PREVENTING DIABETES- A LIFESTYLE DISEASE AMONGST ALL AGE GROUPS

LITERATURE REVIEW REFINED COPY

Literature Overview

The purpose of this literature review is to evaluate and analyze existing studies on Diabetes, including the causes, prevention, and consequential effects of developing Diabetes. The literature review will study secondary peer-reviewed articles. This review will finally identify gaps in the study that will need to be met during future research.

Introduction

Diabetes is a chronic and progressive disorder of the metabolic system propagated by lifestyle and affects all age groups. There are many factors implicated in the etiology of the metabolic disorder, but all revolve around defects in insulin metabolism and the prevalence of type 2 diabetes (CDC, 2019). The other types are type 1, maturity-onset, and gestational Diabetes. The disease can, however, be controlled or prevented by initiating changes in lifestyle and pharmacological therapy. Considering the health risk diabetes poses for all age groups, it is necessary to study the lifestyle that decreases diabetes development and make recommendations to prevent and effectively control Diabetes. The literature below will review the causes of Diabetes, the social health determinants of Diabetes, and people at risk of Diabetes. The review will also analyze the role of nursing practitioners in preventing Diabetes and give a summarized critical review of the researched articles to add an evidence-based body of knowledge.

Causes of Diabetes

Understanding the causes of Diabetes is the key to effective lifestyle modification. Diabetes is a result of hyperglycemia caused by complications in secretion or action of insulin (American Diabetes Association 2014). The pathogenic process in diabetes development commences with pancreatic beta cells destruction by autoantibodies, resulting in insulin deficiency in type1 Diabetes or tissue insulin action resistance for type 2 diabetes. Diabetes can affect kidney function, ocular system, and the cardiovascular system. Other causes of Diabetes include drug-induced (glucocorticoid) diabetes, where some drugs ingested may impair the secretion or absorption of insulin. Some viruses can also cause pancreatic cell destruction, as well as monogenic diabetes syndromes such as maturity-onset Diabetes in the young and neonatal hyperglycemia syndromes. Seemingly, there are various causes of Diabetes, but all lead to an abnormality in the secretion of insulin, leading to hyperglycemia. The strength of the study is it gives a medical understanding of the development of the study. The study is limited in that it only takes into consideration the medical causes of Diabetes without giving proper focus on lifestyle patterns as well. The limitation of the study is it might be complex for scholars who do not understand the medical aspect of the development.

Colosia et al. (2013) carried out a study to evaluate the prevalence of hypertension and obesity amongst patients with type 2 diabetes. The authors noted the prevalence of hypertension and Diabetes is witnessed in both developing and high-income countries; however, the prevalence in developing countries is more due to lack of access to adequate health care.  The authors carried the study because of the contribution of obesity and hypertension in developing complications of type 2 diabetes. The study also makes a contribution to strategies that aid in weight loss and reduction of blood pressure while controlling blood glucose levels. The authors used factors such as waist circumference, body mass index, and blood pressure to test for hypertension and obesity. From their findings, the authors concluded that both hypertension and obesity are comorbidities in adults with type 2 diabetes. The strength of the study is the focus on prevalence in multiple countries, including Asia, Europe, America, and Jordan. The limitations of the study included a risk in disease misclassification, and the study did not conclusively handle the need to control the prevalence of hypertension and obesity and only focused on the prevalence aspect of the conditions

The importance of this study is it contributes to the understanding of contributors to the development of complications of type 2 diabetes. It allows scholars to understand the significant impact of obesity and hypertension on

Diabetes Social Health Determinants

Clark and Utz (2014) carried out a study to understand the social factors implicated in type 2 diabetes in the wake of the epidemiological outcome that at least 11% of adults over the age of 20 had type II DM and is a major reason of death in the USA (Clark & Utz, 2014). Diabetes associated neuropathy, premature death, hypertension, and cardiovascular diseases manifest in autoimmune-mediated type1 and insulin-resistant type 2 DM. Defining social determinants, including education, the environment, family diet, economic stability, and community support, is implicated in diabetes progression and improves outcomes (Clark & Utz 2014). Lack of social amenities reduces outdoor activity, such as fitness exercises. Such limitations cause an increase in people affected by Diabetes through peripheral insulin resistance. Social determinants such as education helped increase the socio-economic stability of a person, and the level of information also helps in encouraging exercise, intake of healthy foods, and access to medical care. The limitations of this study are while focusing on social health determinants; it fails to divulge the reason why the social patterns are witnessed within the specific societies. It also fails to evaluate the prevalence in different classes in society, which in most researches is often found to be different from one society to another.

People at Risk of Diabetes

According to Valdez (2009), anyone with a family history of Diabetes is at risk of contracting the condition. Genetic factors, such as the presence of autoantibodies against insulin, islet cells, or enzymes such as tyrosine kinase are hereditary for DM type I. Diabetes type II can go undetected, and therefore, recommending screening of people with strong familial history will help in early identification. Chien et al. (2009) show that prediction models of Diabetes and impaired glucose tolerance show a rising trend in the Asian community, attributed to their diet and lifestyle. According to the study, diabetes risk factors include body mass index, age, fasting glucose levels, and culinary practices. Chien et al., (2009) additionally compliments Valdez’s (2009) argument regarding the role of the family history, sex, cardiovascular diseases, and geography as predictors of Diabetes. Chien et al., (2009) and Valdez (2009) show how lifestyle practices such as diet, inactivity compound genetic elements in propagating Diabetes. A rise in BMI increases the risk of having diabetes mellitus in men than in women. Lifestyle factors that increase the chances of impaired glucose tolerance include smoking, physical inactivity, and alcohol consumption.

Both studies are limited in the aspect of specificity in the groups of people at risk of Diabetes. There are also minimal specific factors that determine these groups of people.

GROUPS AT RISK OF DIABETES

The prevalence of Diabetes amongst adults in the USA, according to research by Narayan et al. (2003), shows an increase in diagnosed Diabetes by 40%. The authors carried out a study to estimate sex, age, and ethnicity-specific prevalence and incidence of Diabetes. The authors relied on data from the UA Census Bureau. In their findings, women have a lifetime risk of developing Diabetes compared to men. The highest lifetime risk for Diabetes in terms of ethnicity is amongst Hispanics. The limitation of the study is it fails to capture the burden to the society and risk of developing Diabetes in a defined period.

ETHNIC GROUPS AT RISK OF DIABETES

Xiang et al. (2011) carried out a study to understand the disparities amongst ethnic and racial groups amongst women, after gestational Diabetes. The authors focused on Asian, Hispanic, and black women. Gestational Diabetes is a glucose intolerance state that is detected during pregnancy, and heist prevalence is amongst Asian women, while low prevalence is amongst black women. Women with high prevalence have high chances of developing Diabetes. The significance of the study is on two front; one the risk of the gestating mother developing diabetes type 2, and the genetic composition that may cause the child to develop Diabetes at a later stage in their life. The authors found out that there was a risk of developing Diabetes across all races, with the higher risk being amongst black women.

The strength of the study lay in the diversity of races that were tested and the long term follow up with respondents that allowed room for alternating findings to the most accurate and up to date information (Xiang et al., 2011). Limitations of the study included that the pre-index BMI data for pregnancy was only available to a small percentage, and therefore some data was missing. There was also a potential limitation of underestimation of Diabetes incidence rates due to records that were missing and that the study only focused on women

PREVALENCE OF DIABETES AMONGST AGE GROUPS

Valdez et al. (2007) carried out a study to determine whether family history was a useful tool in detecting risk for Diabetes and cardiovascular diseases amongst children. Their research was on facts that type 2 diabetes could be detected in children, but disorders as a result of developing Diabetes may show symptoms in their adulthood. The significance of the study was it would help to reduce the effects of Diabetes amongst children. The authors acknowledged that there is no specific screening method for children recommended for Diabetes, but their findings showed that a child with a positive family lineage has a high likelihood of developing Diabetes. The limitation of the study is it does not provide efficient information categorized into age bands.

Importance of Screening for type two Diabetes.

Waugh et al. (2007) carried out a study to evaluate the process for screening Diabetes, specifically in the UK, under the National screening committee. The necessity of the study was enhanced by facts that people with type 2 diabetes often go undiagnosed in the early stages. People with type 2 diabetes can have risen in sugar levels without symptoms. According to the authors, the dangers of lack of early screening include damage to other organs in the body, such as eyes, damaged arteries, and the risk of exposure to cardiovascular diseases. The significance of the study, therefore, is that it would help in early detection of Diabetes, reduction of blood glucose levels, and prevention of risk of cardiovascular diseases. The results from the study showed that Diabetes could go undetected until symptoms develop, and their recommendation was early detection through screening can allow for the onset of treatment and reduction of the risk of diabetes complications such as eye disease and cardiovascular issues. The authors also focused on the economic impact of screening, where treatment is less costly on the onset treatment of genetic strains in comparison to when the disease is fully developed.

The authors also proposed a method for carrying screening where there would be a two-phase process commencing with the screening people at a higher risk of Diabetes. These people would be selected dependent on primary care records on demographics such as weight, body mass index, and age (Waugh et al., 2007). The second phase would be testing for blood glucose. According to the authors, some limitations of their study were; there is no determinant for the duration of how long Diabetes went undetected, and determinants of progression to Diabetes. There was also a limitation in determining the nature of the rise in blood glucose levels and how to reduce the prevalence of insulin resistance.

This review was significant for the study because it gives a means of preventing the development of Diabetes to full-blown stages. It also allows the public to give attention to the importance of screening for Diabetes to avoid developing complications that can be regulated or treated if discovered earlier.

How to Prevent the Development of Diabetes

Curtis and Wilson (2005) carried out a study to evaluate how to prevent diabetes type II, which they considered costly, severe, and high prevalence disease. Lifestyle trends, such as impaired fasting glucose, obesity, menopause, and hypertension, increase the risk of Diabetes. To curb the development of insulin resistance, Curtis and Wilson (2005) propose weight loss medication for obese individuals, hormone replacement therapy in women who have hit menopause, and a change in lifestyle, including low intake of manufactured foods.

What can Nurses do to Prevent Diabetes?

There are various cost-effective strategies for managing Diabetes. The Archimedes model shows how nurses, practitioners, and patients can make use of lifestyle modification in addition to metformin to achieve glycemic control at lesser costs (Eddy et al., 2005). While prevention is essential, it is also necessary to carry out measures to prevent death and other complications in diabetic patients. Lifestyle modification could slow Diabetes, especially in high-risk people with modeled recommendations, such as advice on dietary plans, weight loss programs, and daily exercise regimens (Eddy et al. 2005). People with high levels of fasting plasma glucose require intensive treatment, and the final modification can be pharmacological therapy and monitoring. Nursing practitioners play an essential role in medicine dose administrations, public health awareness, screening and diagnosis, and monitoring patients’ glycemic control.

Further Questions for Research

From the research carried out above, there are three questions that can further be researched on

• How can nurses control determinant factors such as hypertension and obesity?
• What is the link between lifestyle diseases?
• What are the methods of detecting Diabetes aside from screening?

Literature Gap and Conclusion

Studies on Diabetes have been stretched on a lot of aspects because of the estimated increase in cases amongst all age groups if the people maintain the lifestyles they are living. The studies have also been influenced by the life-threatening complications that develop as a result of the effects of Diabetes in the body. In as much as one could argue that there has been adequate coverage on Diabetes as a whole, there is a gap in the understanding of the impacts of Diabetes on age groups. There is a need for more insight into how Diabetes affects age groups and ethnic groups. There is also minimal research on interrelations between Diabetes and other lifestyle diseases. The study of their correlation might be significant in understanding the pattern of development of diseases such as Diabetes as a result of lifestyle behaviors. Finally, there is a need for an extensive study beyond prevalence, to include how to reduce patterns such as obesity and hypertension amongst other factors as an attempt to control the risk of having undetected Diabetes in the early stages.

In conclusion, non-communicable diseases continually increase with Diabetes, affecting all age groups, and challenging the community’s mortality rate. Risk factors depend on the type of Diabetes and include; family history, genetics, geography, and lifestyle. However, it can be prevented by changing lifestyles to incorporate active routines, modifying the diet to be rich in organic foods, and less in processed meals, including exercise regimens. Lifestyle modifications such as dietary changes and exercise, as well as active routine, contributed to explained variations in glycemic ratios. Interventions should be aimed at improving self-efficacy, social, nursing, and environmental support, which show an independent association with improved diet and exercise patterns and subsequently improved diabetic management. More comprehensive research should be carried to allow the development of frameworks to apply in primary and secondary diabetes prevention.

Reference

American Diabetes Association. (2014). Diagnosis and classification of Diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.

CDC. (2019). Type 2 Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/type2.html

Chien, K., Cai, T., Hsu, H., Su, T., Chang, W., Chen, M., … & Hu, F. B. (2009). A prediction model for type 2 diabetes risk among Chinese people. Diabetologia, 52(3), 443.

Clark, M. L., & Utz, S. W. (2014). Social determinants of type 2 diabetes and health in the United States. World Journal of Diabetes, 5(3), 296.

Colosia, A. D., Palencia, R., & Khan, S. (2013). Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes, metabolic syndrome, and obesity: targets and therapy, 6, 327.

Curtis, J., & Wilson, C. (2005). Preventing type 2 diabetes mellitus. The Journal of the American Board of Family Practice, 18(1), 37-43.

Eddy, D. M., Schlessinger, L., & Kahn, R. (2005). Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for Diabetes. Annals of Internal medicine, 143(4), 251-264.

Narayan, K. V., Boyle, J. P., Thompson, T. J., Sorensen, S. W., & Williamson, D. F. (2003). The lifetime risk for Diabetes mellitus in the United States. Jama, 290(14), 1884-1890.

Valdez, R. (2009). Detecting undiagnosed type 2 diabetes: family history as a risk factor and screening tool.

Waugh, N., Scotland, G., McNamee, P., Gillett, M., Brennan, A., Goyder, E., … & John, A. (2007). Screening for type 2 diabetes: literature review and economic modeling. HEALTH TECHNOLOGY ASSESSMENT-SOUTHAMPTON-, 11(17).

Xiang, A. H., Li, B. H., Black, M. H., Sacks, D. A., Buchanan, T. A., Jacobsen, S. J., & Lawrence, J. M. (2011). Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Diabetologia, 54(12), 3016-3021.