Report on the general nursing management of type 2 diabetes mellitus

Introduction

This report will begin by describing what type 2 diabetes is and how it differs from type 1 diabetes. A short discussion on how it is diagnosed will be given. General non-pharmacological and pharmacological interventions to effectively manage type 2 diabetes will be discussed from a nursing perspective. This means that the roles of nurses in caring for patients with type 2 diabetes will be provided.

What is Type 2 Diabetes?

The National Institute for Health and Care Excellence (NICE) (2017) describes type 2 diabetes as a chronic metabolic condition characterised by insulin resistance. This is in contrast to type 1 diabetes which according to Diabetes.co.uk (2018) is an autoimmune disease where the person’s immune system attacks the beta cells in the pancreas which produce insulin. Insulin resistance means that the body is unable to efficiently use insulin and that there is inadequate production of insulin in the body which leads to high blood glucose level termed as hyperglycaemia (NICE 2017). Overtime, this can lead to complications. Common long term complications of type 2 diabetes include retinopathy, cardiovascular disease, nephropathy and neuropathy (Diabetes UK, 2017).

How is it Diagnosed?

It is vital to highlight that the nursing management of type 2 diabetes must first begin with an actual diagnosis wherein a person is found to have type 2 diabetes. Common symptoms of type 2 diabetes include polydipsia (excessive thirst), polyuria (frequent urination), polyphagia (increased hunger), extreme tiredness and sudden loss of muscle mass (Diabetes.co.uk, 2018). So if a person experiences any of these symptoms, the best initiatory action is to advise the patient to seek medical help such as by setting an appointment with a GP. The GP will order a urine and blood test to check the level of the person’s blood glucose (National Health Service 2017).

Nursing Interventions

Once type 2 diabetes has been confirmed, specific care interventions will be provided depending on the patient’s needs. This is consistent with NICE (2017) stating that the management of type 2 diabetes must be individualised. This implies providing care interventions that is tailored specific to the needs and circumstances of the patient and takes into consideration their personal concerns and preferences, comorbidities and risk from polypharmacy. Part of the individualised care should also include any disabilities which the person may have such as visual impairment (NICE 2017). The National Health Service supports this approach by stating under its Constitution that NHS services must be reflective of and should be coordinated and tailored according to the needs and preferences of patients and their families (Department of Health & Social Care 2015). From a nursing perspective, the Nursing and Midwifery Council (2015) declares under its Code the need for nurses to listen to and respond to the concerns and preferences of their patients. This is important because it will allow the nurses to identify and prioritise the type 2 diabetes-related needs of the patient and therefore provide specifically tailored and appropriate care interventions. In essence, this highlights the application of the patient or person-centred care in the nursing management of type 2 diabetes.

The Royal College of Nursing (2018) supports this by declaring under its Principles of Nursing Practice that nurses must promote and provide care that puts the patients, their carers and families at the centre, helping them make informed decisions about their own care and treatment.  A study by Williams et al., (2016) identified the patient-centred care approach as a potentially important factor in the positive self-care of people with type 2 diabetes.

One important role of nurses in helping patients with type 2 diabetes manage their conditions is to provide them with appropriate health education. NICE (2017) states that it is important to offer people with type 2 diabetes structured patient education at the time of their diagnosis with annual reinforcement and review. The NMC (2015) also supports this role by declaring that nurses must act in partnership with their patients to help the latter access relevant health and social care, information and support they require. Nurses must share with the patients, their carers and families, the information they want and need to know about their own health, care and on-going treatment in a manner that they can easily understand (NMC 2015).

An important point that must be highlighted in this aspect of type 2 diabetes nursing management is the need for the nurse to deliver health education in an easy to understand manner. For instance, the nurse must avoid using medical terminologies and if this cannot be avoided, to use easy to comprehend analogies to ensure that patients understand the information given to them. This is important because according to Ali (2017) medical jargon is one common barrier to effective nurse-patient communication so it is imperative for nurses to avoid ambiguity and to use appropriate vocabulary and easy-to-relate analogies when explaining information. It can be argued that the compliance of a type 2 diabetic patient to the information provided to them will depend largely on whether the patient has in fact understood the information and has realised its significance in the effective management of their condition.  A nurse’s role in delivering relevant health education may come in varied forms. It may be that the patient directly consulted with a diabetes specialist nurse or seek clarification from a registered nurse working in the GP clinic or hospital where the patient was diagnosed for type 2 diabetes or during follow up consultation.

One important component of the health education for type 2 diabetes is lifestyle modification such as increased physical exercise. A study by Colberg et al., (2010) identified physical exercise as important in preventing the onset of type 2 diabetes as well as in its effective management to prevent complications. Another important component is dietary changes. NICE (2017) recommends providing dietary advice that is sensitive to the personal needs, cultural values and beliefs of the person. This is significant to ensure compliance of the person to the recommended dietary advice. Specific dietary advice includes high fibre diet, low glycaemic index sources of carbohydrates (e.g. fruits and vegetables, whole grains and pulses), low- fat dairy products and oily fish (NICE 2017). Food labelled suitable for diabetics should not be recommended (The British Dietetic Association 2018). In order to ensure correct dietary advice, it may be necessary to refer the patient with type 2 diabetes to other healthcare professional for proper advice such as a dietitian. NICE (2017) recommends that the individualised dietary advice should come from a healthcare professional with specific expertise and competence in nutrition. This implies that the role of a nurse in this aspect is to make appropriate referrals.

Another crucial component of the nursing management of type 2 diabetes is on blood glucose management such as the time intervals in measuring HbA1c. It is a blood test that measures the amount of glucose present in the haemoglobin and provides an overview of the level of blood glucose in the last 2 to 3 months (Whettem 2012). The common target for HbA1c is between 6.5 to 7.5% (Whettem 2012). NICE (2017) recommends a 3 to 6 month interval depending on the needs of the patient. It is also vital to identify when self-monitoring of blood glucose should be done. NICE (2017) recommends that self-monitoring of blood glucose is generally not advisable unless the patient is taking insulin, there is evidence of hypoglycaemic episodes, is pregnant or planning to become pregnant or is “on oral medication that may increase risk of hypoglycaemia while driving or operating machinery”.

The initial drug treatment for type 2 diabetes requiring medication is standard-release metformin (NICE 2017). Significant emphasis on the strict compliance to the prescribed medication along with the non-pharmacological interventions should be given to maximise the patient’s self-management of their condition. A study by Asante (2013) identified individualised self-management education, cue-dose training and use of adherence aids can help improve type 2 diabetes patients’ adherence to their treatment regimen ultimately resulting in and therefore prevent complications brought about by hyperglycaemia. 

Conclusion

The nursing management of type 2 diabetes must be individualistic; hence, it must be tailored according to the specifically assessed needs of the patient. The patient’s care management should take into consideration the person’s own preferences and circumstances in keeping with the concept of patient-centred care. General nursing interventions include appropriate health education. This should be delivered in the simplest way possible to ensure full understanding of the information provided to the patient. The content of which should include lifestyle modification advice particularly on the increase of physical exercise and dietary changes as non-pharmacological means to manage blood glucose level. Referral to appropriate personnel may be necessary to give the best advice and information to the person with type 2 diabetes. Facilitating improved adherence to the treatment regimen such as the intake of metformin is also important to prevent complications.

References

Ali, M. (2017). Communication skills 2: Overcoming barriers to effective communication. Nursing Times. 114(1):40-42.

Asante, E. (2013). Interventions to promote treatment adherence in type 2 diabetes mellitus. British Journal of Community Nursing. 18(6):267-274.

Colberg, S., Sigal, R., Fernhall, B., Regensteiner, J., Blissmer, B., Rubin, R., Chasan-Taber, L., Albright, A. and Braun, B. (2010). Exercise and type 2 diabetes. Diabetes Care. 33(12):e147-e167.

Department of Health & Social Care (2015). Guidance: The NHS Constitution for England. [online]. Available at: https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england [Accessed: 27 June 2018].

Diabetes.co.uk (2018). Differences between type 1 and type 2 diabetes. [online]. Available at: https://www.diabetes.co.uk/difference-between-type1-and-type2-diabetes.html [Accessed: 27 June 2018].

Diabetes UK (2017). Diabetes complications. [online]. Available at: https://www.diabetes.org.uk/guide-to-diabetes/complications [Accessed: 27 June 2018].

National Health Service (2017). Type 2 diabetes. [online]. Available at: https://www.nhs.uk/conditions/type-2-diabetes/getting-diagnosed/ [Accessed: 27 June 2018].

National Institute for Health and Care Excellence (NICE) (2017). Type 2 diabetes in adults: Management. [online]. Available at: https://www.nice.org.uk/guidance/ng28/chapter/Introduction [Accessed: 27 June 2018].

Nursing and Midwifery Council (NMC) (2015). The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives. London: NMC.

Royal College of Nursing (2018). Principles of nursing practice: Eight principles that apply to all nursing staff and nursing students in any care setting. [online]. Available at: https://www.rcn.org.uk/professional-development/principles-of-nursing-practice [Accessed: 27 June 2018].

The British Dietetic Association (2018). Diabetes- type 2. [online]. Available at: https://www.bda.uk.com/foodfacts/diabetestype2.pdf [Accessed: 27 June 2018].

Whettem, E. (2012). Nursing & health survival guide: Diabetes. Abingdon: Routledge.

Williams, J.S., Walker, R.J., Small, B.L., Hill, R. and Egede, L.E. (2016). Patient-centred care, glycemic control, diabetes self-care and quality of life in adults with type 2 diabetes. Diabetes Technology & Therapeutics. 18(10):644-649.