Diabetes-Related Nephropathy: A Case Study

Diabetes is a serious medical condition that can also be a risk factor for the development of many different diseases and conditions including dementia, heart disease, and CVA. Thus, effective management of diabetes is very important. Patient compliance can be difficult to achieve if the person affected with diabetes is not educated about the illness or treatment, has not fully accepted the diagnosis or its severity, will not change habits or believes that the prescribed treatment regime is too difficult or ineffective, has cultural beliefs conflicting with the treatment regime, experiences stressful events, lacks social support, or suffers from psychiatric issues unrelated to diabetes (Gerard, Griffin, & Fitzpatrick, 2010). As one may expect, adequate education programs are essential tools when dealing with diabetics. Solid education will provide the patient with information as well as teaching the necessary skills to manage the disorder. The primary focus of any diabetes education program must be to empower patients as a part of the multidisciplinary team. This team should be focused at integrating diabetes into the lives of the patients and this focus should be based on the decisions made by the patient, otherwise the treatment plan can be looked on as forced (Gerald et al., 2010). Every patient stricken with diabetes has the right to benefit from an education program of this type. First, basic education and facts should be administered directly following the diagnosis of

Diabetes has become an epidemic in today’s society. Diabetes affects almost every system in the body, and with an estimated 346 million people in the world with diabetes, healthcare has been heavily affected by the disease (Ramasamy, Shrivastava, P., & Shrivastava, S., 2013). One of the biggest issues for healthcare workers when it comes to diabetes, is that it is such a complicated disease. With so many different systems being affected, medical professionals have had to learn how the disease process works, what causes diabetes to work through the systems, and the best treatments to address all these issues. Through much research, the healthcare system has grown very knowledgeable on diabetes. One important aspect of treating diabetes has been in the introduction of diabetic education. In the past, nurses and dieticians had been responsible for educating patients on diabetes, but now that role is also extended to other people in the healthcare team, including the patient (Tomky, 2013). In fact, patients taking an active role in the education process, including learning to self-care has now become a priority in diabetes treatment. The following paper will discuss diabetic education, the importance of self-care and how this affects a patient’s compliance.

Uncontrolled diabetes can affect nearly every organ of the body; of which, heart disease and kidney failure are most commonly impacted. Known as diabetes mellitus, a collective term for various blood abnormalities, the term diabetes refers to either a scarcity of insulin in the body or the body’s inability to accept insulin. Though the symptoms of diabetes are manageable, many are unaware as to having it. According to the CDC report “2011 Diabetes Fact Sheet,” approximately 6 million people in the United States have undiagnosed diabetes. Undetected, diabetes can become deadly. In a recent World Health Organization report “Diabetes Action Now: An Initiative of the World Health Organization and the International Diabetes Federation,” it

Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications[ ].

However, only about 50% of diabetes patients in the U.S. receive formal DSME (Nelson, Chapko, Reiber, & Boyko, 2005). Through DSME, diabetics acquire the knowledge and learn the skills necessary for successfully modifying their behavior and self-managing their disease. The intention of educating these patients about their disease and its accompanying conditions is to help them achieve optimal health status, better quality of life, and reduce their needs for expensive healthcare (AADE, 2014). Diabetes education emphasizes on behaviors that are essential to improving diabetics’ health status and quality of life and which are within patients’ control. These behaviors are referred to as the AADE7TM (American Association of Diabetes Educators 7 Self-Care Behaviors) and are summarized in the figure to the right. (Mulcahy, et al., 2003).

This approach has proven to be ineffective for many patients, especially those with limited health literacy. Health care professionals generally value educating their patients, but the teaching often times is left to a brief meeting while the patient is ready to be discharged (Slemmer & Thomas, 2011). The National Diabetes Audit revealed that only 6% of individuals newly diagnosed with DM-2 had been offered an additional structured diabetic education (Hall, 2015). Diabetic self care can be a complicated process that the patient has to live with every day of their life. People that know the risks of non-adherence and have the adequate education in self care show an increased and effective participation in their treatment plan. Lifestyle modifications including diet, exercise, and nicotine cessation have proven to be the most difficult aspect for most diabetic patients to adhere to. The World Health Organization estimates that 50% of people with chronic diseases (such as DM-2) do not adhere to long term care plans that call for lifestyle changes (Hain & Sandy). Diabetes education is vital to properly treat patients diagnosed and can also provide the knowledge and skills to prevent or reverse the course of DM-2. There are many aspects to the successful education of the diabetic patient, but having the access to qualified healthcare professionals obtainable by the opportunity of health insurance is

Diabetes is associated with wide range of complications such as chronic renal failure, blindness, amputations, heart disease, high blood pressure, stroke, and neuropathy (Alotabi, A., et al., 2016). There is no known cure for diabetes, but the disease can be controlled through health management that includes multiple perspectives of care such as medications, blood glucose monitoring, diet, nutrition, screening for long-term complications and regular physical activity (Alotabi, A., et al., 2016). Managing diabetes may be complicated and requires the knowledge and skills of both healthcare providers and the clients. Studies have shown that to prevent or delay diabetic complications due to diabetes, counseling and other lifestyle interventions are the effective therapy. Even with many policies set up for diabetes, 8.1 million Americans are undiagnosed with diabetes mellitus, and approximately 86 million Americans ages 20 and older have blood glucose levels that considerably increase their risk of developing Diabetes Mellitus in the next several years (CDC, 2015). For diabetes care to be successful there needs to be a good understanding of the disease and management by both patients and healthcare providers,

Effective self-management strategies are of obvious importance, and it is critical for achieving diabetes treatment goal.

We advised her about the project and what we intended to discuss and handout. She was very interested in the idea and advised that she have to consult with her staff and get back to us. A few days later, on March 20, 2017, we met with Evelyn once again and explained how we planned to talk with the patient’s and use handout pamphlets to explain how hypoglycemic crisis are so detrimental to an individual’s health. Evelyn advised that it was a great idea to raise awareness of these potentially life-threatening medical conditions to the patients at DaVita Dialysis Center so that they can be more conscious of them when planning to take their antidiabetic medications after their dialysis

Patients has a solid grasp on what diabetes is and how it works. This patient was given diabetes education at first diagnosis and when transitioning from insulin pen to insulin pump. The learner appreciated that we brought her updated print outs on diabetes because she prefers to have information to refer back to and also that her boyfriend and eventually her children could look at. The patient’s motivation to learn came stemmed from her feeling like she had a control on her diabetes and wanting to not have another hospital

Diabetes mellitus has risen to epidemic proportions in the United States, from 1980 through 2011, the number of adults with diabetes has increased immensely from 5.5 million to 19.6 million (Centers for Disease Control and Prevention [CDC], n.d.). Diabetes global prevalence research by Wild, Roglic, Green, Sicree, and King (2004) predicted that, the total number of people with diabetes will rise from 171 million in 2000 to 366 million in 2030. Diabetes has many causative factors that encompass genetic, lifestyle, and environmental categories. Diabetes can vary in different individuals in correlation with their surrounding population and environmental exposures. Individuals who manage their diabetes often need specific plans and counseling.

Diabetic nephropathy (DN) refers to a characteristic set of structural and functional kidney abnormalities in patients with diabetes.1 It is the most important long-term complication of diabetes mellitus (DM). It is a progressive condition with high cardiovascular morbidity and mortality. It progresses in both Type 1 and Type 2 diabetes in a relatively predictable manner through the stages of normoalbuminuria, microalbuminuria and macroalbuminuria which often heralds increasing creatinine as the final manifestation of overt diabetic nephropathy.2 One study at BPKIHS has reported 16.6% prevalence of diabetic nephropathy.3 In another study done at BPKIHS among 177 Type2 DM patients, 14.69% had frank proteinuria, 44.64% had micro-albuminuria and 40.68% were without proteinuria.4 Diabetes nephropathy is now the most common cause of End Stage Renal Disease (ESRD) in United States accounting for 45%.5 From several studies it is seen that ESRD develops in 50% of Type 1 DM individuals with overt nephropathy within 10 years and in >75% by 20 years. In the absence of treatment a greater proportion with patient with Type 2 Diabetes compared with Type 1 Diabetes have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. This is because the disease may have been present for several years before

The first theme was the clients had the attitude of just going on with their lives dealing with the disease. The second theme was that they thought they were fine but then realized they were not. This describes how the need for lifestyle changes was not apparent initially. It was only until complications and co-morbidities began emerging that the subjects realized they were not alright. The third theme is the subjects feel that their only way out is to die. The realization that instead of being able to eat what you want and when you want, now they feel trapped in a never-ending regime where diabetes has taken control and dictates the way they must live their lives. Finally, the last theme is your body will let you know: if you miss it you will wind up in a coma. This attitude towards their illness refers to the feeling they get when they experience a hypoglycemic attack. They realize the body is letting them know they need to eat, otherwise they could end up in a coma. Understanding the thought processes, patterns and behaviors of the older population is imperative and must be taken into account when developing an education model for diabetes self-management. It allows healthcare professionals to get an early start to help guide them gradually through lifestyle changes before serious complications

There are seven essential self-care behaviors in public with diabetes which predict good outcomes. These are monitoring of blood sugar, healthy eating, being actually active, compliant with treatment, high-quality problem-solving skills, healthy coping skills and risk-reduction behaviors.[26].

Therefore, my persuasive presentation began with couple compelling stories emphasizing the need for diabetes self-management program to be initiated by Primary Care Provider. Just for clarification, those two case are not to insult practice of medical professionals but to underscore the imperativeness of education in the population affected by this chronic illness. The first individual whom I encountered along my career as a Diabetes Educator was a female in early twenties who was full of anguish over her new diagnosis of diabetes. Consequently, after couple meetings, she revealed that a few years ago she exhibited symptoms of what she thought was diabetes and after reaching out to her medical doctor her concerns were blatantly dismissed. Subsequently,