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Medical Conditions -- There are a number of factors that can increase the likelyhood of type-2 diabetes: hypertension, eleveted cholesterol, and a condition called Symdrome X, or metabolic syndrome (combination of obesity, high cholesterol, sedentary lifestyle, stress, and poor diet). Cushing's syndrome, cortisol excess and testosterone deficiency are also associated with the disease. Often, it is a number of co-dependent conditions that seem to give rise to diabetes (Jack & Boseman, 2004).
Genetics -- There is ample evidence that there is a strong inheritable genetic condition in type-2 diabetes. In addition, there is a genetic mutation to the Islet Amyloid Polypeptide gene that results in early onset diabetes (Lee & Hasim, 2001). There is a stronger inheritance pattern for type-2 diabetes with a significant association between family members. Typically, this is excacerbated by cultural and lifestyle factors that, while not inherited, are culturally shared. Gene expression promoted by a diet of high fats and sugars results in individuals that a prone to insulin resistance (Don't Blame Your Genes, 2009).
Diagnosis- The World Health Organization has formed a global template for type-2 diabetes as a single raised glucose reading with symptoms, otherwise raised values on two occasions of either: fasting plasmal glucose or with a glocose tolerance test, two hours after the dose of plasma glucose as follows:
< 7.8 (<140)
< 6.1 (<110)
Impaired fasting glycemia
< 7.8 (<140)
>6.1 (>110) & <7.0 (<126)
Impaired glucose tolerance
(World Health Organization, 2006).
At present, there is no academic literature that recommends universal screening for diabetes since there is no evidence that such a program would dramatically improve outcomes. However, screening is recommended by the U.S. Preventative Services Task Force in adults without symptoms that have blood pressure greater than 135/80 or those individuals who show certain symptoms and have high-risk components (Valdez, 2009; U.S. Preventative Services Task Force, 2008). Prevention is clear -- type-2 diabetes can be delayed or prevented through proper nutrition, regular exercise, and attention to body-mass ratio. Intensive lifestyle measurement may reduce the risk by over 50%, and are shown to be far more effective than medications (Rispin, Kang, & Urban, 2009).
Theoretical Basis -- The cost of type-2 diabetes in the United States rose from $44 to $92 billion in just five years. This was the equivalent of 20+ years of aging. Combine this with a reduced ability to work (individuals pay taxes, purchase products, etc. And contribute to the overall welfare of the system), and the fact that most individuals with type II diabetes are not receiving the care necessary and we see that there are massive considerations involved. And, if wealthier countries are unable to handle this burden, how can one expect developing countries, which represent the largest portion of countries with this rising problem? (American Diabetes Association, 2009)
We now know that obesity is one of the major contributors to this problem, but what are the factors that contribute to this rise in obesity -- particularly in developing countries? Ironically, it seems that the process of globalism has a darker side, as does the technological access to the Internet. On one hand, sharing of cultural information, the ability to communicate globally, and the ability to receive goods and services from virtually anywhere in the world is a positive way to bring the world's populations closer together. Of course, one of the basic theories promoting globalism is that countries that actively trade with one another rarely make war. Certainly, as the Third World has had access to media and western goods, their desire for more of these products has increased. Additionally, greater urbanization and a change in the lifestyles of the global workforce contribute to the increase in risk factors as well. There are several factors that are a direct result of modernization and globalization, however, that contribute significantly to the problem:
More women in the workforce combined with a move towards cities causes a population that adopts less healthy eating styles (fast food, etc.).
Since people work more, they tend to eat away from home more; lack of home prepared food puts the population at risk.
Fresh fruits and vegetables are now more expensive than fast food; this trend continues because of fewer rural producers
Lesser quality foods with higher caloric value are cheaper and consumed more because of ease (example, pastries for breakfast, starchy empty caloric foods for lunch, etc.)
More indoor work using more time often translates into less outdoor physical activity.
All these factors have one thing in common -- they actively contribute to obesity and are very much a part of the developing world. These are economic realities, and changes in these macro-paradigms are not only difficult, but require the buy-in of the sociopolitical structure as well as the populace. In developed countries, for instance, many school systems have banned soft drinks and candy from campuses, and First Lady Michelle Obama has announced an initiative fighting childhood obesity. She, too, is calling obesity an epidemic and one of the greatest threats to the future health of the United States. Her approach is multifaceted, concentrating on education, availability of healthy foods, and exercise programs for youth so that children become habituated into healthier eating and exercise regimes (Hellmich, 2010). While this process may work in the EU and United States, and is quite necessary to combat one of the highest rates of obesity in the world, the infrastructure and fiscal ability to put a program such as this into place for the developing world remains problematical.
Madden, Loeb and Smith (2008) found that there are a number of issues when discussing lifestyle changes on a global scale that support our study on diet, exercise and intervention. However, when dealing with a global population, culture and the attitude towards food and exercise changes. Although the results from this study are primarily in the form of a meta-analysis and do not lend themselves to statistical analysis, they are nevertheless appropriate indictors to help understand that the issues faced on type-2 diabetes are non-country specific. Similarly, research also shows us that if a robust use of Diabetes Knowledge tests are used as a preliminary and follow up measures there is a far more likely chance of: a) the information and indicators sticking with the patient, and b) a longer-term (1 year or more) follow through on interventions. It is through these measures that the appropriateness of combining three intervention strategies was considered appropriate (Sigurdatdottir, et.al., 2009). These studies are included as follows:
What are the measurable and effective paradigms of using educational interventions for people with Type-2 diabetes?
Types of Type-2 diabetes prevention programs as meta-analysis in literature.
Random study using questionnaires and valid diabetes knowledge measurement tools
Large scale meta-analysis, literature review
2005-7, 5 different diabetes clinics, randomized
Use of database and review of scholarly literature
Weight, BMI, waist circumference, hemoglobin level, psychological measures
Diet, exercise, diet plus exercise, counseling.
Standard diabetes tests, basic statistical analysis
Comparative literature review.
SPSS and standard statistical analysis
The more knowledge the longer and more robust patients will remain on intervention program.
Diet and exercise are effective, but with added counseling, more effective. Cultural bias occurs and is variable.
Measurable Outcomes That Coincide with Project
Knowledge (through training and counseling) is an important component in long-term type-2 diabetes control.
A three part approach is more effective than just diet and exercise, even combined.
Management of Diabetes Type 2 -- Typically, recommended management for type-2 diabetes focuses on lifestyle interventions, lowering cardiovascular risk factors, losing weight, and maintaining blood glucose levels in the normal range. The National Health Service recommends self-monitoring, but regular checks of hypertension, high-cholesterol and microalbuminuria drastically improves a person's life expectancy (Rispin, Kang, & Urban). Oddly, intensive blood sugar lowering does not appear to change mortality (Boussageon, 2011).
Exercise (aerobic) yeilds the best results in improved inslin sensitivity and, when combined with resistance training, is even more effective. A diabetic diet that promotes weight loss is important. The actual type of diet remains controversial, but a low glycemic regime improves blood sugar control. Additionally, cultural appropriate education may help individuals create, and retain, a more healthy lifestyle and diet (Davis, Forbes, & Wylie-Rosett, 2009).
Literature Review -- Previous Studies- One of the common factors in Type-II diabetes is the increasing predominance in children. Studies show this is primarily caused from diet and lack of exercise. More than anything else, Childhood Obesity is a direct result of lifestyle and overeating. Children of today tend towards highly refined products with heavy sugar content, sugary sodas, and snack foods with high carbohydrates and low nutritional value. When combines with a greater sedentary lifestyle, for example, splaying games on the internet instead of working out. Most children, in fact, fail to exercise because the prefer stationary ones: computer games, internet surfing, chatting…[continue]
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Yet they gained tremendous benefits from the diabetes prevention program. It reduced the risks at 71% by choosing a moderate lifestyle. Good health could allow 20 more years to those over 65. It showed that lifestyle intervention dramatically decreased the risks of diabetes. Regular exercise was an important component of the management of Type II diabetes. It kept the weight down. The lack of exercise brought the weight up.
ACE INHIBITORS vs. TIGHT GLYCEMIC CONTROL Diabetic Nephropathy Diabetic Nephropathy: ACE Inhibitors vs. Tight Glycemic Control Diabetic Nephropathy: ACE Inhibitors vs. Tight Glycemic Control Proteinuria is considered a risk factor for end-stage renal disease and coronary artery disease, secondary to diabetes (reviewed by Tan, Jaung, Gamble, & Cundy, 2014). The recommended treatment approach relies on angiotensin-converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB), with the goal of proteinuria remission and the control of
This ahs some relevance to the PICO question in the ability of individuals to provide proper self-care, but it does not address the issues of diet or exercise at all. The Two Best The two most relevant articles that were uncovered during this research process in regards to the specific PICO question identified above were Gulve's 2008 article concerning the effects of different exercise types on glucose levels, and the Mayo
Diabetes and Obesity: What Are the Choices? Diabetes is becoming an increasingly serious health problem across the United States, and indeed across the world. The majority of cases of diabetes, both in terms of new diagnoses and of current cases, are those of Type II diabetes, which is a condition generally brought on by overweight or obesity and lack of exercise, that prevents an individual's body from being able to metabolize
40 43 23 16 12 10 0.50 42 22 15 12 10 0.70 51 27 19 15 13 0.90 66 47 38 32 Can you apply this valid, important evidence from a systematic review in caring for your patient? Do these results apply to our patient? Is your patient so different from those in the study that its results cannot apply? No, the majority of the patients who are diagnosed with Type II diabetes are indicative of the patient issues in the study. In fact, most fall well within the parameters of the study potential, which
In Vallejo, however, because of the Hispanic ethnic background of much of the population, there is a profound, healthy, and deeply culturally ingrained appreciation for the sport of baseball. Thus, to foster this interest, expanding the Little League and offering financial support to existing community organizations is one of the physical activity components of the action plan designed for the area ("Children and Weight: Taking Action in the Vallejo Community,"
Researchers used this information, and designed it in such a way that it fit in with the lifestyle that this population was accustomed to (Acton, Shields, Rith-Najarian, Tolbert, Kelly, Moore, Valdez, Skipper, & Gohdes, 2001). This allowed the researchers not only to study the population more closely, but also to achieve a major degree of success that might not have been possible in a standard intervention program. The study found