The purpose of the proposed solution is to begin to deal with the endemic problems associated with type II diabetes within the community. Research has conclusively demonstrated that type II diabetes poses a significant threat to the long-term wellbeing of the community as a whole, and that the problems associated with diabetes will cost the average taxpayer significantly over time (Lindström et al, 2006; Gæde et al, 2008; Yoon et al., 2006). Because of the potential threat to the community at large, developing coherent strategies for dealing with obesity and type II diabetes is a community-wide problem that must be addressed (FIELD Study Investigators, Yoon et al., 2006; Dixon et al., 2008; Kosaka, Noda, & Kuzuya, 2005).
The program for implementation depends heavily on the prior research done into the best ways to deal with type II diabetes and individuals who are in the pre-diabetic phase of the disease. Diabetes is a difficult and debilitating disease when coupled with obesity, and the complications associated with the disease can be devastating (ACCORD Study Group, 2010; Holman et al, 2008; Salas-Salvadó et al., 2011; Sigal et al., 2006). The proposed solution will integrate facets of the literature which suggest that type II diabetes responds well to diet and lifestyle change, but also that the disease requires other types of interventions as well to ensure that symptoms are addressed quickly and thoroughly (Laaksonen et al., 2005; Nathan et al., 2005; Stumvoll, Goldstein, & van Haeften, 2005).
The purpose of the research will be to conduct a study that allows for thorough and complete intervention in young people who are showing signs of being at risk for diabetes, and for those individuals who have already begun to develop the earliest stages of the disease. Because the disease tends to worsen once an individual contracts it, catching and treating the disease at the earliest possible moment is fundamentally important (ACCORD Study Group, 2010; Holman et al, 2008; Salas-Salvadó et al., 2011; Sigal et al., 2006; Shojania et al, 2006; Laaksonen et al., 2005; Nathan et al., 2005; Stumvoll, Goldstein, & van Haeften, 2005; Look AHEAD Research Group, 2013).
The method for implementing this community intervention will involve a number of quite complex processes, and will require the development of a new program within the clinical facilities. Potential patients will be recommended by physicians and clinicians based on a number of key features: the patient must be under the age of twenty-five, in the early stages of type II diabetes or in the pre-diabetic stages of the disease, significantly overweight or obese according to BMI, and must be willing to commit to a program that expects complete lifestyle changes per the recommendations of the clinicians at the program.
The program will involve a number of clinical interventions to control the disease in the patients and to send the patients into remission; adherence to the program, particularly the diet and lifestyle aspects of the program, will be required of the participants. Because only a limited number of spots will be available, failure to meet milestones will result in removal from the program for patients who are unable to complete the appropriate goals set by their clinicians. Intervention for type II diabetes must be provided to people in the earliest stages of the disease to ensure that these individuals are able to go into remission and avoid the worst consequences of the disease.
There are also a number of variables that must be considered. The first variable will be the number and type of staff members available for the project; such an in-depth clinical project requires a significant amount of staff, including mental health professionals and nutrition experts. Similarly, the number and type of participants should be considered. For full efficacy, each participant should receive adequate time with the appropriate clinicians. Patient attitude and commitment is likewise very important, because the program will be taxing physically and emotionally.
Reduction in diabetic signifiers, including blood glucose level and insulin sensitivity, will be tracked over time to determine whether the program is effective in treating factors associated with the early stages of diabetes. Similarly, secondary factors like BMI and respiratory health will be tracked to determine whether overall health metrics have been improving over the course of the program.
When evaluating project outcomes, the program will be evaluated on holistic progress of the individuals involved in the project. While individual results matter, the general trend of success or failure will be the overall metric by which the researchers will determine whether the programming will be considered enough of a success for duplication with other populations. In addition, the researchers will use successes and failures to adjust the program, and change the program in appropriate ways to ensure greater success if and when the project is duplicated. In the long term, assessments of the prognosis for participants should be tracked to determine if recidivism is likely.
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.
3) FIELD Study Investigators. (2005). Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. The Lancet, 366(9500), 1849-1861.
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