Essay Sample on the Management of Type Two Diabetes

Background

The management of Type Two Diabetes, often considered as a lifestyle disease, focuses on the avoidance of preventable complications by regulating and maintaining blood glucose to acceptable levels. Traditionally nutrition, exercise and medication have played a major role in the management of diabetes. In its management, there are variables that must be considered which contribute to an unhealthy balance in the blood glucose. For example, illness; medication like steroids; the amount of carbohydrates; the quality of carbohydrate; and the timing of anti diabetic medication, among others, can trigger elevations of blood sugar levels. Additionally, apatite loss or insufficient food intake due to illness may lead to malnutrition thereby causing a decrease in blood glucose levels. Research has indicated that persistent hyperglycemia or hypoglycemia is detrimental to health and wellness.

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Introduction

Type 2 diabetes mellitus (TSDM) has been named as one of the most common diseases globally. The etiology of this disease is multifarious and is associated with reversible factors such as diet, exercise, drinking alcohol and smoking, and irreversible risk factors such as ethnicity, race, genetic, as well as age. Sedentary lifestyles and dietary habits are the primary factors for explosively rising incidence of diabetes mellitus in the developing countries. In T2DM, elevated HbA1c levels are one of the leading factors for developing macrovascular and microvascular complications (American Association of Diabetes Educators, 2018, p. 58). Regulation of the elevated HbA1c can be attained by managing diet; therefore, the patients could be saved from developing the complications associated with diabetes. Understanding diabetes complications as well as the subsequent improvement in nutrition attitude, knowledge, and practices result in better management of the disease. Also, the stakeholders (health facilities, healthcare providers, and agencies involved in the care of diabetes) should encourage type 2 diabetes patients to appreciate the significance of nutrition which may assist in disease management, proper self-care and improved quality of life (Rodriguez et al., 2014, p. 204).

Nutrition is among the most complex aspects of controlling glycemia in hospitalized patients. The most common recommendations encourage personalization of the nutrition care plan depending on treatment objectives and propose that liberalization of the hospital diet enhances nutritional intake. The inclusion of glycemic control targets complicates the process of nutritional care; in reality, providing proper diet and attaining glycemic control safely can at times seem impossible. However, it can be achieved (Sami et al., 2017, p. 65). The nutritional care of hospitalized type 2 diabetes patients attracts significant attention among various disciplines. Over time, providing appropriate nutrition has been explicitly demonstrated to affect clinical outcomes. The modern diet for the persons with type 2 diabetes is based on concepts from clinical research, portion control, as well as personalized lifestyle changes. The lifestyle modification support and guidance required needs a team effort, best championed by an expert in this area such as a qualified dietarian, or a referral to a diabetes self-management education program, including instruction on nutrition therapy. Nutritional recommendation needs to be personalized for and accepted by the particular patient (Schnipper et al., 2006, p. 148). It should be noted that dietary goals for diabetes are similar to the ones that healthy persons should strive to integrate into their lifestyle.

Professional organizations and prominent authorities have concluded that a proper diet is a significant aspect of the foundation for the treatment of type 2 diabetes. Nevertheless, appropriate nutritional treatment, adoption, as well as ultimate compliance with the plan remain some of the trivial challenges in type 2 diabetes management for three primary reasons: First, an overabundance of nutritional information is available for the patient and healthcare provider from many sources. Secondly, there exist some difference in dietary structure to consider and; lastly, there is no ideal conformity among professionals as to the best nutritional therapy for people with type 2 diabetes. Several care providers and departments are involved in various aspects of nutritional therapy for the management of glycemia in the hospital setup (Swift, 2012, p. 232). Implementation of the therapy is commenced by physicians, nurses and physician's assistants. The therapy is then planned and operationalized dieticians. The meals are then delivered by catering personnel, and nurse practitioners monitor and incorporate glycemic control components into the medical treatment plan of the patients. While nutrition therapy is seen as a critical aspect of care in the hospital setup, it can be a challenge to properly synchronize meals with blood glucose monitoring as well as insulin administration.

Personalizing glycemic control in hospitalized type 2 diabetes patients is important as it eases recovery from disease and reduces the likelihood of post-operative complications. Previous researches have shown that rigorous management of hyperglycemia with insulin, in combination with insufficient carbohydrate ingestion or lengthened fasting periods, raising the risks of hypoglycemic occurrence. Therefore, this may lead to poor outcomes (Evert et al., 2014, p. 136). Since the majority of type 2 diabetes patients are mostly taken care of in general wards, this systemic literature review seeks to examine the relationship between hospital nutrition, including portion size and timing of meals, and glucose regulation in hospitalized type 2 diabetes patients.

Review Aim

This study aims to show how nutritional factors influence glucose regulation in hospital patients with diabetes. Nutritional factors are inclusive of nutritional plan, meal timing or frequency, type of food served and timing of anti diabetic medication.

Review Question

What is the relationship between hospital nutrition, including portion size and timing of meals, and glucose regulation in hospitalized type 2 diabetes patients?

Review Methods

Study Type

Since this systematic review is part of a learning exercise within the module of "Diabetes and Clinical Research" of the masters program, it was conducted by a single student without any discussions regarding to inclusion inquiries. These queries were resolved alone by the student with the prospect of referring to course tutors or fellow students. Relevant data were extracted based on a pre-determined inclusion and exclusion criteria. Studies with a close connection to the research question were included. A comparison was made between the effects of nutrition on glucose level of hospitalized type 2 diabetes patients. The studies included only adults or adults and children.

Search Strategy

In defining the search strategy for this review, the research question was defined, and then PICO was devised and inclusion and exclusion criteria specified. The patient population included was adult hospitalized patients with type 2 diabetes. The intervention included all forms of glucose regulation. A comparison was sought in nutrition effect on glucose level while hospitalized and the outcomes were that hospital nutrition should have a desirable effect on diabetics, and should contribute to improved health and prevent complications associated with type 2 diabetes mellitus. As nutrition is considered as one of the most complex and dynamic aspects of controlling glycemia in hospitalized patients, the search strategy was narrowed to feature the most recent studies; therefore, all studies between 2005 and 2018 were considered. The scope of the review was on quantitative research; therefore RCT (randomized control trials) were considered to be strongest in the pecking order of evidence. Case studies, observational studies, as well as cohort studies were also deemed to be applicable. The table 1 below shows the PICO strategy that was formulated for this review.

PICO Strategy

Acronym Definition Description

P Population, people or problem Type 2 diabetics

I Intervention, prognosis factor Improve glucose regulation

C Comparison Nutrition effect on glucose level while hospitalized

O Outcome Hospital nutrition should have...