Chronic Disease Health Promotion and Maintenance/for adults age 35–65
Chronic diseases, in addition to the negative impact on an individual quality of life can have some serious economic implications for both the patient and the population. Diabetes is one of the chronic health conditions that can have serious health complications when not managed properly. In this paper, one of the chronic conditions identified is diabetes mellitus which include type 1 and type 2. The World Health Organization (WHO) perceives diabetes as one of the most significant reasons for preventable mortality, morbidity among non-transferable diseases around the world ( Thapa et al. 2019). In the primary care setting the effective management of this chronic condition is crucial to help prevent negative outcomes.
Concepts of health promotion
The concept of health promotion was developed as another way to address the challenge of health maintenance and improvement and has also offered a new way of thinking about health with a strong emphasis on its understanding and not only on avoiding diseases (Duplaga, 2015). In the primary care setting, the role of the primary care provider is to ensure timely screening, identify Individuals at risk to develop chronic diseases. According to Kamran et al. (2015), Pender’s health promotion model includes three groups of elements, personal attributes, and experiences and include two structures, previous related practices, and individual factors, behavior-specific cognitions and affect which are indicative of the main and most importantly behavioral motivation and outcomes of behavior. This concepts also gives the individual the ability to take more control over their health and to avoid behaviors that have negative impacts.
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The prevalence of diabetes varies by age, gender, race, dietary patterns, and hereditary and ecological factor and other hazards for diabetes include those in urban and rural areas, smoking, lack of physical activity and hypertension are among the risk factors for diabetes (Gedik & Kocoglu, 2018). In many cases, not all individual will experience diabetic symptoms. One in 12 people around the globe have diabetes, and 50% of those patients are unaware of their disease status (Porath, Fund & Maor, 2017). Primary care providers must incorporate clinical practice guidelines and evidence based practice to encourage individuals to adopt lifestyle behaviors for the prevention of comorbid health conditions.
Individuals between the ages of 35 to 65 regardless of health risk factors must be screened for diabetes during their annual examination. One of the screening approaches is trough laboratory work up. The American Diabetes Association recommends yearly screening for diabetes in patients over than 45 years and in younger patients with significant risk factors (Karly Pippit, et al 2016). Individuals with blood sugar outside the normal range are given a diagnosis of diabetes. A level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) implies impaired glucose tolerance, a type of prediabetes and that expands the risk of acquiring type 2 diabetes and a level of 126 mg/dL (7 mmol/L) or higher, as a rule, means the diagnosis of diabetes ( John’s Creek, 2018). In the case of pre diabetes, the provider can work together with the individual to implement lifestyle modifications to prevent the development of diabetes.
Practitioners must ensure that at the time of identification of a health condition particularly diabetes mellitus, interventions must be timely initiated for effective management. In caring for diabetic patient, the provider must also take into considerations factors such as cultural considerations, lifestyles management, health behaviors, social determinants of health that may impact their self-care. Self‑care is an outcome‑oriented and objective‑based conduct which is gained under the influence of sociocultural conditions and is affected by the person's values and opinions (Kamran et al. (2015). Preventative screening is crucial at very step of the patient care to help facilitate lifestyle modifications and prevent disease development.
Data from CDC show the US population has currently has 30.3 million people have diabetes, a 9.4% of the US population from which 23.1 million people are diagnosed with remaining 7.2 million people (23.8% of people with diabetes are undiagnosed (Centers for Disease Control and Prevention, 2017). In managing and controlling negative effects of diabetes, the provider must be aware that diabetic management involved the collaboration of other providers. Once a patient is diagnosed, following recommended guidelines to manage the health of the diabetic patient is of great importance.Most diabetic patients received their care from their primary care provider and their care should be coordinated with other specialists when indicated (Deborah Wexler (2019). Medication management for both type 1 and type 2 are managed differently as type 1 require insulin therapy and type 2 with oral agents.
Patients with type 1 diabetes require insulin therapy, however, numerous patients with type 2 diabetes lose beta-cell function after some time and require insulin for glucose control, thus, need for insulin per se does not recognize between type 1 and type 2 diabetes (Mcallough, 2019). Type 2 is found to be the most common type in the primary setting and can be managed by the primary care provider. Intensive insulin therapy is suggested for almost all patients with type 1 diabetes, and accordingly, patients with type 1 diabetes ought to be referred to an endocrinologist for the management of diabetes (Deborah Wexler, (2019) . Also, both types, require monitoring of A1C levels. In order to obtain this A1C objective, a fasting glucose of 80 to 130 mg/dL (4.4 to 7.2 mmol/L) and a postprandial glucose (90 to 120 minutes after a dinner) less than 180 mg/dL (10 mmol/L) are by and large given as targets, but higher achieved levels may suffice (Deboral Wexler, (2019)
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Health maintenance involves conducting recommended testing to help prevent the development of other health conditions, adjust treatment plan or to make referrals. Among the recommended testing and screenings for both type 1 and type 2 are blood work monitoring laboratory values like AIC, renal functions, and Lipid panel. Deborah, Wexler (2019) recommends yearly assessment of risk criteria like blood pressure, fasting lipid profile, and if patient smoking history to help identify cardiovascular risk factors and would benefit from cardiac interventions. The ADA recommends screening for lipid disorders at the time of diabetes diagnosis, at initial evaluation, and every five years thereafter if under age 40 and more often if indicated, as is generally the case in patients age 40 and older (Deborah Wexler, 2019) . Individual with high cholesterol might be placed on a statin therapy. The initiation of statins depends on cardiovascular risk as opposed to an LDL cholesterol level (Deborah Wexler, (2019).
Additional screening include monitoring of urine albumin in both types. Urine albumin-to-creatinine ratio measurement is the preferred screening strategy in all patients with diabetes to identify and elevation and should be done annually as increase urine protein excretion is the first clinical finding of diabetic nephropathy (Deborah, Wexler, 2019). Diabetes can also affect other parts of the body such as a person’s vision, gum disease and its recommended that diabetics have annual eye exams whether they experience vision issues or not. Diabetes also increases the person’s risk to develop foot ulcers and other circulation issues, therefore patient must be educated on proper foot care and referral to podiatry when indicated.
Health restoration and health teaching
Diabetes affects individuals of all racial and ethnic social and economic backgrounds, factors to consider when implementing and establishing a plan of care for patients. Having this knowledge also make it easier for the provider in their approach in patient teaching. Although diabetes can not be cured, however, with the provider support and collaboration, it can be successfully managed. The role of the nurse practitioner in diabetes management is instrumental to improve glycemic control, improving the quality of care, and diminish health care costs (Richardson et al., 2014). One of the most concerning lifestyle changes for diabetes is the dietary changes that come with the diagnosis. There is not a specific diet for diabetic patients as long as they are educated about their carbohydrates and sugar contents and caloric and fat intake. The diabetic patient should be taught to keep a log of their blood glucose readings to review with the provider during their visits. This data helps the provider in the medication management as well or if additional health teaching is needed. The incorporation of standardized patient education stays one of the key strategies in improving blood glucose levels in those with diabetes mellitus and anticipating long term complications (ADA, 2018). Additional teaching include, monitoring of blood pressure, skin checks specially for any break or cracks in the skin, annual vision check and recommended immunizations.
It is important that providers educated the patient to maintain regular check up with their provider for medication management. Also, between that age group it is important that women of child bearing age with either type 1 or type 2 are educated about the effects of high blood sugar and pregnancy. Its recommendedthat newly diagnosed diabetes engage in a comprehensive diabetes self-management education program, which provides individualized guidance on nutrition, physical activity, advancing metabolic control, and avoidance of complications (Deborah, Wexler, (2019). Diabetic teaching should reinforce that patient receive both their annual influenzas vaccine and pneumococcal vaccination.
There is no doubt that health promotion is crucial in helping Indivduals living with conditions such as diabetes mellitus to adopt and practice health behaviors that promote health and minimize their risk of chronic diseases. Diabetes mellitus can be very scary and challenging for patients. Providers need to encourage their patients to adopt lifestyle behaviors to help decrease their risk factors. Not everyone with diabetes mellitus necessarily need to use pharmacological interventions. In type 2 diabetes, some may be able to manage it with physical activity and proper nutrition. Individual with both type 1 and type 2 can keep their diabetes in control by adopting health lifestyle such as getting regular activity, losing weight, decrease their fat and caloric intake. As providers, it is important to recognize the value of self-care in diabetic patient as they are the ones managing their blood sugar, taking their medications and controlling what their eat.
- American Diabetes Association. (2018). Standards of medical care in diabetes. Diabetes Care. 41(1): 1-159. Doi:10.2337/dc18-Sint01
- Centers for Disease Control and Prevention. (2017). National diabetes statistics report. Retrieved from http://www.diabetes.org/assets/ pdfs/basics/cdc-statistics-report-2017.pdf
- Deborah J Wexler, (2019). Initial management of blood glucose in adults with type 2 diabetes mellitus. https://www-uptodate-com.contentproxy.phoenix.edu/contents/initial-management-of-blood-glucose-in-adults-with-type-2-diabetes-mellitus?search=diabetes&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5
- Duplaga, M. (2015). The evolving concept of health promotion: Definitions, outcomes and classification of interventions. Zeszyty Naukowe Ochrony Zdrowia.Zdrowie Publiczne i Zarzadzanie, 13(2), 141-149. doi:http://dx.doi.org.libauth.purdueglobal.edu/10.4467/20842627OZ.15.014.4317
- Gedik, S., & Kocoglu, D. (2018). Self-efficacy level among patients with type 2 diabetes living in rural areas. Rural And Remote Health, 18(1), 4262. https:/ doi.org/10.22605/RRH4262
- John's Creek: Blood sugar test (2018). Ebix Inc. Retrieved from https://libauth.purdueglobal.edu/login?url=https://search-proquest-com.libauth.purdueglobal.edu/docview/2086252812?accountid=34544
- Kamran, A., Azadbakht, L., Sharifirad, G., Mahaki, B., & Mohebi, S. (2015). The relationship between blood pressure and the structures of pender's health promotion model in rural hypertensive patients. Journal of Education and Health Promotion, 4 doi:http://dx.doi.org.libauth.purdueglobal.edu/10.4103/2277-9531.154124
- Karly Pippit, Holly E. Gurgle and Marlana Li, (2016), Diabetes Mellitus: Screening and diagnosis. University of Utah College of Pharmacy, Salt Lake City, Utah Am Fam Physician. 93(2):103-109
- McCulloch, D. k. (2019). Classification of diabetes mellitus and genetic diabetic syndromes . Retrieved from https://www-uptodate-com.contentproxy.phoenix.edu/contents/classification-of-diabetes-mellitus-and-genetic-diabetic-syndromes?search=diabetes type 1 vs type 2&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- Porath, A., Fund, N., & Maor, Y. (2017). Costs of managing patients with diabetes in a large health maintenance organization in israel: A retrospective cohort study. Diabetes Therapy, 8(1), 167-176. doi:http://dx.doi.org.libauth.purdueglobal.edu/10.1007/s13300-016-0212-9
- Richardson, G. C., Derouin, A. L., Vorderstrasse, A. A., Hipkens, J., & Thompson, J. A. (2014). Nurse practitioner management of type 2 diabetes. The Permanente Journal, 18, 13–108.
- Thapa, S., Pyakurel, P., Baral, D. D., & Jha, N. (2019). Health-related quality of life among people living with type 2 diabetes: a community based cross-sectional study in rural Nepal. BMC Public Health, 19(1), 1171. https://doi.org/10.1186/s12889-019-7506-6
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