The Management Of Diabetes During Primary Care

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

The American Diabetes Association (2004) defines diabetes as a subset of metabolic diseases associated with hyperglycemia secondary to insulin failing to release, act, or both. Complications related to chronic diabetes can be detrimental to one’s health including but not limited to: heart disease, stroke, kidney disease, amputations, blindness, and other optical diseases. Furthermore, the prevalence of diabetes is rising at an astronomical rate within the United States as well as internationally. According to the Center for Disease Control and Prevention (CDC) (2016) an estimated 29 million people suffer with diabetes and 86 million are prediabetic within the United States (US). Without major interventions from the healthcare community,

According to the American Diabetes Association, more Americans die each year from diabetes than from AIDS and breast cancer combined. As a result, researchers have extensively studied the causes, treatments, and interventions for diabetes. Despite efforts to ameliorate its effects, diabetes remains a prevalent danger in society. In 2014, 7% of U.S. adults were living with diagnosed diabetes (Centers for Disease Control and Prevention [CDC], 2016). In Louisiana that number was even higher - 10.4% of adults have been diagnosed with diabetes. Breaking it down by age group, however, in Louisiana 3% of people aged 18 and 44 have been diagnosed, and 15.2% of people 45-64. (Centers for Disease Control and Prevention [CDC], 2015a). Several studies have predicted future rates of diabetes both in the United States and worldwide - nearly all of these studies reached a similar conclusion: rates of diabetes will continue to rise (Boyle et al., 2001).

Costs incurred in the management of diabetes can be categorized as either direct or indirect, direct being the costs incurred in the management of the disease through medication, laboratory tests, physician and nursing care. Indirect cost, on the other hand, includes the cost of incurring a loss of productive individuals since the disease is associated with high mortality and morbidity. Over time the cost of management of diabetes has been rising with the increasing number of new cases of the disease. The cost of care for instance in 1980 ranged between 14 and 20 billion dollars. However, in 2002 the cost had increased to $132 billion, while the cost of managing the disease in the year 2007 was estimated at $174 billion in the United States

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 represents one of the most challenging public health problems of the 21st century and is reaching epidemic levels globally. Nevertheless, it remains seriously under-reported, partly because many people with Type 2 diabetes do not realise they have it (International Diabetes Federation, 2008). Diabetes is therefore one of Australia’s leading issues of concern. Type 2 diabetes was declared a national health priority by the Federal Government in 1997. Type 2 diabetes is costing Australia at least 6 billion dollars per annum. This excessive amount is not only costs the government, but the individual as well. It costs the individual $4,025- $9,645 per annum (Baker IDI Heart & Diabetes institute,

“Worldwide, more than 284 million people have diabetes, and this number is expected to reach 439 million by 2030” (Liebl, Khunti, Orozco-Beltran and Yale, 2015, p. 13). There are several types of diabetes present throughout the population (type 1 diabetes, type 2 diabetes, and gestational diabetes) (Mayo Foundation for Medical Education and Research [MFMER], 2016). “Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body 's important source of fuel” (MFMER, 2016). There is a debate about whether or not Type 2 diabetics would benefit from insulin sooner (Liebl, Khunti, Orozco-Beltran and Yale, 2015). When considering diabetes management there are several things to consider, for instance the cost of medication regimens, diabetes complications, and education on self-management (Liebl, Khunti, Orozco-Beltran and Yale, 2015).

Diabetes mellitus (DM) is not classed as single disorder as it represents a series of conditions associated with high blood sugar which are cased in turn by defects in insulin secretion or the effectiveness of insulin or both. It is usually diagnosed by evidence of hyperglycaemia in a fasting state (>7.1 mmol/l plasma glucose) or threw an oral glucose tolerance test (OGTT)( >11.1mmol/l plasma glucose). It can be diagnosed in adults who are not pregnant by a glycated haemoglobin (HbA1c) level ( 6.5% or > 48 mmol/mol) (NICE 2011).

The incidence rate of diabetes in the U.S is 6.6 per 1,000 population (CDC, 2015). Over the years this health issue has decrease from an incidence rate of 8.5 in 2008 to 6.6 per 1,000 in 2014 (CDC, 2015). However, there is still a long way to go. Diabetes causes more deaths than breast cancer and AIDS combined, thus, making it the seventh leading cause of death in the United States (CDC, 2015). Diabetes is a public health concern and it impacts everyone whether directly or indirectly due to how common it has become. The cost of diabetes contributes to a sum of $245 billion each year (CDC, 2015), which causes a serious burden on the health expenditure and the economy. The objective of Healthy People 2020 in regards to diabetes is to reduce its economic burden and improve the quality of life of individuals that at risk of diabetes (Healthy People,

Type 2 diabetes mellitus, a state of relative insulin deficiency with underlying insulin resistance, accounts for majority of the cases of hyperglycemia worldwide. An estimated 422 million people worldwide have diabetes [1], and this number is expected to reach 592 million by the year 2035 [2]. Almost 30 million Americans (9% of the population) have diabetes, with estimated total health care costs of $245 billion due to extensive complications, primarily micro- and macrovascular pathology.

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,

As the rate of diagnosed diabetes cases continues to increase, health care workers are presented with the challenge of preventing additional cases and managing current cases. It is predicted that nearly 1 out of 3 adults in the United States will be diagnosed with diabetes by the year 2050 (Centers for Disease Control and Prevention [CDC], 2011a). If left untreated, diabetes can lead to life-threatening complications that can affect many organ systems including the kidneys, heart, vascular system, eyes and nervous system. While quality of life is greatly affected, diabetes and its complications also produce a heavy financial burden for both patients and health care institutions (CDC, 2011a). Due to the increase in the number of diagnosed cases

Type 2 Diabetes is rapidly becoming the top health concerns in the United States and a major contributor to health care spending and disability. There are an estimated 22.3 million people

According to the Centers for Disease Control and Prevention (CDC) (2017) an estimated 30.3 million people have diabetes, with greater than 90% having Type Two Diabetes. Compared to non-Hispanic whites, the age-adjusted prevalence of diagnosed and undiagnosed diabetes was higher among Asians, non-Hispanic blacks, and Hispanics during 2011–2014 (CDC, 2017). Of consequence the estimated total economic cost of diagnosed diabetes in 2012 was $245 billion, which reflects a 41% increase from the previous 2007 estimate of $174 billion. Furthermore, diabetes imposes a substantial burden on the economy in the form of increased medical costs and indirect costs from work-related absenteeism, reduced productivity at work and at home, reduced labor

The American Diabetes Association (ADA) conducted a 2012 study measuring the “Economic Cost of Diabetes in the U.S.,” the results showed a $245 billion financial ¬-encumbrance from the use of health resources and lost productivity over a 5 year period (American Diabetes, 2013). The cost amounts “accounts for more than 1 in 5 health care dollars in the U.S.,” and about 62% of cost being covered by government insurance (American Diabetes, 2013). The highest financial burden of health resources included: inpatient hospital care (43%), medications prescriptions to treat complications (18%) and anti-diabetic agents and supplies (12%), the overall shift of financial burden increased 41%