Diabetes is a group of metabolic diseases in which the level of blood glucose in patients increases drastically after caloric intake. The main cause of the disease is either the insulin production in the body is non-sufficient or the body cells do not respond to the insulin, or both. Polyuria, polydipsia, and polyphagia are the symptoms of the diabetic patients i.e. frequent urination, high thirst, and high hunger. Moreover, pre-diabetes is a condition in which the blood glucose level of the patients remains normally high but not high enough that it is ranked as diabetic. There are three types of diabetes:
Type 1 – insulin independent
Type 2 – insulin dependent
Gestational – occurs during the pregnancy of females
Diabetes has been considered as the deadly and devastating disease over 2000 years ago. It was referred to as a disease in which the body fluids channel out of the body, though the actual cause of the disease was not known at that time. The disease was diagnosed with simple techniques earlier. Back in the history, patients dying with the disease were seemed to be “Air Hungary” which was scientifically termed as “Internal Suffocation.” As the patient gasped the air due to carbon dioxide accumulation, a sweet smell lingered through the air followed by the diabetic coma . This is now considered as the non-scientific deduction of the disease.
With the advances in science, the causes and cures of the disease were started becoming known. Initially people used to slaughter the animals to get their pancreas for the extraction of insulin, which is lacking in the patients of diabetes. Animals such as guinea pigs and sheep were used for this purpose, but slaughtering animals for this purpose had some moral and ethical issues. In addition, the patients who were injected insulin extracted from the animal pancreas developed certain allergies, as their body reacted against the insulin proteins because of it being non-self .
How is diabetes screened and diagnosed?
Every individual is at a risk of this disease because of the poor dietary habits of the American citizens. Screening of the DM should be timely done even in the non-diabetic patients and normal individuals. People having family histories of the disease should be screened after every six month. The standard chart of the diabetes is as follows:
Blood glucose concentration in the blood after 8 hours or more of meal >126 mg/dL.
Glucose concentration >200 mg/dL 2 hours after in taking 75-g oral glucose.
Symptoms of hyperglycemia and random plasma glucose concentration >200 mg/dL or
AIC level >6.5%
The presence of impaired glucose tolerance is predicted using blood glucose levels given as the above points. For AIC, an oral glucose determinant test is used for diagnosis. Pregnant women having the risks DM should be screened during earlier prenatal visit. During 24th to 28th weeks of gestation, regular gestational screening should be done .
How is Pre-diabetes Managed?
First and foremost thing to treat the patients with pre-diabetes is to manage the weight lose by 5% to 10% of the body if he/she overweighs. Moderate physical activities like walking for at least 150 minutes a week is very helpful . Certain physicians suggest the organized lifestyle change programs for the DM patients, which help them in weight loss efforts.
What are the glycemic treatment goals of DM?
Outpatient glucose targets for non-pregnant adults
Inpatients glucose targets for non-pregnant adults
Outpatient glucose targets for pregnant subjects
How are Glycemic Targets achieved for Type 2 Diabetes?
Therapeutic lifestyle changes
Antihyperglycemic pharmacotherapy for T2D
How should glycemia in Type 1 Diabetes be managed?
Multiple daily injections usually involve 1-2 subcutaneous injections daily.
Continuous subcutaneous insulin infusion.
How is hypertension managed in patients with Diabetes?
The blood pressure goals vary from person to person in the case of Diabetes. Normal blood pressure is generally about 130/80 mmHg . Dietary intervention helps control the blood pressure, low intake of salt in the diet, physical activity can be checked with the help of general physician.
How is Obesity Managed in Patients with Diabetes?
Obesity is diagnosed via Body Mass Index. Individuals with BMI > 30 kg/m2 are considered obese . Obesity is directly linked with the diabetes. The more obese an individual is high chances of diabetes because it applies pressure on the pancreas, which stops producing insulin in the body.
When and how should insulin pump therapy be used?
Patients with Type 2 Diabetes Mellitus depend on the synthetic insulin injected into the body . These patients are highly dependent on the insulin, without insulin; there is no other way for the survival of such individuals.
Which vaccinations should be given to patients with diabetes?
Centers for disease control and prevention advisory committee on Immunization Practices supports the recommendation that patients suffering from diabetes can be immunized with pneumonia and influenza infection. Age factor is of high consideration in the vaccination process . Tetanus, measles, mumps, rubella, polio, and chicken pox vaccines can be given to the DM patients. Mostly DM patients over age of 60 years are given vaccinations based on risk assessment.
How should depression be managed in context of diabetes?
Depression amongst the patients of diabetes can be screened and treated by the mental health professionals who are the members of DM care team.
The above summary of the consulted article which talks about the clinical practices and measures for the Diabetes Mellitus gives us a clear idea of how does it all work. It tells us in detail that the current practices involve treating the Diabetes Mellitus is extremely important. There is no possible alternative available right now to monitor and treat the disease. Undoubtedly, there is potential to further improvise the practices.
Scope and Purpose
For the purpose of critique, 2015 clinical practice guidelines for developing a diabetes mellitus comprehensive care plan was considered which was an update of 2011 American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a Diabetes Mellitus . The paper developed a link of the disease with the micro and macro vascular risk rather than just focusing on mere glycemic control. All sorts of risk factors including cardiovascular risk, coagulation, hypertension, high lipids intake are covered in this paper. Furthermore, the topic also covered obesity; sleep disorders cancer risk, depression among the patients of DM, expanded information on vaccines, hypoglycemia, and weight lose of DM patients. The main objective of this paper is to educate people about the medical care and clinical practices of DM. It also helps the DM patients in decision-making associated with Diabetes Mellitus . The population most affected by the diabetes is obese group of people. As the 2/3rd of American population is obese, so the diabetes is highly prevalent in such population.
The paper discussed different clinical aspects of the diabetes mellitus:
It is highly recommended that the work setting where the clinical practices are performed should be conducive with the promotion of health activities. An extensive range of the stakeholders is interested in the physical activity and diet interventions at the work place. Employees, employers, company, insurance funds, trade unions, labor, and ministers of health are considered as the stakeholders in a work area associated with the health care clinical practices. Stakeholder’s involvement is due to the compulsion, altruism, investment and lost opportunity.
Rigor of Development
Self-management is an important thing when we talk about the clinical practices of Diabetes mellitus. The recurring changes in the health of diabetic patients depend on the choices that the individual make. Around 23.6 million people in US are suffering from diabetes . Dyslipidemia, hypertension, cerebrovascular, cardiovascular, and obesity are highly linked with diabetic and pre-diabetic patients. Moreover, there are not yet identified ways to delay and prevent the T1D, while studies suggested that T2D could be prevented and delayed. Undoubtedly, screening people with the diabetes is the first step in preventing the disease. Diabetic educators encourage the patients to incorporate self-care behaviors in their life like, being active, healthy eating, taking medications, monitoring, problem solving, healthy coping and reducing risks. Diabetes educators keep themselves updated and critically evaluates and meets the challenges of the patients.
Clarity and Presentation
The clarity of the paper is extremely good, as almost all the people who read, could comprehend it. The presentation of the article is in the form of the questions, which gives a reader a clear picture of the clinical practices of DM. The Diabetes is most prevalent in the certain group of people. There is a high risk of diabetes in the patients of specific occupations. People who operate vehicles like bus, truck, ferry, or airplane are more prone to the diabetes mellitus. These clinical practices can further be improved from person-to-person basis. As the above-mentioned criteria tell us about the effect of different factors on the diabetes, different groups can be organized to publically inform the people about diabetes. Actions can be taken at the state level i.e. hospitals, clinical centers, medical care units should encourage the diabetic people to make their life history and disease history charts for the public display. This is no more a devastating disease because the cure is already known of this disease. Some inspirational stories can attract the patients to the clinical practices of diabetes. In this way, the article enlists the recommendations clearly. Each point mentioned is easy to understand and comprehend. In fact, all recommendations are subjected to all kind of audiences.
As mentioned earlier, the article describes the monitoring, diagnosing and screening techniques in detail. However, with each technique the article also highlights the cost-effectiveness as well. In some cases it gives a number of options and then leaves the deciding power to the reader as per his price considerations. The article also highlights the fact that certain techniques are associated with higher healthcare costs and short-term disability. Hence, all the choices must be very careful and they must be made with a physician consultancy.
There is no conflict of interest between the author and the funding body. The clinical practices for the diabetes are majorly acceptable around the world having similar clauses.
Diabetes is a chronic yet complex ailment requiring multifactorial risk lowering strategies beyond glycemic control. The recommendations consist of diagnostic, screening, and therapeutic actions, which are possibly believed to affect the patients with diabetes. Many of these measures are considered to cost-effective. These recommendations are specific for the respective group of people. The important thumb rule is that all type of diabetes is treatable. Patients with type 1 are treated with regular injections, special exercise, and diet. Patient with type 2 are usually treated with tablets, special diet and exercise but sometimes insulin injections are also recommended. The recommendations are important because if the diabetes remained untreated it leads to the complications like foot complications, eye complications, skin complications, mental health, heart problems, and hypertension. .
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