Description of the health issue
In an international consensus meeting, it was agreed that diabetic neuropathy is the presence of signs and symptoms of peripheral nerve dysfunction among people diagnosed with diabetes after all other causes have been excluded. Over one thousand people in Australia died due to lower limb ulceration in 2005 (Perrin et al, 2012). This is equivalent to 8% of the total deaths due to diabetes. Every year, over 10,000 people are admitted in Australian hospitals with foot ulcers related to diabetes. Cross-sectional studies have shown that 10% of the people diagnosed with diabetes exhibit signs of peripheral neuropathy in Australia, 2.1% of them reporting past incidences of foot ulceration related to diabetes (Bergin, et al., 2012).
Prevalence of the issue and its quality of life
Foot neuropathies in Type 2 diabetes are very prevalent. The epidemiological data available is mind boggling. For instance, 4% of the people in Australia have diabetes an increase from 1.5% in 1989. The Australian government spent 990,000,000 dollars in treating diabetes between 2004 and 2005 (Lee, et al., 2013). Over 7.2 million pharmaceutical scripts for diabetes medicines were claimed in 2011 (Australian Institute of Health and Welfare, 2013). Foot neuropathy has adverse effects on the lives of those diagnosed. The quality of life that the patients lead is adversely change. The loss of sensation in the foot requires the patient not to put pressure on the affected foot. Amputations due to extreme symptoms affect negatively the mobility of the patients.
Analysis of the casual and contextual determinants of the health issue
The social-environmental model of health seeks to improve health of the society by addressing the environmental and economic causes of health. Through the model, individuals are required to act collectively so as to change their social and physical environments. Type 2 diabetes with foot neuropathy can be addressed through the principles outlined by this model. There is a close relationship between the health of the individuals diagnosed with type 2 diabetes with foot neuropathy and their material and social contexts.
As such, these are the targets for change in the management of foot neuropathy in type 2 diabetes. Dietary practices and the safety of the environment for people with type 2 diabetes with foot neuropathy is of importance. Due to the degeneration of the nerves, one may not perceive pain and hence may not be aware of injuries. This could lead to wounds that are problematic in healing sometimes leading to amputations. The determinants of type 2 diabetes with foot neuropathy can be altered if individuals organize themselves and take collective action so as to change their environment as opposed to changing themselves. More importantly, acting at the interface between behavioral and environmental approaches to health is bound to offer more reprieve (Perrin et al., 2013).
Roles played by health professionals and health educators
Health educators and professionals have a role to play in collaborative efforts to provide patient-centers care that is effective for those that are affected by type 2 diabetes with foot neuropathy. After health professionals diagnose one with foot neuropathy caused by type 2 diabetes, the patients are referred to health educators. Health educators play the role of educating those affected by diabetes and the general public on foot care and hygiene. Through counseling services and public awareness drives either in the communities or in clinical settings, health educators offer information to those affected and their families. Health professionals also assess the patients constantly in order to monitor the changes due to the conditions. It is during these assessments that they decide on the actions to take. Through collaborative effort, health professionals and educators have the role to offer support based services. For instance, joint education sessions are instituted in clinical settings in order to learn from the experiences. Heath professionals also play the role of educating the patients on self management. In addition, they also play the role of identifying risk factors for foot neuropathy in patients who already have type 2 diabetes and educating the patients on them (AIHW, 2013).
Critique of the services tasked with addressing the social/environmental/health issue
A number of services are tasked with addressing type 2 diabetes with foot neuropathy. One of the services is nutrition counseling. The purpose of nutrition counseling is to educate the patient on how to achieve metabolic control. This service is very effective because studies have shown that glycemic control is important in the management of type 2 diabetes. However, the professionalization of the service is undermining the effectiveness of the service. Where this service was previously offered in clinical settings, nowadays private consultants have sprung up everywhere with information that is not only impractical but also non-evidence based (Boulton, 2005).
Islet cell transplantation is also another service that is aimed at addressing type 2 diabetes with foot neuropathy. This method seeks to achieve stable normoglycemia. Nonetheless, the method is not very practical because the service is available to patients with foot neuropathy in its end stages. The method is also very expensive thereby making it out of reach for many other patients whose social economic status cannot allow them. Pharmacological management is another method of addressing type 2 diabetes with foot neuropathy. Painful symptoms of foot neuropathy have been managed using numerous therapeutic agents (Dunning, 2008). There is not enough evidence to support using nonsteroidal drugs in diabetic foot neuropathy
Nonetheless, some medical professionals have advocated for their use in the management of mild symptoms in patients. As such, it is important for caution when using these pharmacological agents in the management of foot neuropathy because some cause renal impairments. Physical therapy is also a service that is aimed at addressing foot neuropathy in diabetic patients. Some of the physical therapies applied include percutaneous nerve stimulation and static magnetic field therapy (Better Health Channel, 2013). These therapies are not supported by many evidence- based studies. As such, their use should be limited even if positive results are being witnessed.
Conclusion
Ulceration in foot neuropathy does not occur spontaneously. A combination of neuropathy and other intrinsic and extrinsic factors causes ulceration. As such, the management of foot neuropathy should incorporate multiple approaches in order to take into consideration all the factors involved. As seen in the discussion above, the social environmental model of health is practical in the addressing the health issue because it emphasizes more on changing the environment that the individual. This is important because extrinsic factors as well as intrinsic factors are involved in the development of ulceration in foot neuropathy, hence the need to focus on the environmental context.
References
AIHW, (2013). Diabetes: the facts. Available at> http://www.aihw.gov.au/diabetes/
Baker IDI Heart and Diabetes Institute, (2013). Diabetic neuropathy. Available at> http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetic_neuropathy
Bergin, S.M. et al., (2012). Australian Diabetes Foot Network: management of diabetes-related foot ulceration — a clinical update. The Medical Journal Of Australia. 97 (4): 226-229.
Boulton, J.M. (2005). Management of Diabetic Peripheral Neuropathy. Clinical Diabetes vol. 23 no. 1 9-15
Dunning, T. (2008). Nursing Care of Older People with Diabetes. Oxford: John Wiley & Sons. Pp. 163-172.
Lee, C.M. et al., (2013). The cost of diabetes in adults in Australia. Diabetes Research and Clinical Practice Volume 99, Issue 3 , Pages 385-39
Perrin et al (2012). The foot-health of people with diabetes in a regional Australian population: a prospective clinical audit. Journal of Foot and Ankle Research . 5:(6): 1-6.
Perrin et al., (2013). An organized approach to the podiatric care of people with diabetes in regional Australia. Australian Health Review 36(1) 16-21.
