UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 Saleh, A M. (2010). Diabetes type 2. UCQ Nursing Journal of Academic Writing, Winter 2010, 10‐18. DIABETES TYPE 2 by Afrah Moosa Saleh Chronic disease, including Diabetes Mellitus (DM), has become the leading health burden in many developing countries. It is a common chronic systemic syndrome characterized by hyperglycemia and it is one of the major world’s causes of death. DM is defined as a disorder of metabolism that leads to a deficit in the production of insulin, or to an inability on the part of the body cells of converting food into glucose which is needed to produce energy (Sharon & Idolia, 1992, p.1282). According to the World Health Organization action plan (2006‐2011), there are many diseases which can cause impairment and disability; one of them is diabetes. Also, an estimated 10% of the impairment and disability experienced by the world’s population is caused by diabetes. In Qatar specifically, diabetes along with cancer is one of the major causes of morbidity and mortality (WHO, Regional Health Systems Observatory, 2009). Also, According to World Health Organization chronic disease accounted for 76% of all death in Qatar in 2002. Given the significant increase in the rate of diabetes mellitus, this present paper seeks to investigate potentially successful preventative methods which would contribute towards a decrease in the rate of this disease. I argue for the impact of changing lifestyle and starting to exercise on the onset and maintenance of diabetes mellitus and its complications. Through exercise, patients can have a normal healthy life especially since this disease is often referred to as a disease of lifestyle. Evidence shows that there are two major types of diabetes: type 1 and type 2. In type 1 diabetes, which is also called juvenile or insulin dependent diabetes, the body completely stops producing any insulin, which is a hormone that assists the body to use the glucose found in foods for energy. People with type 1 diabetes must take daily insulin 10 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 injections to live normally. This form of diabetes usually develops in children or young adults, but also can occur at any age. Type 2 diabetes, also called adult onset or non insulin dependent diabetes, results when the body does not produce enough insulin or is unable to use insulin correctly. This form of diabetes usually occurs in people who are over the age 40, are overweight, and have a family history of diabetes. The article “Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population‐based study of Qatar” points out that the prevalence of type 2 diabetes mellitus has been increasing amongst the adult population in Qatar. Some of the factors hypothesized to contribute to this is increase in rate include central obesity, hypertension, heart diseases, and metabolic syndromes. Additional major factors contributing to diabetes mellitus include smoking habits and presence of family history (Bener, Zirie, Janahi, Al‐Hamaq, Musallam, & Wareham, 2009). As a diabetes patient nurse educator, I have observed that the incident rate of diabetes is increasing. Although it can occur in anyone, people who have close relatives with the disease are more likely to develop it, as well as other people who are at high risk due to obesity, high cholesterol, high blood pressure, and physical inactivity. In the past, people were very active. However, today we live in a world full of innovations in technology such as cars that help in travel, television, computers and all the recourses that have changed our live to sedentary lifestyle. In addition to being in active, fast food and drinks that contain sugar have become an important part of our daily meals, the result is having uncontrolled diabetes that has its immediate and long term complication. People can live for several years with high blood sugar levels without any signs or symptoms. Then, with stress or an illness, symptoms begin and may lead to complications. 11 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 Along with long term complications of both type 1 and type 2 diabetes mellitus, people with diabetes are usually experience certain immediate symptoms due to hypoglycemia or hyperglycemia. This may present as asymptomatic or may present with the following symptoms: fatigue, increased urination, excessive thirst, blurred vision, skin infections and possible coma. People can live for months or even years without knowing that they have the disease, especially if it remains undiagnosed. Type 2 diabetes mellitus comes on so gradually that symptoms may not even be recognized. Poorly managed diabetes leads to the long term complications such as heart attacks, strokes, blindness, kidney failure, blood vessel diseases that may require amputation, nerve damage, and impotence in men (Sharon & Idolia, 1992, p.1282). Many countries of the Gulf region are reporting the onset of type 2 diabetes at younger ages, and it is becoming highly prevalent among both sexes. Furthermore, the number of people with type 2 DM is expected to increase especially in Qatar because of many reason such as sedentary life style, nutrition, lack of physical activity, obesity, and many other reasons (Bener et al, 2009). But can diabetes be prevented? This is the question that interests me greatly. Perhaps someday we will have the ability to prevent and control it completely. I turn now to method of prevention that includes exercise. Prevention is extremely important because, according to Bener, Zirie1, & Al‐Rikabi (2005), “The prevalence of type 2 diabetes has been rising worldwide” (p. 302). The authors are surely right that type2 diabetes is the most common type of diabetes. However, there are some things one can do to prevent this form of diabetes. Furthermore, Bener et al (2005) argue that “A life‐style modification perspective, the importance of body weight control by diet and exercise as well as refraining from excessive smoking and avoiding consanguineous 12 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 marriages should be emphasized ” (p. 307). To prevent diabetes mellitus, in my opinion, I agree that changing lifestyles can prevent or delay the onset of diabetes in those people who are at high risk of getting the disease, especially since most of patient with diabetes are obese or inactive. In addition, preventive measures such as exercising and eating a healthy diet of well balanced food for high risk people, and good chronic disease management for people who are diagnosed with diabetes, can make a real difference by helping to prevent the onset of diabetes, its crises, and deterioration. These measures can enable people to live with chronic conditions and attain the best possible quality of life, and also prevent the occurrence of the disease for people who are at high risk. The article “Genetics, obesity, and environmental risk factors associated with type 2 diabetes” investigates the involvement and the relation between genetic factors, obesity, and life‐style risk factors for diabetes mellitus among the adult Qatari population. Researchers used a survey which is based on standardized interviews, clinical investigation, and data analysis. The authors found that diabetes is more common among first degree relatives and that obesity and environmental factors influence glucose tolerance. The authors agree that people who are at high risk because of having obesity are more prone to develop diabetes when he writes, “The present study revealed that obesity, consanguinity, blood pressure, total cholesterol, HDL‐cholesterol, and triglycerides were more prevalent in diabetic patients.” (p. 302) I agree with this finding, especially his point on obesity, because the obese body will convert fat in to glucose, this will result in more of glucose in the body insulin production. This leads to more glucose in the blood that cannot enter the body’s cells with the help of insulin, and this will result in even more glucose. If the patient went for a checkup it would show excess sugar in the blood. As Bener et al write (2005), “The characterization of obesity and environmental risk 13 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 factors will contribute to defining more effective and specific strategies to screen for and control diabetes mellitus” (p. 307). The author demonstrates the importance of finding new ways and strategies such as modifying life style by exercising, well balanced diet that lead to reduce weight will prevent the occurrence of diabetes or can control it. I agree with them in most of the points that they claims, such as strategies that include exercising and well balanced diet and early screening. Also, reducing weight will have a great impact on personal health because the body will not have more fat than the body requires, which leads to more glucose in the blood. Eating healthy food that has little sugar and fat also contributes to the health of individuals. Another view of the importance of modifying life style and starting exercising to reduce the risk of getting DM and its complication is discussed in the article “Aggressive management with diet and exercise improves pre diabetic neuropathy” by Goodman, (2006). In this article, the researcher studies patients who have impaired glucose tolerance, neuropathy and neuropathy from other causes were excluded. The goal of this study was to make all participants engage in 150 minutes of exercise weekly, and to lose 5 to 7 % of their body weight. During the study, skin biopsies were taken from the leg and thigh of each participant as baseline. One year later, the author and his colleagues found that patients on diet and exercise had less neuropathic pain and more nerve regeneration. Moreover, the author Goodman gave a clear and specific definition to the meaning of impaired glucose tolerance (IGT) “IGT is defined as a pre diabetic state, in which blood glucose levels are higher than normal but not high enough to be called diabetes” (p.4). In my opinion, it is very important to have a base line of information to build our knowledge on it and to know the definition of IGT Goodman focuses on the preventive measures and on people before they diagnosed with diabetes. In addition, Goodman confirms that “diet and exercise improve 14 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 pre diabetic neuropathy. Patients with impaired glucose tolerance (IGT) who followed diet and exercise recommendations had less neuropathic pain and more nerve regeneration”. (p. 4). Thus, exercising, especially in the early stages of nerve damage, is a good choice and I strongly agree because exercise will help to have a healthy body. Additionally, I am of two minds about Goodman’s claim that “aggressive lifestyle changes involving diet and exercise were more effective than drug therapy with metformin in preventing new‐onset diabetes, and the study was halted early because of robust evidence in favour of diet and exercise”(p. 4). On the one hand, I agree that exercising in the pre diabetes period and eating healthy well balanced diet have a great impact on health and the outcome in the prevention of getting the disease. On the other hand, I am not sure if aggressively applying new strategies such as exercising and eating healthy diet to people who have spent more than 30 years of their life eating without control and not exercising can lead to a positive outcome. It might even have the adverse effect. Often, the main focus in exercise is sport activities such as walking. But in the article “Dance and Peer Support to Improve Diabetes Outcomes in African American Women” by (Murrock, Higgins, & Killion, 2009), the authors examine and explore the effects of dance as an intervention in replacing, for example, walking. They also examine the role of peer support to improve the outcomes of diabetes in a community based outpatient clinic for patient diagnosed with type 2 diabetes. Using social cognitive theory as a theoretical framework for this pilot study to support that positive reinforcement such as verbal advice within a supportive social environment is an important issue for individual’s behaviour to change. Also, pretest and post test design and statistical analysis measured between and within two groups were used. In my opinion, it is important to know how people can change their behavior and what can influence them to change, that we can apply it for example for 15 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 some patients who are obese for long time to make them reduce weight. From my perspective, I agree that peer group support has great effects on people’s strategy in starting to change their behaviour. Moreover, the authors claims “Dancing two times per week for 12 weeks produced significant group differences in systolic BP and body fat and significant intra individual changes” (Murrock et al, 2009). I strongly agree with this point because exercise such as walking or going to gym some may find it boring or no time to do it whereas dancing for enjoyment and laughter will promote attendance. Despite the increasing rates of diabetes mellitus, within the past two decades, a significant improvement has occurred in Qatar in the area of health care and in the prevention of diseases and promotion of health. In fact, diabetes mellitus has become one of the main public health issues in terms of prevention and treatment (Bener, Zirie, Al‐
Rikabi, 2005). I believe that ggood chronic disease management and good preventive measures can make a real difference, helping to prevent crises and deterioration, and enabling people living with chronic conditions to attain the best possible quality of life. Also, the effort to improve the care of chronic disease must begin with the fact that a large majority of patients receive the majority of their care in primary care practices. Therefore, primary health care settings should be up‐to‐date and build their structures on evidenced base nursing practice. As members of integrated, multidisciplinary teams, nurses have important roles to play in the prevention and management of chronic disease. Nurses spend a greater amount of time in direct contact with their clients than any other health care professionals. Nurses have the first‐hand information about the patient’s health, lifestyle and needs. Nurses are skilled at assessment, ongoing care, education and family support. Also, nurses play an important role in advocating for and with people living with chronic diseases. As a result, nurses can work with the community, consider the social 16 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 determinants of health, become aware of complimentary practice, and finally advocate for increased investment in health promotion and prevention care. This will lead to increasing awareness among the public about how to prevent diseases. Prevention is always better. To conclude, the management of chronic diseases such as type 2 diabetes is challenging and it requires nurses as well as individuals working together to have high level of motivation to direct the health of the public to its maximum peak through prevention. In addition, the impact of chronic diseases is driving health systems around the world to work collaboratively to reduce the cost of treatment, and to reduce the workload of health care professionals. Finally, prevention and management strategies must be developed effectively and health care professionals should be involved in prevention and management of chronic diseases such as diabetes. 17 UCQ Nursing Journal of Academic Writing, Winter 2010 http://www.qatar.ucalgary.ca/acwr/w2010 References Abdulbari, B. Mahmoud, Z. Ammar A. (2005). Genetics, obesity, and environmental risk factors associated with type 2 diabetes. Croat Med J 46(2),302‐307. Abdulbari, B. Mahmoud, Z. Ibrahim, J. Abdulla, A. Manal, M. Nick, W. (2009). Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population‐
based study of Qatar. Diabetes Research and Clinical Practice 8. 4, 99‐106. Goodman, A. (2006). Aggressive management with diet and exercise improves prediabetic neuropathy. Neurology Today, 6 (11), 4. Murrock, C., Higgins, P., & Killion, C. (2009). Dance and peer support to improve diabetes outcomes in African American women. Diabetes Educator, 35 (6), 995‐1003. WHO, Regional Health Systems Observatory, 2009. Retrieved from http://gis.emro.who.int/HealthSystemObservatory/PDF/Qatar/Health%20system%2
0organization.pdf World Health Organization Action Plan (2006‐2011). Retrieved from http://www.who.int/countries/qat/en/ 18