The goal of every nurse practitioner is to work with the patients in achieving healing and good health. In this process, the nurse makes a number of decisions. For these decisions to be successful in providing the expected outcome, nurses are expected to base their decisions on well validated scientific evidences. This is called evidence based practice. It is important to know where one is getting with once decisions and this is the fundamental for evidence based practice. This will ensure that the clinical practice is based on the foundation of strong scientific knowledge. Likewise, diabetes specific evidence based practice are also developed and updated from time to time. This will help to improve the quality of diabetic care in line with the opportunities identified by science and technology advancement. (Seidu & Khunti, 2012)
The number of people with type 2 diabetes is increasing like never before. It is already a major public health concern in U.S. In type 2 diabetes, there is insulin resistance and over a period of time leads to beta cell exhaustion and insulin deficiencies. Insulin deficiency leads to hyperglycemia and disruption of carbohydrate, fat and protein metabolism. Though type 2 diabetes is a chronic incurable disease, in most cases it is preventable. For most people, the disease is asymptomatic, until it reaches an advanced stage. For these reasons, a regular monitoring of blood sugar levels in the high risk population, will enable early diagnosis and prevention. Common symptoms of diabetes include lethargy, polyuria, polydipsia, blurred vision, frequent fungal or bacterial infection, poor wound healing and loss of skin sensation. The diagnosis of the disease is usually made through estimation of fasting blood sugar levels, random blood sugar level estimation, glucose tolerance test and HbA1C. The patient’s risk for type 2 diabetes, increases with increasing age, presence of family history of diabetes, overweight/obesity, hypertension, presence of inactive lifestyle, certain medications, presence of certain autoimmune disorders and hormonal imbalance. (Seidu & Khunti, 2012)
Through years of research on this topic, researchers have identified 15 important goals that need to be achieved for the optimum management of type 2 diabetes mellitus in patients. Diet was identified as the first goal in achieving optimum health. People with diabetes are advised to follow healthy eating habits. Overeating and starvation are both detrimental to health. If the patient has a history of cardiovascular disease, he can be recommended to a Mediterranean diet (Psaltopoulou, Ilias, & Alevizaki, 2010). The second goal in diabetes care is body mass index. Maintaining a healthy BMI is very important in controlling blood sugar levels. The incidence of insulin resistance and type 2 diabetes is higher among overweight and people with obesity. Studies suggest that even a 5-to 10% reduction in body weight in people with obesity or overweight, can bring about significant improvement in insulin sensitivity and type 2 diabetes. A patient centered approach may be necessary while introducing lifestyle modification through diet and bariatric surgery. (Ryan, 2012)
Physical activity is the third clinical goal of managing diabetes. Thirty minutes of moderate physical exercise every day or 150 minutes per week, is effective in preventing diabetes. It is also beneficial for patients in improving metabolic control and in preventing cardiovascular complications. Patients on insulin or sulphonyl urea therapy must take precautions to avoid post exercise hypoglycemia, which can be life threatening. Cigarette smoking is injurious to health. Studies suggest that smokers have difficulty in controlling blood sugar levels and have adverse disease outcomes. The fourth goal is to reduce alcohol consumption in the patient to ≤ 20 gms per week (less than 2 standard drink). Few studies identify diabetes as an outcome of alcoholism. (Psaltopoulou, Ilias, & Alevizaki, 2010)
The fifth goal in diabetes management is to maintain stable blood sugar levels (BSL). Normal BSL is 6-8mmol/L during fasting and 8-10mmol/L postprandial level. Glucometer enables self-monitoring of blood glucose level. Regular monitoring will also help to prevent hypoglycemia associated with the intake of glucose lowering medications. The sixth goal in diabetes management is to achieve an HbA1c (mmol/mol; %) levels between 6.5–7.5%. HbA1c refers to glycated hemoglobin levels and it provides the clinician with information on the regulation of blood sugar levels over a period or 1 week or 1 month. Patients whose have poor blood sugar control have elevated levels for many days. (Khattab, Khader, Al-Khawaldeh, & Ajlouni, 2010)
The sixth goal in diabetes management is to regulate blood lipid level. Under this objective, the patient blood lipid profile is: Total cholesterol (optimum value <4.0 mmol/L), HDL cholesterol (optimum value ≥1.0 mmol/L), LDL cholesterol (optimum value <2.0 mmol/L), Non-HDL-Cholesterol (optimum value <2.5 mmol/L) and triglycerides (optimum value <2.0 mmol/L). Maintaining a healthy lipid profile will help to reduce the risk for cardiovascular diseases in the diabetic patient. The seventh goal is to maintain normal blood pressure levels and to prevent hypertension. Hypertension can predispose the patient to adverse disease’s outcome. (Kannel, 1985) doi:10.1016/0002-8703(85)90224-8
The eighth goal in diabetes management is to ensure optimum kidney function. Kidney failure is a common complication of diabetes and common cause of death. Regular monitoring of urinary albumin excretion is done to access kidney function (Ninomiya et al., 2009). Finally, the last goal is to vaccinate patients for pneumococcus, influenza and tetanus. Diabetic patients are susceptible to these infections. All the above nine goals of diabetes management, cannot be applied uniformly to all patients (ADDE, 2014). The physician/nurses can may conscientious decision based on the patient’s presentation.
References
ADDE,. (2014). Vaccination Practices for Hepatitis B, Influenza, and Pneumococcal Disease for People with Diabetes. The Diabetes Educator, 40(1), 122-124. http://dx.doi.org/10.1177/0145721713513545
Kannel, W. (1985). Lipids, diabetes, and coronary heart disease: Insights from the Framingham Study. American Heart Journal, 110(5), 1100-1107. http://dx.doi.org/10.1016/0002- 8703(85)90224-8
Khattab, M., Khader, Y., Al-Khawaldeh, A., & Ajlouni, K. (2010). Factors associated with poor glycemic control among patients with Type 2 diabetes. Journal Of Diabetes And Its Complications, 24(2), 84-89. http://dx.doi.org/10.1016/j.jdiacomp.2008.12.008
Ninomiya, T., Perkovic, V., de Galan, B., Zoungas, S., Pillai, A., & Jardine, M. et al. (2009). Albuminuria and Kidney Function Independently Predict Cardiovascular and Renal Outcomes in Diabetes. Journal Of The American Society Of Nephrology, 20(8), 1813-1821. http://dx.doi.org/10.1681/asn.2008121270
Psaltopoulou, T., Ilias, I., & Alevizaki, M. (2010). The Role of Diet and Lifestyle in Primary, Secondary, and Tertiary Diabetes Prevention: A Review of Meta-Analyses. The Review Of Diabetic Studies, 7(1), 26-35. http://dx.doi.org/10.1900/rds.2010.7.26
Ryan, D. (2012). BMI Guidelines for Bariatric Surgery in Diabetes: How Low Can We Go?. Diabetes Care, 35(7), 1399-1400. http://dx.doi.org/10.2337/dc12-0729
Seidu, S. & Khunti, K. (2012). Non-adherence to diabetes guidelines in primary care – The enemy of evidence-based practice. Diabetes Research And Clinical Practice, 95(3), 301-302. http://dx.doi.org/10.1016/j.diabres.2012.01.015
