Determinant of Longevity in Adult with Type 2 Diabetes

Folasade Ahmed

Morgan State University

Content of Healthcare System

NURS 601

Dr. ValishaPricce

October 7, 2015

Abstract

Knowing that diabetes is one of the leading causes of illness and death throughout the world been the seventh leading cause of death in the USA according to diabetes statistics. Also in the statistics says “After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes”.  Diabetes was an irreversible autoimmune disorder, the disease of the endocrine system that developed when there is an impaired fasting glucose or impaired glucose tolerance. Due to these, the research was based on how the health care professional can effectively improve the quality of life and increase the longevity of diabetes patients. In the study, it was found out that to determine the longevity of diabetes patients there must be collaboration in treatment. The treatment needs to involve psychiatrist, psychology, social worker and level of literacy of patient with type 2 diabetes. The study emphasis on Depression, Quality of life, Peer support, Literacy, Self-efficacy, Lifestyle Intervention and Cognitive Behavioral treatment as the intervention for the determinant of longevity for a patient with diabetes.

Keywords:Depression, Peer support, Quality of life, Literacy, Self- efficacy, Lifestyle- intervention.

                                                Introduction

              Determinant of Longevity in Adult with Type 2 Diabetes

Treatment of diabetes is known to be a life -long commitment to medication, monitoring of blood sugar and lifestyle modification. It involves a physical and emotional commitment that may decrease the life expectancy of a diabetic patient.  Due to their instability, diabetic patients must maintain their blood sugar within a certain range to avoid hypo or hyperglycemia.  Non-adherence to treatment leads to retinopathy (blindness), diabetic nephropathy (kidney disease), neuropathy (amputation) strokes and heart diseases. Diabetes shouldn’t be a death sentences if there’s proper collaboration between a patient’s primary doctor, psychiatrist and psychology.  Severalscholars’ researched on what can contribute to a good quality of life and increases the longevity of patient with diabetes.  Depression treatment, self- efficacy, peer support, lifestyle intervention, literacy, self -management and involvement of social worker when put into consideration, can determine longevity in a patient with diabetes.

[v1] DISCUSSION AND FINDINGS

“Depression and adherence to treatment in diabetic children and adolescents:  a                                                                                        systematic review and meta-analysis of observational studies”

In a study based on the relationship between depression and adherence to treatment in juvenile with diabetes,patients with diabetes were found to have a negative self- perception, low self -esteem and ineffective coping style and may be exacerbated by maternal depression.(Chuenijil et al., 2014).The study defined Diabetes as an irreversible autoimmune disorder that attacks pancreatic bête cell, and there are many compensatory hormonal and inflammatory changes that may exacerbate the depression(Chuenijil et al., 2014).  The Depression was also moderately associated with non-adherence to treatment in diabetic children and adolescents based on the patient self- report. Parental advice and psycho-socio-economic support like self -value and esteem, group psychotherapy, along with the use of antidepressant helped children in overcoming the impediment of adherence. (Chuenijil et al., 2014).

Affirms[v2]  that the diabetic patient must accept diabetes mentally to have an effective treatment.Acceptance[v3]  needed due to the various self-care activities that the patient will be required to do. The[v4]  study based on the patient self- report on depression and overall treatment adherence and report provided by the caregiver.[v5] 

Health literacy and Its Association with diabetes knowledge, Self –Efficacy and Disease self –Management among African Americas with diabetes Mellitus.

Literacy levels were also considered as a determinant of longevity.  The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process and understanding basic information and service, needed to make an appropriate decision regarding their health[v6] ’’.  Low literacy is alsoassociated with difficulty understanding written or verbal medical advice, adverse health outcome and negative effects on the health of individual ( McCleary-Jones 2011). In the study, low literacy in health care affected patient-physician communication and led to substandard medical care. Low literacy is more prevalent in people with fewer years of education, those of certain racial or ethnic groups and elderly. Low literacy increase the risk of health disparities in African American (McCleary-Jones 2011). The National Center for Education Statistics (NCES) found the performance of African American to be lower than that of Whites and Asians on all three literacy scales measured prose, documentation and Qualitative. ((McCleary-Jones 2011).

Diabetes is more common among African- Americans and other minority populationsDiabetes complications are the leading cause of morbidity and mortality among African- Americans, are also known to  have lower health literacy score.  Patients with low literacy had less desire to participate in medical decision making and  less diabetes- related knowledge than that of a patient with a high education background. Low literacy was associated with several adverse health outcome, such as increased odds of poor medication adherence, increased risk of hospitalization and decrease glycemic control resulting inincreasedrisk of developing retinopathy, nephropathy, and neuropathy.

Furthermore, individual’s confidence in the ability to perform health will influence his /her involvement in it[v7] . Patient[v8] s with diabetes needs to have self-efficacy, which being defined as a person’s belief in their ability to succeed in a particular situation. (McCleary-Jones 2011If interventions are made towards self-efficacy, then patients will display improvement in self-management of chronic disease and positive health outcome[v9] . 

While the health care professional delivers diabetes self- management education for initial acquisition of knowledge and skill, diabetes patients still need support in other to maintain learned behavior. (Yin, Wong & AU, 2015) =Peer[v10]  support isreferred to as the transfer of experiential knowledge of a specific behavior or coping strategy for a stressor between people who share a particular characteristic[v11] .People with a common illness can share knowledge and experience in a less hierarchical and more reciprocal relationship than that between patient and health care professional. (Yin et al., 2015).

In the study, individuals who regularly followed the tasks involved in intensive management programs achieve better short and long-term health. The study used individuals with diabetes ready to been trained as a trainer. “Train the trainer” programs  provide a basic knowledge and emotional support to their peers. The training consists of

1. Effective communication, focusing on positive thinking, empathetic listening, and appropriate questioning, taught by a neurolinguistic programming expert

2. Diabetes diet review, with cooking tips, education on common misconceptions of the diabetic diet, and suggestions for weight management, taught by an accredited dietician.

3. Physical activity training, including precautions to take during exercise, stretching exercises, and sustaining motivation for daily physical activity, delivered by a nurse qualified in fitness training.

[v12] Yen et al. concluded that the study prospectively reported long term effects of providing ongoing peer support to other on patients with type 2 diabetes. It captured multidimensional outcomes and provideslongitudinal evidence that by providing ongoing help to others; patient with diabetes benefit in regards to sell-care, psychology health and glycemic control over 4 years.Behavioral psychology emphasized positive thinking, goal -setting, decision making, and coping with negative emotions, delivered by a qualified psychologist.

[v13] 

The result of the study shows that the groups that agreed to be peer supporters had higher self- rated health status. Improvements in glycemic lipid control as well as self –care behaviors at six years even after four years were noted, but control deteriorated in the refused and comparison group. Furthermore, peer support is a means to improve on long term self- management to achieve longevity. The study reported that peer support has improved health behaviors, self- efficacy depression even mortality risk peer supporters.

Furthermore, (Ayalon, Gross, &Hava (2008) [v14] talked about the role of social worker as part of determinants of longevity of patients with diabetes. Information (Ayalon et al., (2008) says "Diabetes has long been acknowledged as a bio psychosocial disease. Its management involves a dramatic change in lifestyle that including keeping a low sugar diet, maintaining an exercise regime, monitoring daily blood sugar and taking oral or insulin supplement". The social worker has a unique impact in helping patients with diabetes to maintain a healthy lifestyle. (Ayalon et al., 2008)[v15] 

     Providing psychosocial support toward diabetes self-management improved patient’s quality of life.  Social workers need to be aware of the potential trade-off between following medical recommendations that advocate for a strict lifestyle and patients ‘quality of life. (Ayalon et al., 2008)

The social worker used the knowledge of specific factor that affect one’s quality of life to developed and implement the future that will help patients with diabetes to manage their condition. (Ayalon et al., 2008)

        Again, in the study it is understandable that successful diabetes management requires a close relationship with medical services.

For a quality of life of diabetes patient to be improved, social workers should be aware of the need to counsel patient and assist them in overcoming bureaucracy and other problems they may encounter with medical services. (Ayalon etal., 2008).

With social worker knowledge of public policy and community work, social workers can help integrate appropriate health behaviors into the public notion. (Ayalon et al., 2008).

     Also (Bot &Welschen 2013) added the Techniques of Problem Solving Treatment, it focused on teaching patient to use own skills to resolved problems and improve their symptom been a key to successful self-management of diabetes.

[v16] 

       CONCULSION

Known to be an irreversible autoimmune disorder that attack pancreatic bête cell and there are many compensatory hormonal and inflammatory changes that may exacerbate the depression.

If the health care provider can collaborate the treatment of diabetes with the review of suggested determinant of longevity as discussed in all the articles patient with diabetes with have good quality of life and have long longevity.

 When self-efficacy enhanced, stress management, goal setting and decision- making improve metabolic control in people with diabetes.

[v17] 

Determinant of Longevity in Adult with Type 2 Diabetes