Asthma or Heart Disease or Diabetes

Diabetes

According to Waryasz & McDermott (2009), the global prevalence of diabetes among people aged between 20 and 79 rose to 6.4% affecting 285 million people in 2010 and the rate will rise to 7.7% affecting 439 million people by 2030. Amid 2010 and 2030, the rate of individuals with diabetes will increase by 69% in developing nations, and a twenty percent rate in developed nations. In 2011, the number rose to 366 and it is expected to rise to 552 by 2030. The pervasiveness of diabetes is advanced in males compared to females, yet the number of women with diabetes is more compared to that of men.

Diabetes affects any part of the human body and people with diabetes are likely to die of heart-related problems or stroke. Seventy-percent of individuals with diabetes show signs of high blood pressure which a risk factor for heart-related diseases. The majority of people with diabetes have type 2 diabetes. The stunning rise in the occurrence of type 2 diabetes is being paralleled through an equally alarming rise of obesity. Obesity is one of the common risk factors for type 2 diabetes. The public health community, both international and national, has been very sluggish to acknowledge the huge public health and socioeconomic threats of diabetes and it is ruining complications such CVD, retinopathy, neuropathy and nephropathy.

However, the World Health Organization has recognized diabetes and its large socioeconomic and personal costs as a foremost society and global health problem. The Health Department in New York confirmed that 5, 695 people passed on because of diabetes linked causes in 2011. In every 90 minutes, one person dies of diabetes and sixteen diabetes-related deaths are recorded every day in New York. Diabetes is a major risk factor for life-threatening diseases such as stroke and heart attack, over four million persons die from diabetes every year, and the number is constantly rising with a higher number of diabetes-linked deaths linked to the elderly. These grim statistics are linked to obesity complications given that 85% of individuals with diabetes are overweight.

Pico Analysis

PICO is a technique of combing a search plan that permits one to take more proof-based perspective to literature search.

P: Population or patient

I: Intervention

C: Comparison

O: Outcome

A PICO format is a dependable formula for forming questions, which can be answered and researched easily in a clinical setting. A well-formed question identifies the population or patient's problem, make out the intervention, identify the major alternative that is to be considered and ends with a specific outcome that identifies the plan one wishes to accomplish.

PICO Format

All African-American patients with type 2 diabetes (both males and females) (P) who adapt healthy eating habits, physical activities, lowered hemoglobin A1C values, and self-monitored behavior to reduce T2DM risk factors (I) compared to those who use medical and counseling therapy (C) enhance management of blood glucose through controlling their cholesterol level and blood pressure.

The above PICO Format is founded on the prevalence of type two diabetes and the increased death rates caused by complications of this type of diabetes. The PICO format development was after a thorough assessment of causes, risk factors, complications and management of type diabetes whose prevalence is to further increase by 2030. The majority of people with type 2 diabetes are overweight and conventional therapy seems not to be effective in the management of this type of diabetes. According to a study carried out in 2002 by Karin et al., most patients suffering from type diabetes don not engage in physical activities and they do not follow dietary guiding principles for vegetable, sugar, carbohydrates, fruit and fat consumption. Physical activities enhance dietary habits in people with type 2 diabetes. Weight increases insulin resistance in type 2 diabetes and insulin hold lowered impacts on cells of muscles so that each cell becomes unable to take in the glucose. The glucose remains in the blood where it attains increased levels that are dangerous to one's health. According to Waryasz & McDermott (2009), exercise, diet, healthy conducts and lifestyles are crucial elements of the treatment plan for people with type 2 diabetes, and they call for self-care. Proper utilization of exercise and diet improves glycemic control and insulin sensitivity thereby decreasing the requirement for insulin or oral medications.

Literature Review: Literature Search

To confirm the relevance of the PICO format appropriately, a thorough search for scholarships and peered reviewed journals, which offered to substantiate information regarding the cause, treatment, management, risk factors and complications of type 2 diabetes, was conducted. Among the sources searched and consulted included journals from EBSCOhost, the internet and American diabetic associations. The first research article," Diet and Exercise Among Adults With Type 2 Diabetes: Findings from the Third National Health and Nutrition Examination Survey (NHANES III)" written by Karin et al. is a British Medical Journal searched through the internet. The search used effectiveness of diet and exercise in treating type 2 diabetes as the key words. The article is a primary source that offers the significance of including healthy eating habits and exercises all components of self-care management in the management and treatment of type 2 diabetes.

The second journal article is" Reappraisal of Metformin Efficacy in the Treatment of Type 2 Diabetes: A meta-Analysis of Randomized Controlled Trials." The search utilized causes and treatment of type 2 diabetes from EBSCOhost. This PLoS Medicine journal confirms that metformin treatment alone increases mortality in overweight patients with type 2 diabetes. The article is a primary source that stressed on combined with conventional therapy; self-care, exercise and diet in treating type 2 diabetes in overweight patients.

The third journal" Exercise prescription and the patient with Type 2 Diabetes: A Clinical Approach to Optimizing Patient Outcome written by Waryasz & McDermott (2009) is a review journal article that confirms importance of physical activity, self-care and diet in enhancing the overall well-being and health of patients with Type 2 diabetes. The article is a Journal of the American Academy of Nurse Practitioners, and it is a secondary source searched through EBSCOhost. The fourth article consulted in this research is "Psychological resistance to insulin therapy in adults with type 2 diabetes: Mixed-method Systematic Review." The journal article written by Wang & Yeh (2011) is a primary source derived from EBSCOhost. It confirms the ineffectiveness of insulin therapy alone in treating and managing type 2 diabetes.

Literature Analysis

According to Waryasz & McDermott (2009), the current epidemic of type 2 diabetes is projected to augment to over three million people world word by 2025. The U.S. presently has over 40 million prediabetics aged between 40 and 74, and a great functional reduction will take place in this populace if their condition progress to diabetes. Insulin resistance and poor glycemic control are usually present in type 2 diabetes, besides potential hyperlipidemia, hypertension and preatherosclerosis. Given these complications, these patients are subjected to coronary heart diseases, peripheral vascular diseases, microvascular diseases and cerebrovascular accidents (Waryasz & McDermott, 2009).

Tight glycemic become the objective of and therapeutic regimen to facilitate reduction of the onset of the complications linked to T2DM. Patients with T2DM report knowledge and attitudes of how to obtain improved health, but these patients do not necessarily utilize this knowledge to generate healthier conducts with regard to exercise, weight and nutrition management. Approximately two-thirds of patients with T2DM reports involvement in physical actions, but only 40 to 43% of these patients attain the ADA (American Diabetes Association) physical activity standards. Waryasz & McDermott (2009) assert that stresses on the advantageous role of physical activities for both T2DM patients and their relations lower the risk of contacting T2DM. Augmenting physical activities in the prediabetic populace are twice efficient as standard medical care and metformin in lowering the probability of developing T2DM.

Physical activities lead to 65% risk reduction and reduction in the intrinsic risk of developing T2DM is linked to weight management. Waryasz & McDermott (2009) further asserts that all immunological and biochemical shifts linked to T2DM are not fully comprehensible. Ectopic adipose tissue in the liver, pancreas and muscle increases free fatty acids in the obese and intramuscular adipose deposits depressingly affects the glucose shuttle into the cell. According to Waryasz & McDermott (2009), exercise and healthy eating and healthy lifestyles counter the impacts of insulin resistance, T2DM and obesity. Through a systematic review of existing literature on significance of physical exercises and healthy eating habits (Waryasz & McDermott (2009), ascertains that T2DM is effectively managed through exercise, healthy habits, healthy lifestyles and health eating compared to insulin therapy alone.

Boussageon et al. (2012) through randomized controlled trials assessed the effectiveness of metformin against mortality or cardiovascular morbidity in T2DM patients and their findings indicated that metformin does not greatly influence the major upshots of all-cause mortality and cardiovascular mortality. The authors ascertained that despite the perceived effectiveness of metformin in treating T2DM, its risk/benefit remains indecisive. The treatment increases the T2DM linked mortality by 31% and lowers the reduced rate by 25%, and increases cardiovascular mortality by 64% and lowers it by 33%. Boussageon et al. (2012) assert T2DM is a major health issue given its economic costs and cardiovascular complications.

T2DM is an independent risk aspect for cardiovascular diseases and the rate of these diseases is twice higher in diabetic patients compared to non-diabetic patients. The participants included in Boussageon et al. (2012) study demonstrated ineffectiveness of diet alone therapy as well as the effectiveness and ineffectiveness of metformin treatment. Metformin demonstrated a decline of all-cause mortality in overweight patients. The general results indicated that metformin did not affect the primary ends. The main aim of the study was to assess the clinical effectiveness of metformin in the treatment of T2DM, and the study indicated no proof of the benefits of metformin as regards cardiovascular or all-cause mortality and all diabetes macros-vascular effects.

While metformin lowers the rate of all-cause mortality by 25%, it increases the rate of cardiovascular mortality by 64%. This is a clear indication that medical therapy alone cannot lower the risk factors and mortality rate linked T2DM. Moreover, Boussageon et al. (2012) confirmed that metformin holds no proven effectiveness against microvascular complications. Insulin therapy is also a linkage to a rise in all-cause mortality particularly for patients with heart failure. As a result, insulin therapy and metformin and other medical therapies in the management of T2DM are not effective, they increase the occurrence of cardiovascular death. The only remedy for the treatment of T2DM is involvement of physical exercise, healthy lifestyles, and healthy eating habits alongside medical therapies that calls for self-care management.

Wang & Yeh (2011) utilized a mixed-method systematic review of the effectiveness of insulin treatment in adults with T2DM. While the advantages of insulin in patients with diabetes exist, setbacks in transition to insulin treatment are evident. The researchers ascertained that comprehending the obstacles to insulin from the viewpoint of clients offer information that enhances effective and appropriate care. Wang & Yeh (2012) conducted a review of studies carried out by different researchers and 16 research articles were consulted. The researchers confirmed that most patients with type 2 diabetes do not see the significance of insulin and they actively search for the means to control blood sugars without insulin. People hold holistic attitudes towards upshot of insulin and they view insulin therapy as less practical. Wang & Yeh (2012) assert that most patients with T2DM require insulin therapy given the progressive temperament of their disease. Between 5 and 10% of patients with T2DM experiences failure of oral hypoglycemic agents, require insulin treatment.

However, there is a delay in changing to insulin treatment among patients with T2DM and delay in insulin treatment causes an extensive period of hyperglycemia that augments the probability of complications. According to Wang & Yeh (2012), insulin therapy can cause problems, which include blindness, and as a result, most patients with T2DM prefer seeking other alternative methods to control their blood sugar through embracing self-care. The main objective of medical management of T2DM is to attain an optimal level of blood sugar, which can be controlled through healthy behaviors, healthy eating habits and healthy exercises.

Patients involved in one of the studies cited by Wang and Yeh (2012) indicated that they suffer psychologically because insulin fails to enhance subjective life quality and feeling. The effectiveness of insulin is rated as below average. Other recipients indicated that prescribed insulin depicted that their disease has shifted into a critical phase, an aspect that psychologically, emotionally and socially affects them consequently hindering the effectiveness of insulin. From this perspective, patients should use less emotive, psychologically and socially hurting means to control their blood sugar levels in efforts of managing type two diabetes bearing in mind that T2DM is linked to being overweight and obese.

Karin et al. (2002) conducted a survey on U.S. citizens with type 2 diabetes to determine compliance with physical activities and healthy eating guidelines. The qualitative research engaged multistate and study sample includes African-Americans and Mexican-Americans. Interviews and laboratory tests were used in sample selection where out of 20, 005 selected, 1, 608 individuals had diabetes. While 1, 480 of the selected samples had T2DM and they were obese or overweight. The researchers assessed data from 1, 480 persons beyond seventeen years diagnosed with T2DM. The results from the study indicated that self-care which entails regular exercise, healthy behaviors and healthy diets enhances glycemic control in people with type 2 diabetes. The researchers aimed at ascertaining the benefits and significance of vegetables, fruits and physical activities in the treatment and management of T2DM. Karin et al. (2012) assert that exercise and diet are viewed as important elements of the treatment strategy for individuals with type 2 diabetes. While there is some disagreement over the finest diet for adults with T2DM, there is agreement to augment consumption of vegetables and fruits and lower eating of saturated fats. Moderate-intensity exercise for thirty minutes, five times a week is recommendable for patients with T2DM.

In a study cited by Karin et al. (2002), involving 2000 people with diabetes indicated that the most regularly reported obstacles in the management of T2DM were devoted to exercise and diet. Only sixty percent of persons with diabetes follow a diabetic diet. This is as per findings from the National Health Interview and other studies conducted in the U.S., which indicated that nutrient consumption among persons with diabetes is suboptimal and this increases the number of deaths linked to diabetes and its complications. According to Karin et al. (2002), the majority of persons with diabetes do not attain the national physical exercise goals. However, Karin et at. (2002) claim that the present challenge in management of T2DM is interpreting research results into routine public health and clinical practice efforts to enhance health upshots for all patients with T2DM.