Long-term Management of Diabetes

Visit “Global: Both Sexes, All Ages, 2016, DALYs” on the Institute for Health Metrics and
Evaluation GBD Compare Data Visualization Hub website. Compare the primary causes of
disability-adjusted life years (DALYs) from countries in two different socio-demographic
index levels or economic regions. Identify three social or political-economic differences that
help explain the differences you observed. Discuss the utility of the disability-adjusted life
year (DALY) measure as a composite measure of health. Why is the DALY helpful given
the different categories of Communicable, Noncommunicable, and Injury when it comes to
comparing mortality and morbidity?

Long-term Management of Diabetes

T2DM is an incessant metabolic derangement that impacts the physical, social, mental
inclusive of psychological health of individuals ailing forms it. The physical and psychosocial
issues that are generally basic in diabetes patients frequently bring about a negative effect on
patient’s social well being when not managed effectively (White. 2016). An unhealthy lifestyle
can include: consuming diets rich in simple sugars and fats, inadequate physical activity, alcohol,
and tobacco abuse and ineffective management of stress (Tuomilehto et al., 2011). The above
lifestyle behaviors predispose one to a myriad of chronic ailments ranging from T2DM, cardiac
ailments, malignant tumors, and obesity, all of which tend to correlate to each other. Some long-
term ailments remain undiagnosed until there are advanced in the stage, which leads to
ineffective management and poor prognosis.
Patient X’s case scenario points out the yearly increase in numbers of persons affected by
chronic diseases. In his diagnosis, it is clear that he is morbidly obese, having a BMI of 36.4,

Long-term Management of Diabetes 2
diabetic, and could be potentially suffering a hypertensive condition; all these are mostly due to
his unhealthy lifestyle behaviors. Presently, non-communicable illnesses are a significant global
public healthcare challenge (WHO, 2016). The World Health Organization (WHO) assessed that
61 percent of all mortalities 35 million and 49 percent of the worldwide weight of diseases were
due to long-term ailments in 2005. It also predicted that by 2030, the extent of mortalities caused
by chronic illnesses would go up by 70% and an estimated increase to 56% of the total burden of
ailments (WHO, 2006).
A significant role is played by nurses in educating the patient on facts and management
of diabetes after patient X being diagnosed he is referred to a DNS, what is the importance of a
DNS in the disease prognosis (Ginzburg, Hoffman, and Azuri, 2017). The current drastic
increases in numbers of chronic disease cases in the U.K have greatly affected the health system;
the NHS has to spend limited resources available to cater to the increasing burden of disease
(NHS Choices, 2018). The paper exploits the effects of lifestyle behaviors on long-term diseases,
available healthcare systems, and what ought to be done to improve care and prognosis to
affected persons and reduce the prevalence of chronic diseases in the country and globally.
T2DM is an incessant metabolic derangement that impacts the physical, social, mental
inclusive of psychological health of individuals ailing forms it. The psychosocial issues that are
generally basic in diabetes patients frequently bring about a negative effect on patients’ social
well being when not managed effectively. Managing these psychosocial upheavals, including
emotional, behavior patterns, and social factors in the treatment intercessions would help

Long-term Management of Diabetes 3
counteract the psychological obstructions related to adherence and self-care for diabetes
(Knowler et al. 2012).
It is frequently hard for some to acknowledge that they need to consume medications
perpetually for the rest of their lifetime, bringing about poor treatment adherence and diabetic
self-care (Tuomilehto et al., 2011). These psychosocial issues can, in the long run, form into
burdensome or even depression and anxiety that are related to poor self-care, declined metabolic
health, higher death rates, expanded social insurance cost, and loss of efficiency. When the
mental and emotional necessities of the patients with diabetes are undermined, if individual
endeavors to address these difficulties and fail to prevail as envisioned, or complications of
T2DM negatively affect physical and psychosocial well being (Albright. 2012).
Depressive status is a major mental issue in individuals with diabetes, with an expected
41% of patients experiences the side effects of poor mental health and increased rates of anxiety
and depression. Individuals with type 2 diabetes have 24% of a greater danger of getting
depressed, and hence co-morbidity effects of depression and DM ought to be cautiously
considered (WHO, 2016). The provision of awareness to the possibility of acknowledging
diabetes stressing is the initial phase in overseeing it. Most patients may not be aware of being
stressed until they are posed to specific inquiries or do self-appraisal by utilizing an organized
screening instrument.
In managing the patient X case scenario, he should be fully informed of his current
condition, the lifestyle changes he needs to adapt to, and the mental, psycho-emotional distress
he will face. It is crucial to inform the patient of not only the physical aspects of diabetes but also
on its psychosocial effects. T2DM is a chronic ailment that means its management is long-term;

Long-term Management of Diabetes 4
hence, an affected individual has to confront changes and be socially able to adjust to their
current situation. Nurses are the primary caregiver of most diabetic patients and therefore play a
role in educating them on the essentials of diabetic self-care. Additionally, even though nursing
attendants give more psychosocial care, they consider themselves to be less ready to deal with
psychosocial needs in patients contrasted to dealing with their physical needs (Peyrot et al.
Pathophysiology, causes, and symptoms of diabetes
Type II DM is the commoner of the two forms of diabetes, it usually kicks off as early
insulin resistance, and over time it is present with sustained high glucose levels in blood and
urine. Blood sugar is derived from the consumption of various foods; once the food is in the
stomach, it breaks it down into a simple form of glucose, which can be absorbed internally
(Ashra et al. 2015). For cells to absorb glucose as their chief source of energy, insulin, a
hormone produced by the pancreas, has to activate cell membranes to absorb glucose. When one
is diabetic, insufficient insulin levels are produced; glucose cannot be absorbed into the cells,
resulting in an abnormal elevation in the blood glucose measure.
The prevalence of T2DM is much more diagnosed as from the 4 th decade and in senior
persons, since they are more likely to have more prolonged exposure to unhealthy habits and
another chronic disease (WHO, 2016). However, this is drastically changing in the U.K, and
globally, currently, more and more cases of T2D are being diagnosed among persons in their
early 20’s and 30’s (Albright. 2012). Diabetes has no specific cause, and it is thought to arise
from genetic and environmental factors that predispose humans, diet is a significant factor in the
development of diabetes (White, 2016. Inpatient X case environmental factors such as

Long-term Management of Diabetes 5
inadequate exercise and poor diet leading to obesity are the lead causes of diabetes; genetic
history is not mentioned. Symptoms of diabetes presented by the patient X include blurring
vision, lethargy and tiredness, pain on passing urine paresthesia, and numbness. Other signs are
imperfect wound healing process, increased hunger, increased infection frequency, and
unexplained weight-loss.
Management and prevention of Diabetes
Currently, there is no remedy for diabetes. However, it is very well may be dealt with and
controlled. The objectives of overseeing diabetes are to maintain relatively normal levels of
one’s blood glucose by maintaining a healthy diet with medical management and regular
physical activities (Albright. 2012). Keeping a patient’s blood cholesterol and triglyceride (lipid)
levels as close to the typical ranges as could be expected under the circumstances. Normalizing
blood pressure levels optimally, at not more than 140/90 mmHg (White. 2016). Minimizing or
potentially forestall the advancement of diabetes-related medical issues, patient X is referred to a
nurse specialty who equally advise on his lifestyle modifications.
In the early stages of the disease, it is easier to control and even possible to reverse
diabetes through strictly adhered to measures such as properly planned and implemented healthy
meal diets, weight loss in obese persons, cessation of drugs, and regular exercise routines
(Tuomilehto et al., 2011). The above are also useful lifestyle modalities in the management of
patient X case, and hence promote a more favorable prognosis and fewer complications.
Medically diabetes is managed through proper counseling and psychosocial support after
diagnosis and effective medication, mostly insulin and oral hypoglycemics.

Long-term Management of Diabetes 6
Diabetes can be controlled through the utilization of different classes of drugs. Not all
patients with type 2 diabetes will profit equally with each medication, and some drugs used are
not appropriate to some affected persons (Chen, Magliano, and Zimmet. 2012), for Inpatient X
metformin was recommended, which is a biguanide drug class that builds the affectability of the
body’s cells to insulin. It likewise diminishes the measure of glucose delivered by the liver.
Additionally, metformin will, in general, stifle hunger, which may profit individuals who are
overweight (Chen, Magliano, and Zimmet. 2012). Other drug classes effective in the
management of diabetes are sulfonylureas, meglitinides, and thiazolidinediones. Insulin is mostly
prescribed in advanced stages and long-term management of the condition, including self-
injection in particular body parts.
Prevention of chronic diseases is a significant public health agenda; lifestyle modalities
are the mainstay preventive measures. Patient X has a busy schedule of working for 12 hours;
seven days a week; this leaves almost no type for the individual to deliberately exercise, having
in mind, the patient is a taxi driver. Healthy eating and regular exercise regulate the body’s
insulin levels, hence maintain healthy blood sugar levels. The earlier, the better; however,
lifestyle interventions are useful at any stage of the disease. Regular screening and check-up for
diabetes is a measure to prevent disease progression and public awareness to educate citizens on
symptoms and further complications of diabetes (Tuomilehto et al., 2011). If not, well-controlled
diabetes has devastating complications such as visual loss, nerve damage, hypertension, and
metabolic coma and eventually, death.
Critical analysis of actions and interventions used to manage diabetes.

Long-term Management of Diabetes 7
The NICE issues guidelines in the management of adults with T1D and T2D to set out the
consideration of those individuals with diabetes ought to be helped in managing their condition.
NICE directions suggest that all individuals with diabetes ought to get organized awareness and
modalities to assist them in dealing with their diabetes. It distinguishes the significant
consideration that individuals with diabetes ought to have the option to get to and suggestions on
focuses on essential estimations (N.I.C.E. 2017).
Many years of scientific research have brought about drastically improved
comprehension of the pathophysiology and effect of diabetes, with the availability of advanced
treatment modalities. Implementation of this investigation into medical practice has prompted
decreases in long-term complications and death in diabetic individuals (Chen, Magliano, and
Zimmet. 2012). However, as the occurrence and predominance of T1 and type 2 diabetes keep on
raising, the requirement for innovative research and related evidence-based practices and
preventive measures is progressively essential to ensure the general well being and to help
control the markedly increasing expenses of diabetes-related insurance care plans (NHS, 2015).
The NICE suggests that adults living with diabetes ought to be enrolled in a yearly care
plan, which prompts the documentation of concurred objectives and an activity plan (N.I.C.E.
2017). This empowers people with diabetes to take control and effectively deal with their
condition. Through the personalized care plan, several set out tests and treatments are monitored
to show control or progression of the disease (Carey & Courtenay. 2015). The following
measures are included in the care plan: BMI is a straightforward measure that permits a rapid
appraisal of individuals into a weight classification of (underweight, normal range, overweight,
obese, or morbidly obese).

Long-term Management of Diabetes 8
Obesity presents a significant risk for developing T2D and its subsequent complications.
In this way, by calculating an individual’s BMI, it is possible to point out the direction of disease
prognosis and to provide necessary interventions in disease management (Carey & Courtenay.
2015). Patient X has a BMI of 36.4, which is presently categorized as morbidly obese; he stands
to benefit from this care plan as the prescribed management is monitored annually, enabling
continuous disease assessment.
Other tests in the NHS care plan are the HbA1c test, which reveals the patient’s glucose
levels over a prolonged timeframe (weeks or months). An increased level of HbA1c increases the
danger of diabetic complications. Recommendations from NICE, advocate for individuals’
HbA1c levels to be measure at least once every six months in already stabilized patients and
every 3-6 months in individuals with unstable T2DM (Lin &Wang. 2012). Additionally, it is
suggested that physicians and patients focus on achieving HbA1c levels of 48mmol/mol or
lower. The cholesterol level is measured by a blood test, which is significant for surveying CVD
risk to diabetic persons. Elevated cholesterol has significant impacts on complications due to
diabetes; hence the NICE insist on an annual cholesterol test (Emerging Risk Factors
Collaboration. 2013).
Continuous research is necessary to address interminable microvascular intricacies of
retinopathy, neuropathy, and kidney vascular, which also point out the complications, deaths,
and increased costs of treatment for T2DM (Lin &Wang. 2012). Identifying the populace of
patients with diabetes that are especially resistant or exceptionally vulnerable to the advancement
of these inconveniences may give significant insights to the hereditary and metabolic antecedents
(Emerging Risk Factors Collaboration, 2013). Scientific approaches that analyze hereditary and
metabolic profiles and the interfaces between pathways may comprehensively comprehend the

Long-term Management of Diabetes 9
shared characteristics and unmistakable impacts of hyperglycemia on different organ frameworks
(Bourne et al. 2013). When the physiological pathways associated with these procedures are
recognized, they should be deliberately dismembered to clarify new focuses for the advancement
of therapeutic specialties
Analysis of partnership in self-management care
Handling the increment in T2D cases is crucial to the feasible duty of NHS. 3.8 million
Individuals in England of 16 years of age and above had diabetes by 2015 (Ham, 2017). The
diagnosis of diabetes is more noteworthy within regions considered as financial deprived, and
persons with black or Asian origins areas twice as prone to develop diabetes compared to those
of white or Caucasian ethnic origin (15% versus 8.0%, respectively). About 90% of individuals
diagnosed with T2D also present with increased weight and, to a great extent is preventable
(NHS DPP, 2017). Expenses to the NHS for diabetic management presently stand at £8 billion
yearly, with diabetes mellitus progressively influencing more youthful and working-age
individuals (NHS. 2018).
Subsequently, concentrates in various populaces have demonstrated the beneficial impact
of daily habits in decreasing T2D development in grown-ups, incorporating translational projects
conveyed in essential consideration or community set-up, some of which were executed on an
enormous scale (NHS DPP, 2017). However, risks decrease in translational projects were
commonly not precisely in the immediate preliminaries. Aggregated T2D hazard decrease of
26% of persons getting an intercession contrasted to natural care was accounted for in an
ongoing audit of healthy livelihood for diabetic counteraction in UK natural care provision
charged by PHE to educate the detail regarding diabetes prevention (English NHS DPP, 2017).

Long-term Management of Diabetes 10
The NHS DPP distinguishes those in danger of diabetes because of high glucose (pre-
diabetes) through the NHS Wellbeing Check and eludes them onto a conduct change program as
suggested through the NICE. The program was propelled in 2016; by 2017, it had arrived at 75%
of the number of inhabitants in Britain and kept on being turned out (NICE, 2017). It speaks to a
joint responsibility from NHS Britain, PHE, and Diabetes UK in the case of patient X if he had
been diagnosed early while in the pre-diabetic stage he would be among persons benefitting from
the program (NHS Choices. 2018).
Individuals who adhere to regular monitoring and other interventions to decrease their
danger of T2DM keeping focused on a healthy diet, getting more physically active are being able
to shed some weight. This has been demonstrated to diminish the exposure to the development of
T2D (Ham, 2017). Patient X relies on being advised on the above interventions and be able to
attain healthy habits progressively, which will significantly help in managing his condition.
Individuals considered to be at high risk are offered a minimum of thirteen instructions and
physical activity routines ranging from one to two hours each continuously and progressively
carried out over nine months.
In the initial examination of the initial cases and first studies, regions by NHS DPP
showed positive progress. Ranging from June 2016 and 2017, almost 44,000 individuals were
referred, and 49% of referrals were able to attend the first meeting at least. In 2018, 4,500
diabetic persons were able to get through to the end of the program (NHS DPP, 2017). A lot still
needs to be done to decrease numbers of those diagnosed with diabetes and effect early detection
of the disease to improve the overall outcome.
Coaching /educative role of nurses in supporting diabetic patients.

Long-term Management of Diabetes 11
In light of the requirement for upgraded backing of patients, numerous progressions have
been established in the management and care planning of patients with diabetes and nursing
attendants, meant to confront the expanding pace of T2DM cases (Riordan et al. 2017). These
interventions incorporate the foundation of Diabetes Specialist Nurse (DSN); the organization
permits attendants to recommend drugs in nations such as the United Kingdom and the
association with the different degrees of healthcare services framework. This advancement has
tangible improvements clinically, to lessen improper referrals for advanced measures, and
decrease outpatient check-ups (Cardwell et al. 2016). There is substantial proof in the writing to
show that nursing care and interventions have a significant impact when directing people with
diabetes on self-care administration, especially in combination with proactive interventions
A significant role played by nurses is in educating the patient on facts and management
of diabetes, after patient X being diagnosed he is referred to a DNS, what is the importance of a
DNS in the disease prognosis (Ginzburg, Hoffman, and Azuri, 2017). Research has investigated
the subject of nursing care and has discovered that nursing attendants are enormously associated
with teaching patients to deal with their ailments, and a few investigations show the changing
tide in diabetes care education. Some studies also indicate the positive results that care-education
conducted by nurses, which improves glycemic controls. All the more explicitly, in an ongoing
descriptive paper, (Bostrom et al. 2012) demonstrated the significance of nursing care in the
understanding care-based educative process, with a (DSNs) members asserting that among their
roles is to teach on their current condition, and advising them on the ailment’s, potential
complexities, and measurement outcomes.
A component of advanced management is that advanced nurse specialists are associated
with the administration of drugs explicitly for diabetics; it involves unspecialized nursing

Long-term Management of Diabetes 12
attendants, for the most part, perform when they provide care to hospitalized patients. Moreover,
various investigations alluded to nursing provisions in medical prescription, with some of them
indicating contrasts concerning the degree to which a nurse attendant has that obligation. For
instance, (Carey and Courtenay. 2015) found that more than 66% of respondents who are
specialist attendants in the UK endorsed drugs for regular complicating stages of diabetes,
including hypertension, hyperlipidemia, and cardiovascular ailment, even though they committed
under 20% of one’s working hours. It indicates that most attendants working time is spent on
managing other nursing-care exercises, and just a base time is given to directing and requesting
prescriptions (Ogurtsova et al. 2017).
Additionally, nurses embrace the job of motivating diabetic patients. A few papers
demonstrate the significance of nursing care in psychological support towards people with
diabetes. (Peyrot et al. 2016) announced that nursing attendants in correlation to specialists see
more noteworthy patients’ issues and identify psychosocial issues as having an extraordinary
effect on self-care and managing T2D patients. Additionally, even though nursing attendants
give more psychosocial care, they consider themselves to be less ready to deal with psychosocial
needs in patients contrasted to dealing with their physical needs.
Even though nursing attendants currently have numerous roles to perform, scientific
literature uncovered that a few hindrances keep nurses from effectively performing their duties.
Various investigations uncovered that nursing attendants need information in explicit territories
of insulin resistance (Schwarz et al. 2017). Additionally, this notion is upheld by ongoing writing
that indicated that nurses possess inadequate comprehension of increasingly useful practices in
diabetes care, for example, information about the planning and organization of particular
insulin’s, the utilization of metformin in advanced kidney disease, also overseeing and perceiving

Long-term Management of Diabetes 13
hypoglycemia side effects (Knowler et al. 2012). Moreover, it has been identified that nursing
attendants have minimum knowledge concerning insulin treatment regardless of their dynamic
association in the clinical administration of diabetic individuals. Moreover, there is proof
proposing that nurses are not adequately prepared concerning foot care and minimizing
T2DM and its related intricacies force overwhelming healthcare consequences
worldwide, and there have been no compelling measures to adapt to the illnesses completely.
The primary driver of the diabetes scourge is the exposure and interaction in hereditary and
ecological hazards. Various variables are likewise owing to the ailments. Though most anti-
diabetic specialists have demonstrated beneficial impacts when utilized as monotherapy or mixed
treatment, they are likewise connected with negative impacts, such as weight gain,
hypoglycemia, gastrointestinal impacts, or cardiovascular ailments. With the expanding rate of
T2DM, developing ideal modalities of treatment gets one of the top needs in battling this illness
(Speight and Bradley. 2011).
Despite programs and activities that have been initiated in the course of the most recent
years to defy the illness of diabetes, increasing numbers of individuals with diabetes are still
being recorded around the world. Notably, nurses have a significant job in being associated with
diabetes care, and it is vital to recognize their importance in T2D care planning to dispose of any
boundaries that prevent nurses from providing sufficient consideration and from improving any
interventions that permit caregivers to conduct services resulting in the best possible outcomes.

Long-term Management of Diabetes 14


Albright, A., 2012. The national diabetes prevention program: from research to reality.
Diabetes care & education newsletter, 33(4), p.4.
Ashra, N.B., Spong, R., Carter, P., Davies, M.J., Dunkley, A., Gillies, C., Greaves, C.,
Khunti, K., Sutton, S. and Yates, T., 2015. A systematic review and meta-analysis assessing the
effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes mellitus in
routine practice. London: Public Health, England.
Boström, E., Isaksson, U., Lundman, B., Sjölander, A.E. and Hörnsten, Å., 2012.
Diabetes specialist nurses’ perceptions of their multifaceted role. European Diabetes Nursing,
9(2), pp.39-44b.

Long-term Management of Diabetes 15
Bourne, R.R., Stevens, G.A., White, R.A., Smith, J.L., Flaxman, S.R., Price, H., Jonas,
J.B., Keeffe, J., Leasher, J., Naidoo, K. and Pesudovs, K., 2013. Causes of vision loss
worldwide, 1990–2010: a systematic analysis. The lancet global health, 1(6), pp.e339-e349.
Cardwell, J., Hardy, K., Ford, N., and O’Brien, S., 2016. Assessment of diabetes
knowledge in trained and untrained ward nurses before and after intensive specialist support. J.
Diabetes Nurs, 20, pp.60-64.
Carey, N., and Courtenay, M., 2015. Nurse supplementary prescribing for patients with
diabetes: a national questionnaire survey. Journal of Clinical Nursing, 17(16), pp.2185-2193.
Chen, L., Magliano, D.J., and Zimmet, P.Z., 2012. The worldwide epidemiology of type
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Ham, C., 2017. Next steps on the NHS five year forward view.
Knowler, W.C., Barrett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., Walker,
E.A., and Nathan, D.M., 2012. Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. The New England journal medicine, 346(6), pp.393-403.

Long-term Management of Diabetes 16
Lin, S.P., and Wang, M.J., 2012. Strategic management of behavioral change in type 2
diabetic patients. Public health, 126(1), pp.18-24.
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diabetes nurse specialist services. BMJ Open, 7(8), p.e015049.

Long-term Management of Diabetes 17
Schwarz, P.E., Schwarz, J., Schuppenies, A., Bornstein, S.R. and Schulze, J., 2017.
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Speight, J., and Bradley, C., 2011. The ADKnowl: identifying knowledge deficits in
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