Question

For this discussion post, you will need to write an original post of at least 450 words. Then respond to at least two peers by Saturday.

Nearly everyone knows someone with type 2 diabetes. It may be your grandfather, mother, professor, or even the young person sitting next to you. Those with type 2 diabetes often do not talk about it and may not even realize they have it. Type 2 diabetes mellitus is rapidly increasing in the United States in parallel with the increase in levels of obesity. Those with a family history are especially prone to developing the disease. Over 30 million peo­ple in the United States are living with type 2 diabetes and the medical care and social costs are estimated at over $300 billion dollars a year. It is predicted that by 2025 there will be over 50 million people with type 2 diabetes costing the country over $500 billion if cur­rent trends continue. Type 2 diabetes is a progressive disease which affects blood vessels and nerves and thereby impacts nearly every organ in the body. The impact on the feet from neuropathy and diminished blood supply may lead to infections and amputations. The impact on the retina can lead to blindness while the impact on the kidneys is among the leading cause of renal fail­ure requiring expensive hemodialysis or transplanta­tion. The impact on the blood vessels also increases the probability of coronary artery disease and stroke. Most recently an increased risk of dementia has been recognized. Thus, type 2 diabetes ranks at the very top of the conditions classified as a 21st-century epidemic. Testing for diabetes is increasingly being done as part of routine health care using the hemoglobin Ale blood test which measures average blood sugar con­trol over a 2-month period. Many of the newly recog­nized diabetics have mild disease that would greatly benefit from weight loss. Weight loss has been the approach to preventing and controlling type 2 diabetes for many years. Even loss of 5% of body weight can have a substantial impact on blood sugars. Approaches to weight loss include a variety of partially successful diets most of which can reduce weight in the short run, but all of which are diffi­cult for individuals to maintain in the longer run. Gas­tric bypass surgery, despite its costs and potential side effects, has been shown to have an immediate effect on type 2 diabetes even before the impacts of weight loss occur. It is now often recommended for those with type 2 diabetes and a BMI of greater than 35. Management of most patients with type 2 diabe­tes requires the efforts of several types of clinicians. A primary care clinician, and increasingly a nurse practitioner or physician assistant, is often key. Other health professionals who are needed for high quality preventive care may include nutritionists to work with patients on their eating habits, podiatrists to prevent and treat foot problems, as well as optometrists and ophthalmologists to identify and treat diabetic eye problems to prevent blindness. Type 2 diabetes is often cited as a disease which requires shared decision-making and self-care. Ifinsulin is required for management of the disease, adjustment to prevent high and low blood sugars often rests on the knowledge and engagement of patients and families. Type 2 diabetes can be a very expensive disease to treat especially when hospitalization is required for very high blood sugar or for complications of the disease. Treatment of high blood pressure among type 2 diabetics has been shown to reduce costs as have annual influenza vaccinations. Early identifica­tion of damage to the retina from type 2 diabetes and laser treatment has been shown to be an effective and low cost approach to preventing blindness. Studies of the underlying mechanism for the development and progression of diabetes may in the future lead to better methods for prevention and treat­ment. An increasing number of treatments for type 2 diabetes have been approved by the U.S. FDA. It is not yet clear which treatments work best and for whom they are most effective. Comparative effectiveness research is now under way to help clinicians tailor the available treatments to the individual patient.

1. Identify interventions discussed in this case which can be classified as primary, secondary, and tertiary. Explain.

2. Identify ways that this case suggests that coordi­nation of health care can improve the quality of care for type 2 diabetics. Explain.

3. Identify ways that this case suggests that the cost of care for type 2 diabetes can be reduced while increasing or maintaining quality. Explain.

4. What role should society at large play in reduc­ing the epidemic of obesity? How should it be accomplished?

5. How would you suggest combining the approaches to type 2 diabetes discussed in this case to prevent and treat type 2 diabetes?Explain.

Answer 1

Nearly everyone knows someone with type 2 diabetes. It may be your grandfather, mother, professor, or even the young person sitting next to you. Those with type 2 diabetes often do not talk about it and may not even realize they have it. Type 2 diabetes mellitus is rapidly increasing in the United States in parallel with the increase in levels of obesity. Those with a family history are especially prone to developing the disease. Over 30 million peo­ple in the United States are living with type 2 diabetes and the medical care and social costs are estimated at over $300 billion dollars a year. It is predicted that by 2025 there will be over 50 million people with type 2 diabetes costing the country over $500 billion if cur­rent trends continue. Type 2 diabetes is a progressive disease which affects blood vessels and nerves and thereby impacts nearly every organ in the body. The impact on the feet from neuropathy and diminished blood supply may lead to infections and amputations. The impact on the retina can lead to blindness while the impact on the kidneys is among the leading cause of renal fail­ure requiring expensive hemodialysis or transplanta­tion. The impact on the blood vessels also increases the probability of coronary artery disease and stroke. Most recently an increased risk of dementia has been recognized. Thus, type 2 diabetes ranks at the very top of the conditions classified as a 21st-century epidemic. Testing for diabetes is increasingly being done as part of routine health care using the hemoglobin Ale blood test which measures average blood sugar con­trol over a 2-month period. Many of the newly recog­nized diabetics have mild disease that would greatly benefit from weight loss. Weight loss has been the approach to preventing and controlling type 2 diabetes for many years. Even loss of 5% of body weight can have a substantial impact on blood sugars. Approaches to weight loss include a variety of partially successful diets most of which can reduce weight in the short run, but all of which are diffi­cult for individuals to maintain in the longer run. Gas­tric bypass surgery, despite its costs and potential side effects, has been shown to have an immediate effect on type 2 diabetes even before the impacts of weight loss occur. It is now often recommended for those with type 2 diabetes and a BMI of greater than 35. Management of most patients with type 2 diabe­tes requires the efforts of several types of clinicians. A primary care clinician, and increasingly a nurse practitioner or physician assistant, is often key. Other health professionals who are needed for high quality preventive care may include nutritionists to work with patients on their eating habits, podiatrists to prevent and treat foot problems, as well as optometrists and ophthalmologists to identify and treat diabetic eye problems to prevent blindness. Type 2 diabetes is often cited as a disease which requires shared decision-making and self-care. Ifinsulin is required for management of the disease, adjustment to prevent high and low blood sugars often rests on the knowledge and engagement of patients and families. Type 2 diabetes can be a very expensive disease to treat especially when hospitalization is required for very high blood sugar or for complications of the disease. Treatment of high blood pressure among type 2 diabetics has been shown to reduce costs as have annual influenza vaccinations. Early identifica­tion of damage to the retina from type 2 diabetes and laser treatment has been shown to be an effective and low cost approach to preventing blindness. Studies of the underlying mechanism for the development and progression of diabetes may in the future lead to better methods for prevention and treat­ment.