Download Philippine Practice Guidelines   on the Diagnosis and Management of   Diabetes Mellitus (DRAFT) (PDF)

2011 DIABETES PHILIPPINESSCHEDULED ACVITIES

  42nd Diabetes WorkshopIloilo Business Hotel, Iloilo CityJuly 15, 2011 (Friday)Download Preliminary Programme (PDF)

7th Diabetes ForumIloilo Business Hotel, Iloilo CityJuly 16, 2011 (Saturday)Download Preliminary Programme (PDF)

43rd Diabetes WorkshopAsiaBlooms Hotel, Resort and RestaurantNational Highway, Brgy. Patimbao,Sta. Cruz, LagunaOctober 7, 2011 (Friday)Download Preliminary Programme (PDF)

8th Diabetes ForumAsiaBlooms Hotel, Resort and RestaurantNational Highway, Brgy. Patimbao,Sta. Cruz, LagunaOctober 8, 2011 (Saturday)Download Preliminary Programme (PDF)

 28th Annual Convention of Diabetes Philippines7th Course on Diabetes and Vascular DiseaseCentury Park HotelNovember 9 – 11, 2011 (Wednesday-Friday)

Download Preliminary Programme (PDF)Download Registration Form (PDF)

 Gimik Diabetes Year 5World Diabetes Day Celebration/Lay Annual ConventionNovember 12, 2011 (Saturday)

FOR INQUIRIES PLEASE CALL:Diabetes Philippine Secretariat

Telefax:  (632) 531-1278  Tel.:  (632) 534-9559Email:  diabetesphilippines@pldtdsl.net

Website:  www.diabetesphil.org

. This page features the full text of 

    Republic Act No. 8191 National Diabetes Act of 1996 

AN ACT PRESCRIBING MEASURES FOR THE PREVENTION AND CONTROL OF DIABETES MELLITUS IN THE PHILIPPINES, PROVIDING FOR THE CREATION OF A NATIONAL COMMISSION ON DIABETES, APPROPRIATING FUNDS THEREFOR

AND FOR OTHER PURPOSES.   

 

   

Section 1. Short Title. — This Act shall be known as the "National Diabetes Act of 1996."

Sec. 2. Declaration of Policy. — The State shall protect and promote the right to health of the people and instill health consciousness among them. There shall be priority for the needs of the underprivileged sick, elderly, disabled, women and children.

Sec. 3. The National Commission on Diabetes. — There is hereby created a National Commission on Diabetes, hereinafter referred to as the "Commission," which shall be composed of nine (9) members, as follows: one (1) shall be a practising clinical diabetologist, one (1) shall be a licensed

physician involved in research and education on diabetes, one (1) shall be an epidemiologist, one (1) shall be a nutritionist with experience in the control of diabetes, one (1) shall be a social scientist, one (1) shall come from a non-government organization engaged in the prevention and treatment of diabetes, one (1) shall come from the academe and one (1) shall be a diabetic with a record of public service in reducing the impact of the disease on affected individuals and their families. The Undersecretary for Public Health Services shall serve as the ex officio Chairperson of the Commission.

The members of the Commission shall be appointed by the President within thirty (30) days from the promulgation of the rules and regulations as specified in Section 14 of this Act, upon the recommendation of the Secretary of Health. Each member shall be entitled to a monthly honorarium to be determined by the Secretary of Health subject to the pertinent budgetary laws, rules and regulations on compensation, honoraria and allowances.

The Commission shall be attached to the Department of Health (DOH) for administrative, technical and budgetary purposes.

Sec. 4. Duties and Functions. — The Commission shall:

(a) assess the social and economic impact of diabetes mellitus on individuals, families, households, communities and the nation;

(b) evaluate the adequacy of national resources devoted to the prevention, diagnosis, and treatment of diabetes mellitus; and

(c) formulate, in accordance with Section 7 of this Act, the National Diabetes Prevention and Control Plan.

Sec. 5. Meetings. — The Commission shall meet not later than thirty (30) days after it has been fully constituted and not less frequently than every month thereafter of the call of the

Chairperson of the Commission. chan robles virtual law librarySec. 6. Secretariat and Technical Staff . — The Commission shall have a secretariat and technical staff to provide administrative support and technical assistance to the Commission to effectively carry out its functions.

Sec. 7. The National Diabetes Prevention and Control Plan. — The long range national plan for the prevention and control of diabetes mellitus shall provide for:

(a) the development of strategies and programs, including awareness campaigns and the continuing education of health personnel and concerned individuals, to prevent diabetes mellitus and its complications;chan robles virtual law library(b) the adoption of cost-effective and appropriate screening methods for the detection of diabetes mellitus in its early or pre-symptomatic stages;

(c) the investigations into the epidemiology, etiology, diagnosis, treatment, prevention and control of diabetes mellitus;

(d) the evaluation of measures employed, including drug and diet therapies, in the control of diabetes mellitus;

(e) the establishment of mechanisms to reduce the socio-economic impact of diabetes mellitus on affected individuals and families;

(f) the granting of incentives and support for organizations of affected individuals and families;

(g) the establishment of coordinated health systems, which shall involve clinicians, researches, allied health professionals, community — based health workers and lay volunteers, for dealing with diabetes mellitus and its complications;

(h) the participation of local government units, alongside with concerned government agencies and non-government organizations, in the implementation of programs on diabetes prevention and control;

(i) the periodic review of research needs and potential in the control of diabetes mellitus;

(j) the systematic utilization of public and private resources to achieve the objectives enumerated above; and

(k) the recommendations of the Commission for legislation.

Sec. 8. Implementation of the Plan. — The DOH, through its Office of Public Health Services shall implement the National Diabetes Prevention and Control Plan.chan robles virtual law librarySec. 9. Comprehensive Report. — The Commission shall submit to both Houses of Congress and the Secretary of Health, within one (1) year of its initial meeting, the National Diabetes Prevention and Control Plan, specified in Section 7 hereof. A report which describes the activities and expenditures of the Commission shall likewise be submitted.

Sec. 10. The Oversight Committee for the Prevention and Control of Diabetes. — Upon submission of the report, the National Commission on Diabetes created by virtue of this Act shall cease to exist and be reconstituted as the Oversight Committee for the Prevention and Control of Diabetes, hereinafter to as the "Committee." The Committee shall continuously be attached to the DOH.

Sec. 11. Function of the Committee. — The Committee shall review and evaluate the implementation of the National Diabetes Prevention and Control Plan and make recommendations to the Secretary of Health for the attainment of the objectives set forth in such plan. 

Sec. 12. Sunset Provision. — The Oversight Committee for the Prevention and Control of Diabetes provided in Section 10 hereof shall cease to exist five (5) years after its organization. Its functions, duties and responsibilities together with all of its records, assets and obligations shall devolve to the DOH. 

Sec. 13. Appropriations. — The amount necessary to carry out the provisions of this Act shall be included in the General Appropriations Act of the year following its enactment into law and thereafter.

Sec. 14. Rules and Regulations. — The Secretary of Health shall within ninety (90) days from the approval of this Act, promulgate the rules and regulations necessary for the effective implementation of this Act.

Sec. 15. Separability Clause. — If any provision of this Act is declared invalid, the remainder of this Act or any provision not affected thereby, shall remain in form and in effect.chan robles virtual law library

Sec. 16. Repealing Clause. — All laws, presidential decrees, executive orders, administrative orders and their implementing rules inconsistent with the provisions of this Act are hereby repealed, amended or modified accordingly.chan robles virtual law library

Sec. 17. Effectivity. — This Act shall take effect fifteen (15) days following its publication in the Official Gazette or in at least two (2) newspapers of general circulation.chan robles virtual

law library    

Approved: June 11, 1996

Statistics on Diabetes Mellitus, obesity and hypertension are startling. In the United States, a report says that 2 out of 3 (66.6%) adult Americans, and 15% of the children, are overweight.

In the United States alone, there are about 17 million diabetics. Five to 10% have Type I (juvenile), and the rest, Type II (adult onset) diabetes. Before insulin was discovered in the early 1920s, type 1 diabetes had 100% mortality. In the past 10 years, there has been a 33% increased in the number of diabetic patients. It is indeed scary.

In another report by the Medical Observer, “Diabetes is not only a disease of the middle age. More and more, high school and elementary students [are being affected]. At age 22, bulag na e hindi pa kumikita (blind already while not yet earning money). At age 20 plus, nagda-dialysis na, possibly stroke and heart attack,” says Dr. Tommy Ty Willing, president of the Philippine Diabetes Association (PDA), during the recent observance of World Diabetes Day in November.

Pediatric endocrinologist Sioksoan Chan-Cua said that patients as young as five years old are coming to her clinic with type 2 diabetes, a disease usually associated with people 40 years old and above. “I’m getting patients with blood sugar of more than 1,000. They come in with diabetic ketoacidosis, a breakdown of fat tissues when the body cannot utilize the glucose very well anymore,” she said.

While there are no clear data yet among the young on the running incidence of type 2 diabetes, related statistics add up to a grim scenario. Type 1 diabetes is rising by three percent worldwide, with 17 percent of children 14 and below developing the disease each year.

Chan-Cua said the Philippines is still low on this score compared with other countries, but we are also seeing an increase every year.  My perception on this is simple – Filipinos love sweets and fatty foods. Also, our staple food is rice, which is a starchy food item. This makes diet as the primary risk factor to diabetes in the Philippines in my view.

Moreover, mathematical modelling on projection yields that 380 million people are expected to develop diabetes by 2025 based on International Diabetes Federation/World Health Organization data, a good percentage will be coming from Southeast Asian countries, including the Philippines. This finding is no longer astonishing considering the latest statistics on Pinoys afflicted with diabetes and hypertension which continues to increase on the scale of medical records. This goes to show that statistics on Diabetes Mellitus in the Philippines continues to be unfavorable to the general population because of the continuous rise in the number of Filipinos developing diabetes every year which adds to the number of people who cannot enjoy life and are becoming less productive due to this disease.

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The epidemiology of diabetes mellitus in the AsiaPacific regionCS CockramThe Asia-Pacific region is at the forefront of the current epidemic of diabetes. There are currently morethan 30 million people with diabetes in the Western Pacific region alone. The World Health Organizationpredicts that this number will rise dramatically by the year 2025, by which time India and China mayeach face the problem of dealing with 50 million affected individuals. The problem in the region resultsfrom a combination of large population size with rapidly rising prevalence rates, particularly of type 2diabetes mellitus. Although much heterogeneity exists, rising prevalence rates are being seen throughoutthe region and appear to be closely associated with westernisation, urbanisation, and mechanisation. Therisk for diabetes appears to result from a combination of genetic predisposition and lifestyle change. Themost important lifestyle changes relate to changes in dietary habits and physical activity and diabetesrisk, particularly in younger individuals, is associated with the development of obesity and particularlycentral obesity. In some populations, for example Chinese, the relationship between diabetes and weightgain begins to appear at levels of body weight that would not be conventionally regarded as representingobesity. The increasing trend for type 2 diabetes to develop in young people is of particular concern. Inchildren and adolescents in some parts of the region, type 2 diabetes now outnumbers type 1 diabetes bya ratio of 4:1. In view of the severity of the long-term complications of diabetes, the health consequencesof this epidemic will become increasingly devastating and threaten to overwhelm the health care systemsin the most vulnerable countries. There is an urgent need for prioritisation of diabetes as a key issue bygovernments throughout the region. Diabetes prevention programmes can be justified on economic, as

well as humanitarian grounds. At the level of primary prevention, such programmes can be linked toother non-communicable disease prevention programmes which also target lifestyle-related issues.HKMJ 2000;6:43-52Key words: Diabetes mellitus/epidemiology; Forecasting; Incidence; Prevalence; World healthWestern Pacific region, along with the Indian subcontinent, is at the forefront of the current epidemic oftype 2 diabetes mellitus. In 1998 it was estimated that,globally, there were already 140 million people withdiabetes. Predictions compiled by Dr Hilary King ofthe World Health Organization (WHO) indicate thatthis figure will rise to 300 million by the year 2025.Of these, more than 150 million will be in Asia. Thefigures for India are predicted to rise from an estimated15 million in 1995 to 57 million in 2025. For China,current estimates are 15 to 20 million, with a predictedrise to 50 million by 2025. Thus, more than 30% ofthe global number of people with diabetes in 2025will be in these two countries alone.1In some countries, much epidemiological information is available, while in others, data are scarce or44 HKMJ Vol 6 No 1 March 2000Cockramnon-existent. Prevalence rates of diabetes vary greatly,and generally parallel the level of affluence and degree of industrialisation of individual countries.Geographically, Australia and New Zealand belongto the Asia-Pacific region. With their predominantlyCaucasian populations, patterns of diabetes in Australiaand New Zealand generally resemble those of Caucasian populations in Europe and North America. However, even these countries demonstrate diversity as aresult of the presence of the Aboriginal population inAustralia, and the Maori and Pacific Island populationsin New Zealand. Both countries also have significantimmigrant populations from other parts of Asia, livingmainly in urban areas.Comparison and interpretation of prevalencestudies are also sometimes rendered difficult by differences in methodology, diagnostic criteria, or ageof subjects studied. This is particularly true of olderstudies. Prevalence figures for diabetes require age standardization to allow meaningful comparisons tobe made. Where possible age-standardised data willbe given, unless otherwise stated.

General epidemiological pointsDespite the diversity within the region, a number ofcommon themes can be found with regard to patternsof diabetes and prevalence rates.2 With the exceptionof Australia and New Zealand, type 1 diabetes isrelatively less common throughout the region than inEuropean populations, with some of the lowestincidence rates in the world (1-2 per 100 000 personyears). As a result, type 1 diabetes accounts for lessthan 3% of the total burden imposed by diabetes.Type 2 diabetes prevalence rates show markeddifferences throughout the region, according to lifestyle, affluence, mechanisation, and urbanisation. Theyremain low in traditional societies but are rising rapidly in association with urbanisation and modernisation, to rates which are among the highest reportedanywhere (in excess of 30% of the adult population).Type 2 diabetes is also becoming increasingly common in younger people and (except in Australia andNew Zealand) outnumbers type 1 diabetes, even inthe very young. Teenagers and children with type 2diabetes are emerging with increasing frequency. Inthose developed countries with predominantly Caucasian populations, most people with diabetes are olderthan 65 years. In developing countries, however, themajority are aged between 45 and 64 years. Epidemiological studies consistently demonstrate that morethan 50% (up to 85%) of identified cases had not beenpreviously diagnosed and are therefore not receivingtreatment.Commonality of environmental risk factors isalso invariably observed: notably changing nutrition,obesity and central obesity, decreasing physicalactivity levels, and urbanisation. However, as discussedlater, the quantitative details may vary betweendifferent populations and ethnic groups—for example,quantitative definitions of obesity risk among Chineseand Pacific Island populations. Prevalence rates ofimpaired glucose tolerance (IGT), with few exceptions,generally mirror those of diabetes, and in many countries the IGT prevalence rates are higher than those ofdiabetes. High rates of IGT can be taken to indicatethat a future rise in diabetes prevalence is likely.Changing lifestyles, human history, anddiabetes prevalence

Homo sapiens, and his probable direct ancestors withinthe genus Homo, have a lengthy history dating back atleast 2 million years. For the vast majority of this time,a hunter-gatherer lifestyle was pursued. In some partsof the region, this either continues or has continueduntil within the last few generations—for example, inPapua New Guinea and Australia. Palaeoanthropological evidence indicates that this lifestyle has involved a mixed carnivorous-herbivorous diet. Regionaldietary variations would have existed according tohabitat, but overall fat intakes consistently below 25% oftotal energy intake seem probable. The hunter-gathererlifestyle is characterised also by very high levels ofphysical activity and by periodic shortages of food.The development of agriculture in certain parts ofthe Asia-Pacific region may date back 10 000 years,but is still very recent in terms of evolutionary time.Agriculture probably had little or no impact on the riskof metabolic disorders such as obesity and diabetes.Physical activity levels remained high and dietarypatterns shifted towards a greater herbivorous foodintake and an even lower fat intake. There would alsohave been an increased risk of famine as a result ofcrop failure and dependence upon relatively few crops.The main change which agriculture allowed was anincrease in population density.Thus, there is strong and lengthy evolutionary pressure for adaptation to a hunter-gatherer lifestyle. Morerecent selective evolutionary pressures may have operated in a specific manner in response to adaptationto different environments and habitats, and suchpressures may explain, for example, the different bodyHKMJ Vol 6 No 1 March 2000 45Epidemiology of diabetes mellitusbuilds of the slender Chinese and Japanese comparedto the heavily built Polynesians. The stocky build ofthe Polynesians, with high muscle and fat mass, maybe a specific adaptation to a harsh oceanic environment, combined with geographical isolation, culturalacceptance of relative obesity, and an abundant supply of high-quality food staples and seafood. This‘baseline’ physique of Polynesians has been describedas ‘healthy obesity’.In general terms, metabolic adaptations duringhuman evolution have developed in response to theprincipal environmental stressor: food shortage andweight loss. This is in keeping with the ‘thrifty gene’

hypothesis proposed by Neel in 1962 which basically states that individuals with a genotype which isfavourable in terms of metabolic economy in times offamine, may be most at risk when exposed to overnutrition and physical inactivity.3 It is also in keepingwith recent suggestions that infants with low birthweight (reflecting intrauterine poor nutrition) may alsobe more prone to obesity, diabetes, and hypertensionin adult life.4 The advent of industrialisation, modernisation, and urbanisation is associated throughout theregion with rapidly rising prevalence rates of bothdiabetes and obesity. It is significant that particularlyhigh diabetes prevalence rates are being seen in PapuaNew Guinea and in Australian Aborigines who havemoved directly from a hunter-gatherer lifestyle to anurbanised setting within only one to two generations.The difference in baseline body builds—for example, between Chinese and Pacific Island populations—makes correlation between diabetes and obesity difficultto quantify. However, within all populations studied,diabetes prevalence rates rise rapidly with increasingobesity, particularly central obesity. In the slenderChinese and Japanese, the presence of such obesity mayonly be recognised by careful examination and conventional criteria cannot be applied. By contrast, in Nauru,massive obesity is associated with a diabetes prevalenceexceeding 40% of the population.5 At present, theextreme circumstances of Nauru, Papua New Guinea,and Australian Aboriginals are associated with extremesin diabetes prevalence (35%-40%).5 It remains to beseen whether other populations in the region carrythe same potential degree of risk or whether diabetesprevalence rates will stabilise at lower levels.Since prevalence rates of type 2 diabetes are generally lower in Caucasian populations, it has beensuggested that, in Caucasians, the risk may havebecome attenuated by a more lengthy exposure to thelifestyle changes of the modern era.The epidemiological transition

The rising prevalence of diabetes in the region reflectsoverall changes in disease patterns. Improvements innutrition, hygiene, and control of infectious diseaseshave led to increases in life expectancy and to the emergence of non-communicable diseases as the foremosthealth problems. This shift in disease patterns has beentermed the ‘epidemiological transition’, and is seen inits completed form in developed countries. Many newlyindustrialised nations in Asia have undergone, or areundergoing, this transition at a very rapid rate and maybe caught by a double burden from both ends of thespectrum if development is patchy, heterogeneous orvery rapid. China is a good example of this. The WHOestimates that in China, 15% of the population remainstraditional, the emphasis remaining on infectiousdisease while 25% have already undergone transition,the emphasis being non-communicable diseases. Theremaining 60% are in the transition phase and arethreatened by a double burden.The concept of epidemiological transition can alsobe applied within diabetes. In those countries whichhave not yet undergone epidemiological transition (egCambodia) diabetes prevalence rates remain low, butthe problems are still considerable. Such countriesexperience particular problems with infectious complications of diabetes, notably severe foot sepsis, pneumonia, and tuberculosis. Diabetic ketoacidosis alsoposes problems, due to combinations of chronicallypoor glycaemic control, superimposed infections, andlack of adequate treatment facilities. Medical care andavailability of supplies may also be patchy and erratic,and drugs and insulin may not always be available. Asepidemiological transition occurs, prevalence rates ofdiabetes rise and the familiar pattern of chronic diabetic complications becomes increasingly apparent.However, at the same time, improved delivery of healthcare helps to reduce the burden imposed by infectionsand their associated problems. Countries undergoingrapid transition may again show a double burden, reflecting the legacy of the immediate past together withthe consequences of rapid change. All three situationsmay coexist within one country (eg Indonesia and thePhilippines), particularly where there is markedmaldistribution of wealth and resources.South East Asian Peninsula and ‘ASEAN’The countries forming the Association of SouthEast Asian Nations (ASEAN) are Thailand, Malaysia,

Indonesia, Singapore, the Philippines, Myanmar, andVietnam. Cambodia and Laos also fall naturally into46 HKMJ Vol 6 No 1 March 2000Cockramthis region. Economic diversity is considerable asreflected, for example, by the affluence of Singaporecompared with Cambodia. No reliable epidemiological data are available from Cambodia, Laos, or Myanmarand the magnitude of the problem of diabetes is unknown. Since these countries are, at best, in the earlystages of epidemiological transition, it seems probablethat diabetes prevalence rates remain relatively low.In Cambodia, there are no trained diabetologists, 50%of people with diabetes use traditional remedies, andthe main problems encountered are tuberculosis,other infections and lack of supplies. One vial ofU40 insulin (40 U/mL) costs US$7 compared with anaverage monthly income of less than US$10 (S Hel,written communication, 1999). Recent prevalence ratesreported from this part of the region are summarisedin Table 1.

Literature Review on the Best Methods for helping DM Patients to Maintain

Optimal Blood Sugar Level

 

            Diabetes mellitus is a syndrome resulting from a variable interaction of

hereditary and environmental factors, and characterized by abnormal insulin

secretion and a variety of metabolic and vascular manifestations reflected in a

tendency toward inappropriately elevated blood glucose levels, thickened

capillary basal lamina, accelerated nonspecific atherosclerosis, and neuropathy

(Robbins, 1998).

            The syndrome has no distinct etiology, pathogenesis, invariable set of

clinical findings, specific laboratory tests, or definitive and curative therapy,

although it is nearly always associated with fasting hyperglycemia and decreased

glucose tolerance.

            A relative or absolute lack of insulin secretion associated with an excess

of circulating stress hormones (including glucagon, catecholamines, and cortisol)

is responsible for inappropriate elevation of blood glucose and associated

alterations in lipid metabolism characterizing the metabolic syndrome (Guyton &

Hall, 2000).

            Diabetes mellitus increases the risk of coronary heart disease, myocardial

infarction and peripheral vascular disease as well. High blood sugars are linked

with accelerated development of atherosclerosis as well as high levels of serum

lipids and triglycerides. Closely monitoring blood sugar levels in diabetics and

checking blood sugar levels in all patients for the development of increased

levels is an important nursing function. Control of blood sugar levels can greatly

reduce risk and slow development of atherosclerosis (Kozier & Erb, 2004).

The primary objective in the treatment of diabetes mellitus is to achieve

the patient’s optimal health and nutrition. Whether treatment of asymptomatic

hyperglycemia decreases morbidity and mortality is unknown, and there is

significant risk of hypoglycemia in elderly patients given oral hypoglycemic

agents or insulin therapy. Therefore, it appears best not to use drug treatment for

glucose intolerance in elderly patients with normal fasting plasma glucose levels

or asymptomatic fasting hyperglycemia.

            Some diabetes rapidly progress with a course complicated by episodes of

ketoacidosis and vascular manifestations, while others go through life with mild

nonprogressing glucose intolerance and few other manifestations of the

syndrome. The earliest symptom of elevated blood glucose is polyuria from the

osmotic diuretic effect of glucose. Continued hyperglycemia and glucosuria may

lead to thirst, hunger and weight loss.

This paper will attempt to discuss and critique five research-based journal

articles that relate specifically to the chosen specific nursing topic which is about

the best methods for helping diabetes mellitus (DM) patients to maintain

optimal blood sugar level. A review or an analysis will be written regarding the

chosen articles and a conclusion shall be formulated about the topic based on

the articles reviewed.

 

Journal Article 1: A Controlled Trial of Population Management: Diabetes

Mellitus: Putting Evidence into Practice.

            There are already many studies about nutrition principles and

recommendations for diabetes and related complications. Long ago, this has

been based on scientific evidence and diabetes knowledge when available and,

when evidence was not available, on clinical experience and expert consensus.

            The particular study is about population level strategies to organize and

deliver care that may improve diabetes management. The research design

employed in the study is both a combination of the qualitative and quantitative

approach. Measurement of cholesterol levels and blood pressure could be

considered as quantitative approaches in collecting data while the use of

administrative records and billing claims can fall under the qualitative approach.

This is appropriate for the kind of data that is needed in the study.

Evidence-based nutrition recommendations attempt to translate research

data and clinically applicable evidence into nutrition care. However, the best

available evidence must still be moderated by individual circumstances and

preferences. The goal of evidence-based recommendations is to improve the

quality of clinical judgments and facilitate cost-effective care by increasing the

awareness of clinicians and patients with diabetes of the evidence supporting

nutrition services and the strength of that evidence, both in quality and quantity

(Wheeler, 2002).

            The current nutrition principles and recommendations for diabetes focus

on lifestyle goals and strategies for the treatment of diabetes. Whether for

management or prevention of diabetes and its complications, basic to the

nutrition recommendations is the underlying concern for optimal nutrition

through healthy food choices and an active lifestyle.

            Population-level clinical registries combined with summarized

recommendations had a modest effect on management. The intervention was

limited by good overall quality of care at baseline and temporal improvements in

all control clinics, it is unknown whether this intervention would have had greater

impact in clinical settings with lower overall quality.

Overall, the study can be used to further educate health care practitioners

in helping DM patients. Further research into more effective methods of

translating population registry information into action is still required though.

 

Journal Article 2: A Revitalized Battle Against Diabetes Mellitus for the New

Millennium.

            Diabetes mellitus, one of the world’s most serious health problems and

most prevalent diseases, has been a major cause of morbidity worldwide. Nurses

are continuously employing new research findings and aggressive strategies to

help overcome the disease. A significant population has one or more risk factors

for developing diabetes.

            This particular study aims to inform and educate health care

professionals, most especially the nurses in the control and treatment of DM.

Managing diabetes successfully is a lifelong commitment, which emphasizes

continual education and management adjustments as health status and

conditions change. Components of the diabetes management plan include:

medical nutrition therapy, physical activity, blood glucose

monitoring, diabetes medications (if needed), behavioral strategies to promote

lifestyle changes, and education regarding how to integrate the above

components and related healthy habits.

            This particular study is basically an evidence and research based paper

which discusses the various control and treatment strategies for DM patients.

Nursing care strategies are being discussed more specifically. Aside from that,

the role of the DM patient in learning about how to overcome the disease is also

emphasized.

            This particular paper could help health care professionals and DM

patients alike in being more aware of the proper control and treatment measures

for the disease. This could be a good source of education for both the health care

professionals and the DM patients alike.

            The study concluded that more aggressive approaches to diagnose and

treat diabetes are now a critical goal for health care providers. The number of

treatment modalities for diabetes is increasing as researchers develop more new

oral anti-diabetic agents. Nursing care needs to be "in sync" with this new

proactive stance against diabetes. Nurses in acute care will be using new drug

combinations to treat patients with diabetes. Nurses in all settings must

understand the significance of glycemic control. The health care system is

declaring war on diabetes, one of the oldest diseases known to man. Nurses are

on the front line armed with new strategies for the new millennium.

 

Journal Article 3: Relationship of Depression and Diabetes Self-Care,

Medication Adherence, and Preventive Care.

            This particular study assessed whether diabetes self-care, medication

adherence, and use of preventive services were associated with depressive

illness. One study has concluded that that the initial occurrence of clinically

significant depression, major depressive disorder (MDD), results from either

biochemical changes directly due to type 2 diabetes or its treatment or from the

psychosocial demands imposed by the illness or its treatment do not seem to be

supported. MDD in diabetic individuals represents a multi-determined

phenomenon resulting from interactions between biologic and psychosocial

factors. This interaction may increase the probability of developing type

II diabetes in otherwise healthy individuals (Nouwen, 2000).

            Empirical studies strongly suggest that depression is more prevalent

among adults with diabetes than among the general population. To date, the

reasons for the higher prevalence rates of depression in diabetic patients are not

yet fully understood. The two dominant hypotheses concerning the initial

occurrence or recurrence of clinically significant depression in individuals

with diabetes are as follows: 1) it results from biochemical changes directly due

to the illness or its treatment and 2) it results from the psychosocial demands or

psychological factors related to the illness or its treatment (Nouwen, 2000).

            In this study, the research design and methods used are of the qualitative

approach. In a large health maintenance organization, 4,463 patients with

diabetes completed a questionnaire assessing self-care, diabetes monitoring,

and depression. Automated diagnostic, laboratory, and pharmacy data were

used to assess glycemic control, medication adherence, and preventive services.

This is suitable for the kind of data that the research needs.

            The results of the study showed that in a primary care population,

diabetes self-care was suboptimal across a continuum from home-based

activities, such as healthy eating, exercise, and medication adherence, to use of

preventive care. Major depression was mainly associated with patient initiated

behaviors that are difficult to maintain (e.g., exercise, diet, medication

adherence) but not with preventive services for diabetes.

            In particular, diabetic patients with depression need support for self-

management activities such as lifestyle modifications and medication adherence,

this study can somehow help health care practitioners in how to provide

appropriate services that can help DM patients. Further research is needed to

evaluate whether integrating depression screening and treatment into

comprehensive care of diabetes could enhance self-management, adherence,

and patient outcomes.

 

Journal Article 4: Increasing Incidence of Diabetes After Gestational

Diabetes: A Long Term Follow-Up in a Danish Population.

            The objective of this research was to study the incidence

of diabetes among women with previous diet-treated

gestational diabetes mellitus (GDM) in the light of the general increasing

incidence of overweight and diabetes and to identify risk factors for the

development of diabetes.

            Gestational diabetes mellitus (GDM) is defined as any degree of glucose

intolerance with onset or first recognition during pregnancy. The definition applies

regardless of whether treatment includes diet modification alone or in

combination with insulin. It does not exclude the possibility that unrecognized

glucose intolerance may have antedated or begun concomitantly with the

pregnancy (Gabbe, 1998).

            Maternal morbidity due to GDM may be immediate or long-term. Many

studies have documented an increase in preeclampsia, polyhydramnios, and

operative delivery in pregnancies complicated by GDM. Infants of mothers with

GDM (IGDM) are not at increased risk for congenital anomalies unless these

women have preexisting diabetes mellitus. However, IGDM do have an

increased risk of perinatal mortality and morbidity, including hyperbilirubinemia,

macrosomia and birth trauma, and hypoglycernia (Gabbe, 1998).

            In the research design and method, women with diet-treated GDM during

1978-1985 (old cohort, n = 241, also followed up around 1990) or 1087-1996

(new cohort, n = 512) were examined in 2000-2002. Women were classified by a

2-h, 75-g oral glucose tolerance test according to the World Health Organization

criteria or an intravenous glucagon test supplemented by measurement of GAD

antibodies. Historical data from index-pregnancy and anthropometrical

measurements were collected. This is a qualitative form of research and is

suitable for this type of data.

            The results of the study showed that the incidence of diabetes among

Danish women with previous diet-treated GDM was very high and had more than

doubled over a 10-year period. This seems to be due to a substantial increase in

body mass index (BMI) in women with GDM. The study supports previous

findings that women with GDM are at high risk for subsequent diabetes. The risk

is further increased if obesity is present before pregnancy. The importance of this

study is that this could provide further information for health care professionals in

helping women with GDM.

 

Journal Article 5: How Well Do Patient’s Assessments of Their Diabetes Self-

Management Correlate with Actual Glycemic Control and Receipt of

Recommended Diabetes Services?

            Although patient diabetes self-management is a key determinant of health

outcomes, there is little evidence on whether patients' own assessments of their

self-management correlates with glycemic control and key aspects of high-

quality diabetes care. Because of this, there is a need for further research on this

area, and that is why this study was conducted.

            For this study, the researchers abstracted information on achieved level

of glycemic control and diabetes processes of care from medical records of 1,032

diabetic patients who received care from 21 VA facilities and had answered

the Diabetes Quality Improvement Program survey in 2000. The survey included

sociodemographic measures and a five-item scale assessing the

patients' diabetes self-management (medication use, blood glucose monitoring,

diet, exercise, and foot care).

Using multivariable regression, the researchers examined the associations

of patients' reported self-management with glycosylated hemoglobin [HbA1c] level

and receipt of each diabetes process of care. The researchers then adjusted

for diabetes severity and comorbidities, insulin use, age, ethnicity, income,

education, use of VA services, and clustering at the facility level.

The study used the qualitative method of research and employed

statistical computations to come up with the needed data. There was further

explanation in the paper on the overall strategy of how the researchers came up

with the data.

            The results showed that higher patient evaluations of their diabetes self-

management were significantly associated with lower HbA1c levels and receipt of

diabetes services. Those in the 95th percentile for self-management had a mean

HbA1c level of 7.3, whereas those in the 5th percentile had mean levels of 8.3.

For every 10-point increase in patients' ratings of their diabetes self-

management, even after adjusting for number of outpatient visits, the odds of

receiving an HbA1c test in the past year increased by 15%, of receiving an eye

examination increased by 16% (7-27%), and of receiving a nephropathy screen

increased by 13%.

            Measurement of HbA1c thus provides information useful for the

management of DM. Since the mean half life of an erythrocyte is 60 days, the

HbA1c level reflects the average blood glucose concentration over the preceding

6-8 weeks. And elevated HbA1c, which indicates poor control of blood glucose

level, can guide health care professionals in the selection of appropriate

treatment – more rigorous control of diet or increased insulin dosage (Murray, et

al, 2000).

            The findings of this study were useful in reinforcing the usefulness of

patient evaluations of their own self-management for understanding and

improving glycemic control. The mechanisms by which those patients who are

more actively engaged in their diabetes self-care are also more likely to receive

necessary services warrant further study.

 

Conclusion

            Diabetes mellitus is a syndrome of impaired carbohydrate, fat and protein

metabolism caused by either lack of insulin secretion or decreased sensitivity of

the tissues to insulin. The basic effect of this lack in insulin is the increase in

blood glucose concentration.

            In the journals discussed, there are several methods for helping DM

patients maintain optimal blood sugar levels. This includes administering enough

insulin so that the patient will have metabolism that is as normal as possible.

Dieting and exercise are also recommended in an attempt to induce weight loss

and to reverse insulin resistance. If these methods fail, drugs may be

administered to increase insulin sensitivity or to stimulate increased insulin

production.

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