Assessment 2 Instructions: Change Strategy and Implementation

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Change Strategy and Implementation

According to the National Institute of Diabetes and Digestive and Kidney Diseases approximately 20% of the American population is afflicted with diabetes (Edmonds et al., 2021). Consistently high blood glucose levels are a hallmark of diabetes, a metabolic disorder in its own right. The circulatory system, eyes, neurological system, endocrine system, and internal organs are all vulnerable to complications caused by diabetes. The characteristic feature of diabetes is persistently high blood glucose levels. High blood glucose levels that do not go down might make diabetes harder to control. Types I, II, and gestational diabetes account for the vast majority of cases of diabetes mellitus. Insulin production is completely absent in those who have type 1 diabetes. After adjusting their insulin dosage, nutrition, and exercise routines, people with type 1 diabetes may lead quite normal, active lives. The great majority of instances of diabetes are type II. Insulin is ineffective for those with type II diabetes. Without oral medicine or insulin, a healthy lifestyle with frequent exercise and a balanced diet may be all that's needed to keep type II diabetes under control. There is a high risk of developing gestational diabetes in every pregnant woman, regardless of her family history of the disease. Like type 2 diabetes, this condition has a treatment protocol (McIntyre et al., 2019).

Diabetic issues, albeit prevalent on a global scale, get very little focus. It is considered the worst pandemic in human history because to its massive global prevalence and the enormous costs associated with treating and studying it (Pradeepa & Mohan, 2021). Death toll from diabetes exceeds 1.5 million per year, affecting 422 million people worldwide. Countries with moderate or low per capita incomes are home to the great bulk of these individuals. By 2025, the World Health Organization aims to have achieved worldwide prevention of diabetes and obesity (World Health Organization, 2019). The enormous challenge of finding ways to make individuals with diabetes live longer and better lives requires a lot of planning and discussion. Healthcare providers, patients, and loved ones all need to know as much as possible about diabetes and how it affects the body. Being aware of the consequences of disregarding diabetes is a crucial part of controlling the condition.

Kidney Disease and Diabetes

People who have type 2 diabetes are at increased risk for developing chronic kidney disease (CKD). Life expectancy and quality of life may be considerably affected by a diagnosis of chronic kidney disease (CKD), according to Krishnan et al. (2020). Dialysis and kidney transplantation are options for patients with severe renal failure. Controlling blood sugar levels, eating well, and keeping a healthy weight are three things diabetics may do to reduce their risk of chronic kidney disease (CKD) (Elshahat et al., 2020).

Depression and Diabetes

After hearing that you have diabetes, you may experience a range of emotions, including anxiety, depression, and frustration. These emotions could set off a depressive episode. Depressive symptoms may last in persons with diabetes for as long as the disease remains a chronic condition. Elshahat et al. (2020) found a link between mental illness and harmful eating habits, inadequate exercise, and high blood sugar levels. Individuals with diabetes have a greater frequency of depression compared to the general population.

Change Strategies

Knowing what diabetes is and how to acquire a diagnosis is crucial for individuals with the disease. In order to manage and control diabetes, education is key (refer to appendix 1). Everyone from the individual with diabetes and their loved ones to the diabetes care team, the community, and lawmakers all have a part in the educational process (Youssef, 2021). Diabetes patients might benefit from healthcare providers' provision of health education resources in many media forms (Litchfield et al., 2019). Important aspects of diabetes care include educating patients on the need of a healthy diet, regular exercise, taking medicines as directed, and stress management. One way to gauge a patient's familiarity with diabetes is using the Diabetes Knowledge Questionnaire (DKQ-24). There was a 60% success rate out of 50 individuals who took the DKQ-24 in that trial. Diabetes education has already been provided to the great majority of these people. Research by Tan et al. (2019) shown that education is crucial for reducing the impact of this health issue. To better educate people with diabetes, a multidisciplinary group is required. The group would consist of family doctors, nutritionists, nurse educators, and primary care physicians. If deemed essential, a podiatrist and endocrinologist might be involved.

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Maintaining healthy feet is a top priority for diabetes patients. Proper footwear and consistent foot care may reduce the risk of diabetic foot ulcers and amputations. A podiatrist or nurse can teach you everything you need to know about foot care. The group's foundation is a dietitian's guidance and diabetes education. By delineating the fundamental principles of a well-balanced diet, this assists folks in acquiring the ability to manage their body weight and prevent perilous fluctuations in blood sugar levels. Diabetes experts not only diagnose and treat patients, but also provide education on proper blood sugar monitoring and adherence to medication instructions. Having access to this interdisciplinary team helps both the patient and their primary care physician manage diabetes more efficiently (Miller-Rosales & Rodriguez, 2021).

Encouraging patients to have faith in their healthcare providers and the support of their families may help them cope better with a diabetes diagnosis and the necessary lifestyle changes. Feeling supported increases, the likelihood that the patient will cooperate with therapy. Smokovski & Smokovski (2021) include renal failure, cardiovascular illness, blindness, and amputation as potential consequences of untreated diabetes. Patients with diabetes may have a higher quality of life if they get education on blood sugar monitoring, drug importance, symptom management, and overall disease management. Before starting training, it is crucial to determine the patient's present educational level. Regular evaluations of improvement should be done as well. Issues may arise if patients struggle to acquire new material. To find the most effective way to educate in these scenarios, teachers should collaborate with their students.

The patient may need to take medicine to alleviate their depression symptoms. Psychotherapy may also be useful. Another such resource is social support groups. Maintaining a healthy mind is as crucial as taking care of your body when you have diabetes (American Diabetes Association. (2021). Some individuals refuse treatment completely, while others vehemently deny they have a problem. Perhaps they are too embarrassed or awkward to express their true feelings. 

Poorly treated diabetes may lead to severe repercussions, such as renal and cardiac damage, vision loss, limb amputation, or even fatality. Patients' likelihood of survival increases significantly when they are provided with precise knowledge on the perils associated with diabetes. Patients with depression as a result of the emotional and physical toll that diabetes may take are healthcare providers' top priority when it comes to improving their quality of life. Education and healthcare should not be mutually exclusive opportunities for people based on their financial level. When a patient's reluctance or incapacity to pay for medical care is a predicate, the risk of bad consequences is increased. Everyone coping with diabetes or a condition connected to it would benefit from easier drug access and comprehension. Establishing a relationship grounded in trust and mutual respect may create an environment where the other person may feel more at ease in discussing their challenges. Individuals afflicted with mental health illnesses often avoid seeking aid and participating in support groups as a result of the shame and guilt they experience while seeking therapy. Patients with diabetes who received care from interdisciplinary teams had better outcomes.

References

American Diabetes Association. (2021). 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2021. Diabetes Care, 44(Supplement_1), S53-S72. https://doi.org/10.2337/dc21-S005 

Edmonds, M., Manu, C., & Vas, P. (2021). The current burden of diabetic foot disease. Journal of clinical orthopaedics and trauma, 17, 88-93. https://doi.org/10.1016/j.jcot.2021.01.017

Elshahat, S., Cockwell, P., Maxwell, A. P., Griffin, M., O’Brien, T., & O’Neill, C. (2020). The impact of chronic kidney disease on developed countries from a health economics perspective: a systematic scoping review. PloS one, 15(3), e0230512. https://doi.org/10.1371/journal.pone.0230512

Krishnan, A., Teixeira-Pinto, A., Lim, W. H., Howard, K., Chapman, J. R., Castells, A., ... & Craig, J. C. (2020). Health-related quality of life in people across the spectrum of CKD. Kidney international reports, 5(12), 2264-2274. https://doi.org/10.1016/j.ekir.2020.09.028

McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019). Gestational diabetes mellitus. Nature reviews Disease primers, 5(1), 47. https://doi.org/10.1038/s41572-019-0098-8

Miller-Rosales, C., & Rodriguez, H. P. (2021). Interdisciplinary primary care team expertise and diabetes care management. The Journal of the American Board of Family Medicine, 34(1), 151-161. https://doi.org/10.3122/jabfm.2021.01.200187  

Pradeepa, R., & Mohan, V. (2021). Epidemiology of type 2 diabetes in India. Indian journal of ophthalmology, 69(11), 2932. https://doi.org/10.4103/ijo.IJO_1627_21

Smit, D., Vrijsen, J. N., Groeneweg, B., Vellinga-Dings, A., Peelen, J., & Spijker, J. (2021). A newly developed online peer support community for depression (depression connect): qualitative study. Journal of Medical Internet Research, 23(7), e25917. https://preprints.jmir.org/preprint/25917 

Smokovski, I., & Smokovski, I. (2021). Impact of Diabetes Complications. Managing Diabetes in Low Income Countries: Providing Sustainable Diabetes Care with Limited Resources, 25-37. https://doi.org/10.1097/MED.0000000000000642 

Tan, E., Khoo, J., Gani, L. U., Malakar, R. D., Tay, T. L., Tirukonda, P. S., ... & Tang, T. Y. (2019). Effect of multidisciplinary intensive targeted care in improving diabetes mellitus outcomes: a randomized controlled pilot study–the integrated diabetes education, awareness and lifestyle modification in Singapore (IDEALS) program. Trials, 20(1), 1-10. https://doi.org/10.1186/s13063-019-3601-3 

World Health Organization. (2019). Classification of diabetes mellitus. https://apps.who.int/iris/bitstream/handle/10665/325182/9789241515702-eng.pdf

Youssef, G. A. (2021). 2019 Health Care & Education Presidential Address: It’s All About Access!. Diabetes Care, 44(1), 1-7. https://doi.org/10.2337/dci20-0050

Zelnick, L. R., Batacchi, Z. O., Ahmad, I., Dighe, A., Little, R. R., Trence, D. L., ... & de Boer, I. H. (2020). Continuous glucose monitoring and use of alternative markers to assess glycemia in chronic kidney disease. Diabetes Care, 43(10), 2379-2387. https://doi.org/10.2337/dc20-0915

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Appendix 1

Table 1: Current Outcomes, Change Strategies and Expected Outcomes.