Chronic hyperglycemia management: hospital-based care versus nurse practitioner assistance

Hyperglycemia

Chronic Hyperglycemia:

Management and Care

Because of the growing world population suffering from chronic hyperglycemia, or diabetes, diabetes remains a hot topic in medical research. Much of the research and study focuses on management and care. In this paper, I will examine key studies influencing diabetes management, including home-based or hospital-based care, NP and PA assistance, and the use of modern management methods like telehealth. I will also examine key studies influencing diabetes care, including exercise, insulin pump therapy, and PKC-? inhibitors.

One of the fastest-growing medical problems facing the world today is chronic hyperglycemia, or diabetes. Although diabetes is found in nearly 30 million people over the age of 65, it is rapidly materializing in adolescents and even children (White, 2006). Hyperglycemia occurs when a disproportionate amount of glucose is distributed throughout the blood plasma. Excess glucose may have several causes, including genetic cases of diabetes mellitus, eating disorders such as bulimia nervosa, or times of psychological stress. Because of the multitude of causes, significant attention is beginning to be focused upon the management and care of the disease.

While past treatment of diabetes has been limited to insulin injections, recently other options have become available. It is this influx of medication that has further instigated the research and development of diabetes management and care. Many scientists have endeavored to find the optimal path for patient management and/or care. In this paper, I will chronicle several of these studies.

Diabetes Care

Perhaps one of the most established methods of care beyond insulin injections, particularly in type I diabetes, is aerobic exercise. The long-term effects of aerobic exercise in patients may be more beneficial than just insulin and dietary refinements alone, as suggested by Rajprasad Loganathan in his study "Exercise-Induced Benefits in Individulas with Type I Diabetes" (2006). By observing diabetic animal models, Loganathan concluded that the beneficial effects on diabetic tissue was a result of cellular mechanisms revealed through exercise. He suggests, then, that "exercise training leads to improved tissue function by targeting specific adptive mechanisms in diabetes, especially when initiated at the early stages of the disease" (p 77). Thus, long-term aerobic exercise remains one of the most proffered treatments for diabetes.

Because aerobic exercise is self-motivated and may not be appropriate for patients with more progressive forms of diabetes, however, healthcare providers rely on many other, clinical treatments, the most prevalent of which is insulin injections. Since its inception as a treatment for diabetes in the 1920s, insulin treatments have been painstakingly refined and developed. One of the more recent developments is the use of insulin pump therapy. In her study, " Experiences of Parent of Young People with Diabetes Using Insulin Pump Therapy" (2008), Valerie Wilson examined the experiences of patients currently incorporating pump therapy in their diabetic care plan. According to her findings, Wilson found that within a group of parents of 44 children and young people, "in addition to improving gylcaemic control, insulin pump therapy offers flexibility, choice, and a better quality of life" (p. 14). The results came from a collection of self-completion questionnaires received by the parents of the patients via both electronic and postal venues. In her report, Wilson states that many healthcare providers remain reluctant to incorporate pump therapy, due to patient acceptance, safety, and efficacy. Despite these concerns, nouveau administrations of insulin continue to emerge in the world of diabetic care.

Many treatments in use today, however, reach beyond the means of insulin. Currently, much focus has been placed on protein kinase c-? (PKC-?). Because of its link to the development of adverse effects associated with hyperglycemia, such as retinopathy and nephropathy, many suggest that regulation of this particular protein may aid in reducing further deterioration in diabetics. Two such scientists are Yuzuru Ohshiro and Nobuyuki Takasu. In their study, "Role of Protein Kinase C-? Activation in Diabetic Nephropathy" (2007), Ohshiro and Takasu propose that in the near future PKC-? inhibition may be combined with standard treatments. These findings were the result of a series of clinical studies as well as observations of diabetic animal models. Ohshiro and Nobuyuki report that "the overactivation of the PKC-? isoform appears to play a critical role in diabetic complications" (64). Further, the specific PKC-? inhibitor RBX has proved to be effective against retinopathy as well as nephropathy. Thus, PKC-? inhibitors are part of the most modern methods of treating hyperglycemia.

As on may easily see, treatments, like the use of RBX, are continually being developed to effectively care for diabetes. Other treatments, though effective, have caused harsher problems for some patients. One such treatment that has been prevalent in recent years is the administration of thiazolidinediones. Thiazolidinediones, sometimes called glitazones, was introduced in the late 1990's as an adjunctive therapy for diabetes. Curt D. Furberg, MD, PhD, professor, Departement of Public Health Science, Wake Forest University School of Medicine, Winston-Salem, NC has found that glitazones are particularly precarious for patients with a family history of heart failure. In randomized studies, heart failure was apparent, regardless of drug dosage (Davis, 2007).

Conclusion

Because occurrences of diabetes continue to increase rapidly around the world, diabetes management and care will remain a hot topic in medical research and study. Researchers will persist in studying the questions between home-based and hospital-based management, NP vs. PA assistance, and over specific diabetic care techniques. Further, as new studies continue to develop, such as those concerning PKC-? inhibitors, new and better treatments and care plans will emerge to be used in conjunction with classic exercise and insulin for patients with diabetes. It is this constant influx of study and development of treatment that has kept and will maintain the interest in chronic hyperglycemia.