Purpose of Study
The purpose of this particular plan is to design and implement a new, patient-based approach to the prevention of diabetes in high-risk young people and the avoidance of increasing fatality for young people who have already developed the disease. Diabetes is a growing problem in the United States and elsewhere, and developing a coherent program for lowering the rates of diabetes—particularly Type II diabetes in young people—must be one of the major goals of the medical establishment going forward. Fortunately, the treatment for Type II diabetes is relatively well understood; the medical establishment has determined that the treatment of obesity is closely linked to remission of the disease. The literature and the supporting evidence for lifestyle and diet change will be discussed in some depth in this study.
Problem Statement
Type II diabetes presents a serious risk to the population as a whole, as the cost associated with a highly diabetic population are extremely high. Once the disease has progressed, there is a high fatality rate, and complications with the disease can cause limited mobility and loss of independence for adults and children alike. Treating the root causes of diabetes—including obesity and poor diet—can be incredibly difficult, especially in adults, because these habits become ingrained in individuals from a very young age. However, there is no doubt that community intervention is absolutely necessary—without help, many young people and their families will be unable to break free from the problems that are so commonly associated with this almost entirely preventable disease. Young people with diabetes are slated to live shorter lives fraught with health complications; early intervention can offset these problems before they become life altering forever.
Proposed Solution
The proposed solution includes intervention in severe or high-risk cases for individuals with Type II diabetes. Ideally, the focus for the project will be on children and young adults; if the program can help these individuals and prevent them from ever developing problems associated with Type II diabetes, then the program will be a success and will be working towards the goal of halting the spread of the disease throughout the population as a whole. Of course, diet and exercise intervention are not easily accomplished; if changing one’s diet and exercise strategy were easy, many more people would be successful.
The goal of the program will be to provide an integrated approach to lifestyle change, including familial support, counseling, and all the resources necessary for individuals enrolled in the program to make a very real and lasting change in their lives. The program will focus on young people, including children who are at risk for diabetes; this will allow these children to grow up with a better attitude and a better understanding of the steps necessary to protect their health in the long run.
The program will offer nutrition counseling, exercise programming, and integrated mental health services opportunities to families and individuals. These programs will be invitation-only, so individuals who join the program must be truly engaged in making new life choices and changing the way that they interact with food. Failure to make the necessary changes in the program will lead to removal from the program, as the program requires adherence to ensure that lifestyle changes are effective in slowing or halting the progression of the disease.
Support for Proposed Solution
Diabetes comes in a number of different forms, but Type II diabetes is one of the fastest-growing problems in the world—not just the western world, but the world as a whole (ACCORD Study Group, 2010). In fact, Type II diabetes used to be called “adult-onset” diabetes by the medical establishment; however, in recent years, due to the growing levels of obesity in young people, the descriptor has been changed and now the disease is called “Type II” diabetes (Dixon et al., 2008). A number of programs have been designed to deal with the problem of Type II diabetes, and many of these programs integrate a number of solutions (Dixon et al., 2008). The literature suggests that diabetes Type II is influenced heavily by the development of obesity, and that diet and lifestyle changes can alter and even halt the development of the disease (Dixon et al., 2008; FIELD Study Investigators, 2005; Lindström et al., 2006).
Diet and exercise change for individuals who are on the cusp of developing Type II diabetes has become recognized as one of the primary methods of slowing or even stopping the development of the disease (Diabetes Prevention Program Research Group, 2003; Look AHEAD Research Group, 2013; Rejeski et al., 2012). However, there is no doubt that interventions that require lifestyle change can be difficult for individuals to implement; this is why there is a driving need for a much more thorough, complete structure for at-risk individuals in the population (Gæde et al., 2008; Holman et al., 2008). Children who are at risk for diabetes are particularly important, as the development of the disease at a young age is often associated with a shorter lifespan and a generally lower quality of life (Nathan et al., 2009).
Once an individual has developed diabetes, the problems become much more severe. This is why many interventions focus on individuals who have not yet developed all the worst symptoms of the disease and on individuals who are at high risk for the disease but have not developed the disease yet; intervention can change the course of these individuals’ lives quite effectively without some of the most extreme forms of intervention (Salas-Salvadó et al., 2011; Shojania et al., 2006; Yoon et al., 2006). Although there are options for extreme cases, there should also be options to keep people from ever developing the disease in the first place (Kosaka, Noda, & Kuzuya, 2005; Sigal et al., 2006).
Pharmaceutical and surgical intervention are options for individuals who are suffering from the worst cases of Type II diabetes and show no sign of being able to control the development of the disease (Look AHEAD Research Group, 2013). However, research suggests that these interventions should not be used as a first step to solving the problem of Type II diabetes, but instead should be used as a last resort for individuals who would otherwise be incapable of controlling their problems with diabetes and the symptoms so often associated with the disease (FIELD Study Investigators, 2005; Laaksonen et al., 2005). The research supports an intervention strategy focused on those who have newly developed the disease and for those who are at the highest risk for the disease; this intervention strategy will help slow the process of the disease throughout the population as a whole, while individual cases experiencing severe effects can be individually treated (Gæde et al., 2008; Holman et al., 2008; FIELD Study Investigators, 2005; Laaksonen et al., 2005).
Gastric bypass surgery and medication have been demonstrated to be extremely effective solutions for individuals who are already suffering from some of the worst complications insofar as diabetes is concerned, but children and young people often have not done the same lasting harm to their bodies that many adults have done (Gæde et al., 2008; Holman et al., 2008; FIELD Study Investigators, 2005; Laaksonen et al., 2005). Diet and exercise changes can be extremely effective for young people, but these young people require the help and support of their families to ensure that they are able to maintain weight loss and healthy lifestyle choices; without the familial support, it is more likely that young people—indeed, any individual who attempts to make a lasting change—will fall back into older, unhealthy habits (Gæde et al., 2008; Holman et al., 2008; FIELD Study Investigators, 2005; Laaksonen et al., 2005). The maintenance of healthy habits is the underlying, foundational support upon which diabetes remission and avoidance is built (Holman et al., 2008; FIELD Study Investigators, 2005).
Implementation Logistics
Staff will be necessary to create the program, but some of the staffing necessary for the program can be outsourced to other locations. Exercise professionals, for instance, can easily be outsourced to local gyms willing to pair with the program for the purpose of community betterment. The organizational structure will need to be rewritten, and mental health professionals brought in to ensure that individuals interested in joining the program have the necessary ability to cope with the stress that is likely to be closely associated with the program. It is likely that the program will require extra funding, but funding can be made available through partnership with insurance organizations as well as community outreach groups—the problems of diabetes and obesity are problems that affect the community as a whole, so everyone must be engaged in the program.
The program must also be marketed to the public, and participants must be found. This might be done through partnership with local physicians, who would be able to recommend potential participants based on the individuals that they see in their specific practices. The overall goal of the new program will be to create community through wellness, and this means that many different members of the community must be involved in finding the solution to end obesity and Type II diabetes, particularly in young people and the children, who represent the next generation.
Familial support and education will also be built into the program, as children and young people must rely on their families for support and help with many issues. This is why group and family counseling is so fundamental to the success of the program; telling families what not to do is less effective than teaching them the proper way to eat and life a healthy lifestyle. Fear of the implications of obesity will only go so far, and people must have the tools that they need to be able to really make changes and establish a lifestyle that is sustainable. Continuing support and education in the form of literature, therapy, and expert advice is fundamental to the success of the program.
REFERENCES
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2) Dixon, J. B., O’Brien, P. E., Playfair, J., Chapman, L., Schachter, L. M., Skinner, S., & Anderson, M. (2008). Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. Jama,299(3), 316-323.
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