specifically in type 1 diabetes is revealed by the comparison of long-run result among patients without and with nephropathy. (Mokdad AH. 2003) The mortality rates among diabetic patients on end-phase renal failure plans are almost twice for patients with end-phase renal diseases from other such causes. However various treatment strategies have been recognized that postpone progression of renal disease among diabetes that is also related with patient survival. (Lewis EJ, 2003). With present directions setting firm targets aiming to treat nephropathy and also increasing proof that prior interference may provide advantages to this group of patients, it is obvious that there is a dire need for the developing effective applicable strategies. (Engelgau MM. 2001) Reduction in the prevalence of end-phase renal failure among diabetes can have a major effect on economics of provision of health care. Even though aggressive screening procedures along with exhaustive treatment strategies, may incur extra costs, various studies have observed the cost-effectiveness of managing diabetic nephropathy aggressively. (Harris MI, 2005) The application of evidence-established therapeutic interferences in diabetes outside the limitations of a clinical trial has confirmed difficult. One element implicated is that the diabetes patients are not referred to specialist rental clinics on time. (Tyrrell K, 2003) Study made in this regard has demonstrated that most of the patients were not timely referred as the renal failure complications were already present at the time of referral and delayed referral was linked with suboptimal clinical controlling and managing of renal disease. The shifting of care towards professional renal clinics is termed as delaying progression of diabetic nephropathy and ultimately resulting in the development of patient mordibity. 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