Clinical Practice Guideline for Type 2 Diabetes Mellitus

Type 2 Diabetes

            Today, Type 2 Diabetes Mellitus has emerged as one of the most serious and pervasive chronic health conditions plaguing developed nations such as Canada and the United States. According to the Centers for Disease Control and Prevention (CDC), Type 2 Diabetes Mellitus is currently considered a major public health concern in the United States given the fact that 1 in every 10 Americans suffers from the condition (AlSaraj, 2015). T2D is a heterogeneous disorder that develops among at-risk populations as a consequence of low production of insulin in the body. As a consequence, blood sugar levels rise to dangerous levels, further exposing sufferers to the risk of adverse clinical events such as cardiovascular disease (CVD) and autoimmune complications.

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 T2D is often associated with loss of proper working of the β-cell secretory function often associated with the accompanying resistance to insulin. Although T2D is a manageable condition, its clinical expression is often linked to patient’s failure to participate in a proper management program, in addition to a wide spectrum of genetic and environmental pre-disposing factors. T2D often manifests in the body’s inability to regulate how well it expends glucose while focusing primarily on its efficiency compared to healthy individuals (Lu, Anderson, & Huang, 2017). Type 2 Diabetes Mellitus commonly manifests during adulthood, but may also emerge among children predisposed by factors such as pre-term birth, obesity, family history, and further exacerbated by a sedentary lifestyle. The evolutionary origin of the condition is a malfunction in an obsolete genotype commonly associated with metabolic abnormalities such as hypertension and cardiovascular problems.

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            The subsequent malfunctioning of insulin β-cells forms the very basis of the pathophysiology of Type 2 Diabetes Mellitus. This is primarily due to the accompanying malfunctions which emerge as a consequence of transformed molecular pathways. Islets are, ultimately, unable to cope with the pressure which typically causes a high level of toxicity within this region. Individuals in this phase of disease progression will experience hyperglycemia as one of the initial signs of β-cell death and unregulated pro-insulin biosynthesis. The process forming the basis of the pathophysiology of T2D is, therefore, linked to a combination of physiological and environmental factors which hasten its rate of progression, causing both lipotoxicity and glucolipotoxicity (AlSaraj, 2015). Yet, healthcare experts recommend managing body mass, regular exercise, reducing sugar intake, smoking cessation, and avoiding a sedentary life as promising solutions to managing T2D.

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Type 2 Diabetes Mellitus Clinical Practice Guideline

            The management of T2D in the United States is guided by a set of elaborate clinical guidelines compiled and published by the American Diabetes Association (ADA) in the Standards of Medical Care in Diabetes. Its implementation seeks to ensure patients suffering from T2D remain in a state of remission after the initial diagnosis while comorbid health conditions are addressed, and appropriate standards for care are established. Furthermore, clinical practice guidelines addressing T2D seek to standardize management practices, provide elaborate guidelines on the identification of symptoms marking the onset of the condition, glycemic control recommendations, and the participation of patient’s family in the management of the condition.

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            Practice guidelines for T2D seek to address comorbid conditions such as hypertension and cardiovascular disease. Owing to the frequency of hypertension among diabetics, common practices now dictates that patients suffering from the condition consent to routine evaluation of their blood pressure level during routine clinical visits. In order to meet the minimum threshold for elevated blood pressure levels, readings should be above 140/90 mm Hg and also confirmed by a specialist after conducting several measurements (American Diabetes Association, 2019). In scenarios where patient readings indicate an elevated blood pressure level, voluntary admission is recommended and warranted to prevent a life-threatening event linked to pre-existing comorbid health conditions. The initial blood pressure measurement should then be followed by regular follow up sessions after setting respective targets for systolic and diastolic blood pressure levels. The execution of the aforementioned targets should also be accompanied by a clear weight loss regimen for obese patients, a regular exercise routine, and the consumption of a healthy balanced diet. Severe cases of hypertension among patients with T2D should be treated with a prescription of angiotensin-converting enzyme (ACE) inhibitors as a first-line pharmacological treatment option for the condition.

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            Medical care standards also form the basis of practice guidelines in the management of T2D. Pharmacological interventions should aspire to lower glucose levels while targeting a specified glycemic target.  Additionally, practice standards recommend patient education as a promising framework when seeking to reduce the number of individuals who ultimately develop the condition while mapping out pre-diabetics to address the risk of developing the conditions. This typically includes clinically obese children and adults yet to be diagnosed with the condition mainly since preliminary symptoms have not yet manifested.

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            Moreover, clinical practice standards for T2D now target early detection of the symptoms associated with condition, rather than focusing exclusively on the management of condition after its subsequent progression. Such efforts are geared towards the teens and young adults recently identified as a new frontier in the fight against T2D. Key elements to look out for include patient’s hepatic insulin resistance among overweight teens based on an appropriate screening method (Ndisang, Rastogi, & Vannacci, 2015). Factors which pre-dispose such individuals to developing the condition such as family history, gestational period, insulin resistance, and ethnicity should also be taken into account. Subjects should also adhere to a strict weight management program while making certain patients are fully cognizant of their current conditions and its implications. The provision of this information should also be done within cultural framework from which the patient is from to boost the odds of succeeding during the initial trial.

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            Hyperglycemia management also takes precedence in the proper management of T2D based on accepted clinical practices. Health care providers are expected to prioritize hyperglycemia management among patients with T2D due to its delicate nature and a high likelihood of disease progression within a relatively short period. Clinical staff should, therefore, direct their efforts towards patient education with the ultimate aim of ensuring patients are equipped with relevant resources and information to support self-management and self-monitoring. These efforts will then be bolstered by the application of pharmacological interventions such as sodium-glucose co-transporter-2 (SGL T2) to lower the glucose level present in the blood (Goldstein & Mueller-Wieland, 2016).  A balanced diet consisting of whole grains, fruits, and green vegetables is also recommended, in addition to metabolic surgery for morbidly obese patients unable to lose weight.

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            Within the United States, clinical guidelines for the management of T2D currently incorporate and acknowledge the family’s role and that of associated physicians in the management of T2D while averting adverse clinical events. Family and friends play an important role in the management of diabetes by ensuring patients meet set glycemic targets, body mass, and take medications as prescribed by their respective physicians (American Diabetes Association, 2019). The family is expected to play a central role in promoting appropriate management of the condition by ensuring patients commit to treatment, make lifestyle changes, and maintain up-to-date vaccines for a better glycemic control. This approach will also seek to reduce patient’s overall risk of succumbing to cardiovascular disease while aspiring for a healthy weight, practicing smoking cessation, taking vascular protective drugs, and avoiding a sedentary lifestyle.

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 Analysis

            The current healthcare environment within the United States is a source of concern for many healthcare pundits given the high likelihood of the general population being predisposed to developing T2D. This reality now prompts future reflections on how to address this problem appropriately given the rapid changes witnessed over the past decade. In my opinion, the Standards of Medical Care in Diabetes does an exceptional an exceptional job in providing practice guidelines for the management of T2D (American Diabetes Association, 2019). Yet, I hold the view that it still requires systematic improvements to address factors liked to demographic changes witnessed in the United States and emerging patient needs. The practice guidelines evaluated above should emphasize more on the importance of screening in suspected pre-diabetics to guarantee immediate attention to the condition while preventing disease progression. Physicians will also have a unique opportunity to categorize the condition appropriately devoid of distractions presented by comorbid conditions such as hypertension that are likely to mislead the initial diagnosis. This will then allow them to determine the exact stage in which a patient is in before deciding on the most appropriate intervention.

            In a scenario where I would be in a position to review the clinical guideline provided for T2D, I would focus more on tracking the progress of individual patients after starting treatment. The rationale behind my decision is informed by the relatively low progress rate recorded amongst patients with T2D. This is likely the result of a systematic failure by healthcare providers to fully evaluate patients after commencing treatment while applying data recorded during previous hospital visits to gauge progress. The introduction of this change in policy will also promote compliance with treatment plans and prescribed medications while also gauging their effectiveness in managing the condition. This would also guarantee the application of an individualized approach to the management of T2D among patients with the condition; enduring patient-specific issues linked to management of the condition addressed appropriately. During this period, physicians will also be expected to evaluate patient’s compliance to prescribed medications and determining whether incidences of non-compliance are associated with negative side effects (AlSaraj, 2015). Further lab tests will be conducted during the second visit to track progress and whether the metabolic targets have been attained as part of their management of the condition. Results of the implementation of these changes in the mode of operation will reduce the frequency of cardiovascular events and hypertension among patients with T2D. The reviewed segment of the clinical guideline should also contain evidence-based solutions on some of the most practical alternatives to preventing the condition and associated comorbidities. These solutions include a structured instructional guide on lifestyle management, drinking alcohol in moderation, consuming a healthy balanced diet, and smoking cessation. Patient education should also take precedence with the aim of emboldening patients to take direct charge of the management regimen while gaining a better understanding of the condition. The application of this structured approach will improve patient outcomes while boosting their confidence in self-care knowledge and nutrition therapy.

            The demographics in the United States have undergone wide-ranging transformation, with healthcare reform likely to have a major impact on T2D practice guidelines. Perhaps the most notable reasons for this change is the economic progress realized within the past decade and the likelihood the Department of Health and Human Services (HHS) focusing more on chronic health conditions such as T2D. Improved responses will also shape the direction taken by major healthcare agencies when attempting to curb the permeation of incurable yet manageable health condition. The implication of this new response will be in the enactment of healthcare policies which identify at-risk populations such as those residing in impoverished inner-city communities in an attempt to address factors predisposing them to chronic health conditions such as T2D.  It is also important to consider the possibility of an exponential increase in the population of morbidly obese individuals in the United States given the limited dissemination of crucial information associated with the prevention of T2D. According to Lukana (2019), close to 66% of the American population is represented by the middle-class likely to run the risk of developing chronic health conditions due to changes in lifestyle and an increase in incidences of individuals living a sedentary life. However, these same changes may also be beneficial to the healthcare system. Policymakers will become aware of some of these risks and work consistently to ensure pre-existing risks to developing T2D diabetes are addressed to reduce its prevalence within the US. Federal agencies in charge of healthcare will also partner with private players to address socio-economic barriers to care given transformation noted within the country.

            A number of useful frameworks can be enacted to increase the chances of the subsequent adoption of a new or revised clinical guideline to address T2D.  As a rule of thumb, EBP should inform any change made to the existing guidelines. This will ensure only properly-researched solutions are implemented by healthcare practitioners and dependable in the wake of numerous transformations present within the sector. Additionally, new guidelines should be practical and champion the collaboration of specialist from dissimilar fields but with the ultimate goal of introducing feasible solutions. Practice guidelines should also take the social context of their respective patients into account while basing their interventions on knowledge of patient’s needs. The application of pharmacological interventions should also be based solely on randomized clinical trials as practical guides to effective and highly dependable treatment options.

Evaluation

            The overall applicability of this revamped clinical practice guideline for patients with T2D can be gauged by assessing the subsequent impact of specified changes when attempting to manage the condition among target patients. An in-depth review of barriers to diabetic treatment adherence within the context of T2D would be an ideal starting point. This process should then be accompanied by efforts to identify feasible solutions to the problem through the implementation of an individualized framework when attempting ascertain the veracity of patient-specific concerns. Reacting to individual patients and their concerns will also promote efforts to shape the direction of new guidelines based on their efficiency when applying an iterative and elaborate framework.

Learning points

  • Type 2 Diabetes Mellitus is a serious chronic health condition with no cure and currently addressed through early intervention and adhering to a management framework based on clinical practice guidelines.
  • The American Diabetes Association (ADA) lists a multifaceted approach involving the use of prescribed medications and lifestyle modifications under the Standards of Medical Care in Diabetes as a practical solutionto managing Type 2 Diabetes Mellitus.
  • The paradigm shift witnessed within the context of demographics will also result in a higher life expectancy, a wealthier society, and the likelihood of an exponential increase in cases of Type 2 Diabetes Mellitus.
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