For this discussion post, you will need to write an originalpost of at least 450 words. Then respond to at least two peers bySaturday.
Nearly everyone knows someone with type 2 diabetes. It may beyour grandfather, mother, professor, or even the young personsitting next to you. Those with type 2 diabetes often do not talkabout it and may not even realize they have it. Type 2 diabetesmellitus is rapidly increasing in the United States in parallelwith the increase in levels of obesity. Those with a family historyare especially prone to developing the disease. Over 30 millionpeoÂple in the United States are living with type 2 diabetes andthe medical care and social costs are estimated at over $300billion dollars a year. It is predicted that by 2025 there will beover 50 million people with type 2 diabetes costing the countryover $500 billion if curÂrent trends continue. Type 2 diabetes is aprogressive disease which affects blood vessels and nerves andthereby impacts nearly every organ in the body. The impact on thefeet from neuropathy and diminished blood supply may lead toinfections and amputations. The impact on the retina can lead toblindness while the impact on the kidneys is among the leadingcause of renal failÂure requiring expensive hemodialysis ortransplantaÂtion. The impact on the blood vessels also increasesthe probability of coronary artery disease and stroke. Mostrecently an increased risk of dementia has been recognized. Thus,type 2 diabetes ranks at the very top of the conditions classifiedas a 21st-century epidemic. Testing for diabetes is increasinglybeing done as part of routine health care using the hemoglobin Aleblood test which measures average blood sugar conÂtrol over a2-month period. Many of the newly recogÂnized diabetics have milddisease that would greatly benefit from weight loss. Weight losshas been the approach to preventing and controlling type 2 diabetesfor many years. Even loss of 5% of body weight can have asubstantial impact on blood sugars. Approaches to weight lossinclude a variety of partially successful diets most of which canreduce weight in the short run, but all of which are diffiÂcult forindividuals to maintain in the longer run. GasÂtric bypass surgery,despite its costs and potential side effects, has been shown tohave an immediate effect on type 2 diabetes even before the impactsof weight loss occur. It is now often recommended for those withtype 2 diabetes and a BMI of greater than 35. Management of mostpatients with type 2 diabeÂtes requires the efforts of severaltypes of clinicians. A primary care clinician, and increasingly anurse practitioner or physician assistant, is often key. Otherhealth professionals who are needed for high quality preventivecare may include nutritionists to work with patients on theireating habits, podiatrists to prevent and treat foot problems, aswell as optometrists and ophthalmologists to identify and treatdiabetic eye problems to prevent blindness. Type 2 diabetes isoften cited as a disease which requires shared decision-making andself-care. Ifinsulin is required for management of the disease,adjustment to prevent high and low blood sugars often rests on theknowledge and engagement of patients and families. Type 2 diabetescan be a very expensive disease to treat especially whenhospitalization is required for very high blood sugar or forcomplications of the disease. Treatment of high blood pressureamong type 2 diabetics has been shown to reduce costs as haveannual influenza vaccinations. Early identificaÂtion of damage tothe retina from type 2 diabetes and laser treatment has been shownto be an effective and low cost approach to preventing blindness.Studies of the underlying mechanism for the development andprogression of diabetes may in the future lead to better methodsfor prevention and treatÂment. An increasing number of treatmentsfor type 2 diabetes have been approved by the U.S. FDA. It is notyet clear which treatments work best and for whom they are mosteffective. Comparative effectiveness research is now under way tohelp clinicians tailor the available treatments to the individualpatient.
1. Identify interventions discussed in this case which can beclassified as primary, secondary, and tertiary. Explain.
2. Identify ways that this case suggests that coordiÂnation ofhealth care can improve the quality of care for type 2 diabetics.Explain.
3. Identify ways that this case suggests that the cost of carefor type 2 diabetes can be reduced while increasing or maintainingquality. Explain.
4. What role should society at large play in reducÂing theepidemic of obesity? How should it be accomplished?
5. How would you suggest combining the approaches to type 2diabetes discussed in this case to prevent and treat type 2diabetes?Explain.
