DIABETES
Introduction
Diabetes is a condition that limits the ability of the body to maintain the optimum amount of glucose in the blood (Strom and Egede, 2012). It was selected for the discussion in this essay because it is complex, serious, and highly prevalent in the United Kingdom (UK). Grintsova, Maier and Mielck (2014) elucidate that diabetes necessitates daily self-care and often leads to complications. The essay starts with a discussion of diabetes as a public health issue that impacts negatively the overall well-being of affected individuals, families, and communities. The determinants of health and policy issues related to diabetes are also discussed in the essay. The last part of the essay includes a discussion on the implications of the increasing prevalence of diabetes for nursing practice.
Public Health, Wellbeing, and Disability
Public health refers to the discipline and practice of protecting the health of individuals, populations, and communities through the prevention of illnesses (Strom and Egede, 2012). Whiting et al., (2011) assert that public health practice describes organized activities or actions that aim at promoting the health and well-being of a population. Diabetes is a public health concern because of its increasing incidence, prevalence, and contribution to mortality. Notably, the WHO estimates that by 2025, 300 million people from around the world will be diabetic (Shaw, Sicree and Zimmet, 2010). Empirical research evidence indicates that diabetes among members of high-risk groups can be prevented through the implementation of effective public health programs and initiatives (Dyson et al., 2011).
Well-being refers to the overall condition of a person, population, or community (Grintsova, Maier and Mielck, 2014). High wellbeing describes a positive state of physical, social, spiritual, medical, cognitive, and psychological condition. Diabetes has a negative impact on an individual’s well-being. Whiting et al., (2011) explain that diabetes elicits negative emotions, such as frustration, anger, helplessness, and fear, which limit the well-being of affected individuals. Diabetes is also associated with psychological symptoms such as depression. Schabert et al. (2013) elucidate that a person with diabetes has increased mental health needs. Notably, the emotional worries and burdens experienced by people with diabetes occur due to anxiety about complications and constant concern over eating and hypoglycemia (Strom and Egede, 2012).
Disability is a developmental, physical, or cognitive situation that limits, impairs, or interferes with an individual’s ability to execute specific actions, tasks, or activities. Schabert et al. (2013) argue that diabetes is a disability because most legal frameworks protect diabetic people in the same manner as individuals with disabilities. Whiting et al., (2011) explain that it is the limitations of the endocrine system in diabetes which inform its categorization as a disability. However, it is notable that when diabetes is effectively managed, affected people are able to lead productive lives.
Determinants of Health
Diabetes is closely linked to socioeconomic determinants of health. Diabetes, U.K (2015) demonstrates that in the UK, individuals or groups that are socioeconomically deprived are 2.5 times more likely to be diabetic than the general population. Notably, the prevalence of diabetes is significantly high in North East England. For example, the prevalence of diabetes is 45% higher among women in North East England as compared to the national average (Grintsova, Maier, and Mielck, 2014). Schabert et al. (2013) reveal that the risk of being diabetic increases with age. Notably, 1.3 diabetic patients in the UK are aged 65 or above (Gale, 2010). The risk of diabetes is also associated with ethnicity. Dyson et al. (2011) illustrate that people from minority ethnic groups in the UK, such as non-whites are six times more likely to be diabetic than the general population (Sargeant et al., 2010). Complications that develop due to diabetes, such as kidney damage, stroke, and heart disease are also linked to socioeconomic determinants. Hayes et al. (2013) indicate that individuals from low socioeconomic groups in the UK are 3.5 times more likely to experience complications of diabetes than the general population. Education is also a health determinant of diabetes. Courtenay, Stenner, and Carey (2010) clarify that less educated people are likely to demonstrate poor diabetes control and resultant complications.
Dyson et al. (2011) reveal that socioeconomic deprivation is linked to unhealthy diet, physical inactivity, poor control of blood pressure, and smoking. The aforementioned factors are strongly connected to the risk of diabetes and its complications among adults (Strom and Egede, 2012). Notably, diabetes is among the biggest health concerns in the UK. This is because about 3.9 million people in the UK are diabetic (Grintsova, Maier, and Mielck, 2014). The increase in the prevalence of diabetes is also associated with limited access to care. Dhatariya et al. (2012) explain that people who are unable to access high-quality or appropriate care have an increased risk of developing diabetes. Whiting et al., (2011) indicate that type 2 diabetes is particularly linked to both the level of access to care and diversity. Schabert et al. (2013) point out that the socioeconomic disadvantages that are related to diabetes contribute to inequalities in the health outcomes of diabetics. Hayes et al. (2013) add that uncontrolled hypertension and smoking are specifically linked to increased morbidity of diabetes among adults from low socioeconomic groups in the UK. Schabert et al. (2013) show that unemployment, referral bias, housing status, and raised cholesterol also heighten the risk of diabetes among adults. Additionally, the inaccessibility of elderly people who live alone increases their risk of diabetes morbidities (Strom and Egede, 2012).
Dhatariya et al. (2012) associate diabetes with the psychosocial orientation of affected individuals. For example, resistance to behavior change, hopelessness, and depression are reported to increase the risk of developing diabetes. Health inequalities in diabetes are also associated with unsafe neighborhoods which hinder cycling, jogging, or walking. Hayes et al. (2013) add that low-income households are less likely to eat vegetables and fruits, leading to an increased risk of diabetes (Heslehurst et al., 2010). Dyson et al. (2011) indicate that inequalities in the quality or standards of care impact diabetes outcomes. For example, serious complications of diabetes, such as kidney failure, heart disease, blindness, nerve damage, and stroke among ethnic minorities and socioeconomically deprived groups in the UK are strongly related to inequalities in the quality of care (Grintsova, Maier, and Mielck, 2014).
Policy Issues
The alarming increase in the prevalence of diabetes in the UK, especially in North East England, necessitates the development and implementation of policy frameworks, plans, strategies, and programs on diabetes at national and local levels. Diabetes, U.K (2015) illustrates that obesity and healthy eating policy provides for the implementation of public health interventions for promoting healthy living in Middlesbrough and other parts of North East England. This is due to the close correlation between obesity and diabetes. The NHS Diabetes Prevention Program (DPP) is interpreted in North East England in the context of its role in dealing with the increasing prevalence of diabetes (Gale, 2010). The main goal of the NHS DDP is to prevent obesity and diabetes in high-risk populations, such as minority and deprived groups in North East England. It also aims at reducing the risk of diabetes-related complications. The program was developed on the basis of the provisions of the obesity and healthy eating policy (Dyson et al., 2011). The NHS DDP works with a wide range of providers, such as Living Well Taking Control, Pulse Healthcare Limited, Reed Momenta, and Ingeus UK in the implementation of public health interventions at local and national levels aimed at reducing the prevalence of type 2 diabetes and obesity (Grintsova, Maier and Mielck, 2014).
The NHS efficiency policy is interpreted in North East England in the context of its contribution towards the reduction of inequalities related to access to NHS services (Heslehurst et al., 2010). For example, the diabetes inequalities that affect low-income and minority groups in Middlesbrough and other parts of North East England are addressed through the increase in the efficiency of NHS services. Grintsova, Maier, and Mielck, 2014) demonstrate that the low performance of NHS services in the prevention and mitigation of diabetes is attributed to its increased prevalence in Middlesbrough (Sargeant et al., 2010). The NHS efficiency policy provides for the prioritization of NHS services to high-risk groups, such as women and the elderly. The policy is relevant in the implementation of preventive and primary care services for diabetes in Middlesbrough because it is linked to socioeconomic disparities and risk factors (Diabetes, U.K., 2015).
Diabetes education programs and initiatives in North East England are designed to reduce inequalities in health education and preventive interventions for diabetes. For example, the Community Diabetes Imitative seeks to provide locally accessible diabetes care for high-risk groups in Middlesbrough, Cleveland, and Redcar (Grintsova, Maier, and Mielck, 2014). The diabetes teams of the Community Diabetes Imitative involve dietitians, registered nurses, diabetes care experts, and family physicians. These healthcare professionals work to provide personalized and community-based diabetes care services for populations that are most affected by health inequalities (Heslehurst et al., 2010).
Dyson et al. (2011) recommend that diabetes policies, strategies, and initiatives in the UK should be focused on understanding and changing health behaviors that contribute to the increasing prevalence of diabetes. Notably, the Diabetes Prevalence Model of Public Health England (PHE) supports diabetes prevention strategies and interventions that focus on changing health behaviors among members of high-risk groups (Dyson et al., 2011). Courtenay, Stenner, and Carey (2010) demonstrate that diabetes prevention initiatives and programs should help members of high-risk groups to change their dietary habits and to engage in more physical activities. Hayes et al. (2013) add that lifestyle interventions that are based on evidence-based behavior-change principles are effective as they allow individuals to reduce their risk of diabetes through the making of healthier choices. Scholars recommend that government regulations on unhealthy foods should be tightened to reduce the risk to the UK population from obesity and diabetes (Sargeant et al., 2010). Mass media campaigns on diabetes should also be implemented with the goal of promoting healthy lifestyles among members of high-risk groups (Dyson et al., 2011).
Implications for Nursing Practice
Nurses play important public health roles pertaining to the prevention of diabetes and improving the overall health and well-being of the community. For example, nurses provide prevention advice to promote healthy lifestyles among members of high-risk groups (Stenner, Carey, and Courtenay, 2010). Dhatariya et al. (2012) indicate that nurses should apply effective health coaching and behavior change techniques to enhance the effectiveness of prevention programs for diabetes. Nurses also play specific roles, such as screening that enable early detection and prevention of type 2 diabetes among members of high-risk communities (Heslehurst et al., 2010). Furthermore, nurses promote self-care among diabetic patients, which is aimed at safeguarding the health of patients and the well-being of families and communities (Stenner, Carey, and Courtenay, 2010). Courtenay, Stenner, and Carey (2010) add that nurses assess the nutritional needs of patients, which supports preventive programs for diabetes.
Diabetes Specialist Nurses (DSNs) safeguard the well-being of patients with diabetes by referring them to providers of specific specialist services such as dieticians and mental health professionals (Dhatariya et al., 2012). Therefore, nurses contribute to the physical, mental, medical, and social well-being of patients and communities that have an increased risk of diabetes and associated health disparities. According to Stenner, Carey, and Courtenay (2010), the annual foot and diabetes checks carried out by nurses demonstrate their important public health role in safeguarding the well-being of the community. Courtenay, Stenner, and Carey (2010) point out that complications and disabilities that are related to diabetes are prevented through the effective implementation of the clinical roles of nurses, such as supporting and maintaining the health of diabetic patients.
Hayes et al. (2013) illustrate that the NMC code provides guidelines that make nurses effective in safeguarding the well-being and health of the community. Notably, the NMC code requires nurses to act with integrity and to respect the dignity of the people they serve (Dyson et al., 2011). Therefore, nurses should provide dignified and high-standard preventive and clinical services to members of socioeconomically disadvantaged and minority groups that experience an increased risk of diabetes. In addition, nurses are required to advocate for the needs of patients, such as access to high-standard care, regardless of their ethnic or socioeconomic backgrounds (Diabetes, U.K., 2015).
Conclusion
Credible research evidence indicates that inequalities in the risk of diabetes, access to appropriate health services, and health outcomes among adults are strongly correlated to social exclusion, poverty, extreme age, and non-white ethnicity. Adults in disadvantaged groups in the UK have compounded problems related to diabetes, which negatively impact on their health outcomes and increase the risk of complications and morbidity. Intervention for addressing the problem of diabetes should be based on the appreciation of the complexity of the problem. Therefore, context-specific and multifaceted approaches which involve community groups and healthcare professionals should be implemented to reverse the increasing prevalence of diabetes in the UK. Additionally, government policies should support preventive initiatives and programs for diabetes. Prevention strategies and policies effective mass media campaigns and tightening regulations on unhealthy foods will help in reversing the increasing prevalence of diabetes in the UK.
References
Courtenay, M., Stenner, K. and Carey, N., 2010. The views of patients with diabetes about nurse prescribing. Diabetic Medicine, 27(9), pp.1049-1054.
Dhatariya, K., Levy, N., Kilvert, A., Watson, B., Cousins, D., Flanagan, D., Hilton, L., Jairam, C., Leyden, K., Lipp, A. and Lobo, D., 2012. NHS Diabetes guideline for the perioperative management of the adult patient with diabetes. Diabetic Medicine, 29(4), pp.420-433.
Diabetes, U.K., 2015. Diabetes: facts and stats. 2014. Accessed 23 April, 2017.
Dyson, P.A., Kelly, T., Deakin, T., Duncan, A., Frost, G., Harrison, Z., Khatri, D., Kunka, D., McArdle, P., Mellor, D. and Oliver, L., 2011. Diabetes UK evidence?based nutrition guidelines for the prevention and management of diabetes. Diabetic Medicine, 28(11), pp.1282-1288.
Gale, E.A.M., 2010. Diabetes in the UK: time for a reality check?. Diabetic Medicine, 27(9), pp.973-976.
Grintsova, O., Maier, W. and Mielck, A., 2014. Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review. International journal for equity in health, 13(1), p.43.
Hayes, A.J., Leal, J., Gray, A.M., Holman, R.R. and Clarke, P.M., 2013. UKPDS outcomes model 2: a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30 year United Kingdom Prospective Diabetes Study: UKPDS 82. Diabetologia, 56(9), pp.1925-1933.
Heslehurst, N., Rankin, J., Wilkinson, J.R. and Summerbell, C.D., 2010. A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989–2007. International journal of obesity, 34(3), pp.420-428.
Sargeant, L.A., Simmons, R.K., Barling, R.S., Butler, R., Williams, K.M., Prevost, A.T., Kinmonth, A.L., Wareham, N.J. and Griffin, S.J., 2010. Who attends a UK diabetes screening programme? Findings from the ADDITION?Cambridge study. Diabetic Medicine, 27(9), pp.995-1003.
Schabert, J., Browne, J.L., Mosely, K. and Speight, J., 2013. Social stigma in diabetes. The Patient-Patient-Centered Outcomes Research, 6(1), pp.1-10.
Shaw, J.E., Sicree, R.A. and Zimmet, P.Z., 2010. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes research and clinical practice, 87(1), pp.4-14.
Stenner, K., Carey, N. and Courtenay, M., 2010. Implementing nurse prescribing: a case study in diabetes. Journal of Advanced Nursing, 66(3), pp.522-531.
Strom, J.L. and Egede, L.E., 2012. The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review. Current diabetes reports, 12(6), pp.769-781.
Whiting, D.R., Guariguata, L., Weil, C. and Shaw, J., 2011. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes research and clinical practice, 94(3), pp.311-321.
