Essay Sample on Diabetes as One of the Major Global Public Health Problems

Introduction

Diabetes is one of the major global public health problems. According to the Centre for Diabetes and Endocrinology (CDE), the pervasiveness of diabetes is projected to increase from 420 million people in 2017 to 630 million people by 2045 (Distiller et al., 2010 ). Focus should be geared in channelling investment that aims to modify factors that are related to diet, physical activity, and weight. Diet has been proven to be the principal contributor to diseases and mortality worldwide bestowing to the Global Burden of Disease Study carried out in 188 countries (Who et al., 2003).

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The subject of this research proposal is Diabetes Mellitus which is a non- communicable disease that has become a major challenge globally (Arredondo 2013). Statistic by American diabetes association has it that in 2015, 30.3 million Americans, which is equitable to 9.4% of the population, had diabetes (William et al., 2012). The writer says that type 2 diabetes is of great concern because of its high mortality as opposed to type 1. This mandate is achieved by keeping glycaemic control as close to normal as possible. According to Global Diabetes Community UK, for healthy individuals, normal blood sugar levels are as follows between 4.0 to 5.4 mmol/L (72 to 99 mg/dL) when fasting and up to 7.8 mmol/L (140 mg/dL) 2 hours after eating (Inzucchi et al., 2012). The writer further notes that for people with diabetes, blood sugar level targets are as follows: Before meals: 4 to 7 mmol/L for people with type 1 or type 2 diabetes. After meals: under 9 mmol/L for people with type 1 diabetes and under 8.5mmol/L for people with type 2 diabetes.According to the Global Burden of Disease, there are a number of factors that contribute to the interruption of glycaemic control in people with diabetes. However, nutritional management and anti-diabetic medication are essential ways of preventing complications and monitoring prognosis.

To manage to control type 2 diabetes, one needs to factor in the significance of dietary need. Progress has been noted in coming up with well-formulated dietary evidence in the recent past. However, questions have been raised in regards to calorie diet for glycaemic control among hospitalized clients with type 2 diabetes. As a result of this, the paper is going to focus on providing evidence in relation to the 1800 calorie diet nutrition as well as a diet for glycaemic control for type 2 diabetes patients. The study will provide results based on group nutritional therapy as well as identifying the difference between nutritional therapy and a standard 1,800 calorie diet. Respondents with an HbAlc of 7% or higher were selected purposively and it included adults, and teens admitted to the Princess Alexandra Hospital aged 16 and above. Results show that optimal glycaemic control is necessary for the prevention of preventable complications and the progression of complications in people with diabetes.

A study conducted by national institute of health state that Foods type to be eaten by type 2 diabetic patients includes complex carbohydrates such as whole wheat, quinoa, oatmeal, fruits, vegetables, and lentils (Dyson et al., 2011). The study further states that a person with diabetes on a 1,800 calorie diet should get 45%-50% of these calories from carbohydrates. Personal interest in diabetes care, at my present institution of employment, has been the catalyst for my advocating for preventing complications of diabetes. NIH further notes that type 2 diabetes patient should consume around 45 to 60 grams of carbohydrates per meal. This study no doubt is timely since it will present new knowledge to clients and team of persons providing care while influencing policy in the care and management of clients with diabetes locally, regionally and internationally. The opportunity for conducting this research study, in diabetes, was granted by the professions of the Diabetes Master's program of Kings College London, class of 2017- 2019

Problem Statement

According to ADA diabetes was recorded to be the seventh chief cause of death in the United States in 2015 centered on the 79,535 death certificates in which diabetes was listed as the primary cause of death(Distiller et al., 2010). ADA in a statement said that in 2015, diabetes was a cause of death in a total of 252,806 certificates. Dietary is fundamental in controlling and regulating type two diabetes. However, the notion of being placed on a monitored diet for a prolonged lifelong state like diabetes is sufficient to put many people off. Reason being it is hard to know what to eat and when to eat it as well as to maintain an optimal eating pattern. Due to this, the study is trying to focus on the effects of implementing nutritional therapy with less than 1,800 calories diet versus 1,800 standard calorie diet for glycaemic control in hospitalized clients with type two diabetes. The result from the study will serve the purpose of stipulating a clear pathway to be followed by a group of people with type 2 diabetes when it comes to proper dietary.

Objectives of the study

General Objective

The general objective of the study is to compare the effect of low calories verses high calories diet on glycaemic control in patients with type 2 diabetes.

Specific Objectives

The objectives of this study include:

• To establishing relevant knowledge on low carbs in relation to nutritional therapy
• To identify the difference between individualized nutritional therapy and a standard 1,800 calorie diet
• To assess the impact of different dietary in relational to the blood glucose level

Research Methodology

Study Area

The study is being carried out in The Princess Alexandra Hospital which is located in Anguilla in the Caribbean.It is a public district general hospital with a bed space of 36 and a total number of nine doctors. Regardless of its small size the hospital delivers routine surgical and medical care with a 24hour emergency room. The hospital has a well-equipped obstetric unit.

Research Design

Data was collected through Clinical trials by conducting search on online medical data base such as on PubMed, EMBASE and Cochrane library. Keywords used to conduct the search were: "type 2 diabetes","diabetes mellitus", "and mortality", "sudden death"; "hypoglycaemia, hypoglycaemic. The study restrictedsearch to randomized clinical trials (RCTs), systematic reviews and meta-analyses of RCTs.

Study Selection

We included RCTs in comparing nutritional therapy for 1800 calories verse a glycaemic control on T2D patients aged 18 to 70 years. RCTs with a comparison control group that compost of usual care were included. Usual care includes typical diabetes dietary treatment for instance those that are recommended by the American Diabetes Association or carbohydrate exchange-type diets.The study excluded patients who are over the age of 70. This was mainly to reduce exposing patient to the risk ofhypoglycaemia. RCTs of diabetes prevention or RCTs in populations at risk for type 2 diabetes was excluded too. RCTs that targeted multiple chronic diseases, gestational diabetes, or type 1 diabetes was also excluded in the study.

Statistical Analysis

A sample size was selected with the aim to provide a statistical power of 80%. This will be used to distinguish a 1% difference in HbA1c values between the groups mean, 6.5% verse 7.5% with standard deviation of 1.40%. Statistical Package for Social Science (SPSS) version 12.01 (Chicago USA) will be used to perform analysis. The result will be expressed as mean and standard deviation (SD). Students paired t-test and at least one-sample t test will be used on data analysis. Statistical significance will be set at p<0.05.

Research Significance

The subject matter of this research study is of importance to the Princess Alexandra Hospital which needs addressing and was identified by stakeholders of the hospital as such. An observation was made that there is a lack of glycaemic control despite medical intervention in hospitalized clients with diabetes particularly type 2 which make up more than 90% of all diabetes cases admitted to the hospital. This is evident by glucometer test done at various times, pre meals and post meals, audited for the period January to December 2015 - 2018, are never normal or near normal. Hyperglycaemia is very prevalent among hospitalized clients with type 2 diabetes. This prompted other observations of:

• a standard calorie diet which may be considered large meals for all clients with diabetes
• a frequent serving of meals as evident by three main meals and three snacks in between meals (appendix 1)

A stakeholders meeting was held on 9th January 2019, comprising of heads of departments including representation from the nutrition department, pharmacy, nursing department, and specialist physician. The main agenda was to discuss the problems associated with Hyperglycaemia. The nutritionist lamented the fact that there is no policy to guide nutritional therapy. Therefore, an 1800 calorie diet adopted by the American Diabetes Association is used for all patients with diabetes. The audience agreed that roles had to be defined and enacted in an effort to obtain better outcomes of the hospitalized clients. Th...