Literature Review on Current Diabetes Disease Management [this means reviewing more than one system]
Diabetes is a disease that occurs as a consequence of abnormality in sugar metabolism. This occurs as a result of impairment in the secretion of insulin due to pathologic destruction of these islet cells of Langerhans in the pancreas (Bonner-Weir and O’Brien, 2008). This impairment can either be congenital in which a patient is born with intrinsic abnormality of the pancreas leading to Type 1 diabetes or Juvenile onset diabetes. The most common variant, Type 2 diabetes or Adult on-set diabetes occurs due to insufficiency in pancreatic function that happens later in life. Gestational diabetes arises when abnormality in sugar metabolism occurs in pregnancy. Secondary causes of diabetes include Hormonal and genetic abnormalities, Cushing syndrome, cancer and drugs, (Alemzadel and Ali 2011).
The exact pathogenesis responsible for the development of diabetes (especially type 2) is not known but several etiologic factors have been implicated. Factors such as environmental and genetic influences have been suggested as possible etiologic factors. Environmental influences that contribute as risk factors to the development of diabetes include unhealthy food choices, sedentary life style, obesity, and cigarette smoking amongst other causes (Alemzadel and Ali 2011).
The aim in diabetes disease management is to keep the blood sugar within normal unit. Uncontrolled sugar level leads to the disease progression that can often result in complications and comorbidities. Complications that can result from poorly controlled diabetes include blindness, kidney disease, peripheral nerve disease, leg ulcers that can result in amputation. (ADA 2011). Additionally, poorly managed diabetes can result in high blood pressure that can progress to cause cerebrovascular disease.
Co-morbidities associated with diabetes contribute immensely to the cost burden of diabetes. Appropriately, best approaches in managing diabetes aims at keeping the blood sugar level under control to prevent the onset of complications (Qaseem, Visan, Snow et al 2008).
The standard approach used in managing diabetes follows the guidelines set by the ADA. In a nutshell, these include :(i) diagnoses of diabetes through blood sugar test; ii) continuous glucose monitoring after establishing a diagnosis. Sugar level can be controlled either through life style modifications, use of oral Hypoglycemic or insulin therapy depending on the severity of the disease; iii) self-management of diabetes under physician supervision; iv) medical nutritional therapy; v) energy balance, overweight and obesity management; vi) hypertension and blood pressure control; vii) dyslipidemia and lipid management; viii) coronary heart disease screening and treatment; ix) kidney disease screening and treatment; x) eye disease screening and treatment; xi) nerve disease screening and treatment; xii) foot care ( ADA,2011)
In adhering to ADA guidelines, two approaches can be employed in managing diabetes: Individual management approach or community based approach.
In the individual management approach, individuals diagnosed with diabetes can be managed in the clinic by a multidisciplinary team of experts comprising of physicians such as Endocrinologist, Nurse, Nutritionist, Podiatrist and other related specialists in managing various complications.(ADA 2011). The management of individual patients generally involves regularly monitoring patient blood sugar level after diagnosis and screening for associated complications. The approach to management will depend on the severity of the disease. Usually life style modifications are recommended for patients with mildly elevated glucose level; use of oral hypoglycemic drugs in addition to life style modifications for patients with moderately controlled diabetes without complications; and insulin therapy and management of associated complications for those with poorly controlled sugar level.
In the community or population based approach, interventional preventive measure that adheres to ADA guidelines are used to target members of the community at risk of developing diabetes as a proactive measure. Diabetes disease distribution are determined, risk factors for different age bracket established within a geographical region and appropriate interventions are instituted to prevent the prevalence of diabetes in the community as a whole (McCullough, Price, Hindmarsh et all, 2012)
Several institutions employ different strategies in their population based management approach depending on the unique need of their target population. This may vary from simply educating the general public on diabetes prevention without any specific intervention to actual intervention involving identification of individuals in the community with diabetes and managing them at their homes (Noris, Nicholas, Capersen et all 2002)
[What is your suggestion of best approach/practices based on the literature and programs out there? Of course it is both]