Principles of Diabetes for Professional Practice Assignment Sample

Introduction - Principles of Diabetes for Professional Practice Assignment Sample

Diabetes mellitus is a long-term condition with raised blood glucose levels that substantially raises the risk of CVD. Diabetes patients bear an increased risk of atherosclerosis, hypertension, and heart failure. Therefore, cardiovascular diseases remain the most frequent cause of morbidity and mortality in diabetic patients (Brown and Abdelhafiz, 2010). Diabetes mellitus is steadily becoming more common all over the world, which is why it is crucial to apply research-based practices to minimise risks and enhance patient care. Diabetic management entails using medicine alone and in combination with changes in diet and daily practices, plus short and close follow-up to the patient for better self-management.

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This report considers the development of diabetes, its cardiovascular effects, and the significance of screening for and managing the condition. It addresses current practice and best-practice principles of interventions, focusing on enhancing clinical decision-making. Moreover, the contribution of history-taking and clinical assessment during the diagnosis and management of diabetes will be analysed, and approaches to adapting care will be reviewed and assessed.

Pathophysiology of Diabetes and Cardiovascular Complications

Diabetes mellitus is a common cause of cardiovascular complications, which are caused by several metabolic changes (Brown and Abdelhafiz, 2010). Diabetes mellitus also causes endothelial dysfunction by exaggerating the effects of hyperglycaemia through the formation of AGEs. Such compounds affect the enzyme nitric oxide synthase, which reduces the widening of blood vessels and increases the rigidity of arteries (Tran et al., 2022). The end produced is vessel dysfunction that puts someone at risk of high blood pressure, atherosclerosis, and thrombosis, all the critical factors relating to CVD.

Other features that worsen the cardiovascular issues in T2D are inflammation and oxidative stress. Insulin resistance leads to chronic low-grade inflammation, elevated C-reactive protein, tumour necrosis factor-alpha, and interleukin six levels (Sinclair et al., 2017). These factors actively participate in the creation and destabilisation of atherosclerotic plaque, the development of plaque rupture, and such thromboembolic events as myocardial infarction and ischemic stroke.

Abnormal lipid profile or dyslipidaemia is another dominant factor of cardiovascular complications in T2D., high triglycerides, low high-density lipoprotein cholesterol and high small dense low-density lipoprotein cholesterol because insulin resistance changes the lipid profile. This could explain Danny's cholesterol profile of 5.2 mmol/L total cholesterol and an HDL of only 1.0 mmol/L, which is even more dangerous as it increases the risk of atherosclerosis (American Diabetes Association, 2003).

These metabolic derangements are further exaggerated by hypertension through augmentation of the cardiac workload and injury to blood vessels. Danny’s pressure of 148/92 mmHg is higher than the recommended target pressure for people with diabetes. Chronic hypertension is a potential of left ventricular hypertrophy, heart failure and cerebral vascular events, which have measurable adverse effects on morbidity and mortality in diabetic patients.

Considering these mechanisms, cardiovascular risk management in Danny presupposes the complex of interventions, including lifestyle changes, pharmacological treatment, frequent clinical monitoring, and other measures that will provide the therapy's optimal results (Diabetes UK, 2017).

Current Guidelines and Evidence-Based Interventions

Reducing cardiovascular risk in T2D patients should involve compliance with current recommendations in terms of general and medicinal therapeutic approaches (Bruemmer and Nissen, 2020). Different guidelines like the National Institute for Health and Care Excellence (NICE), USA American Diabetes Association (ADA), and the European Society of Cardiology (ESC) issue guidelines to reduce cardiovascular disease (CVD) risk in diabetic patients (American Diabetes Association, 2003). Consequently, Danny requires personalised management for hypertension, dyslipidaemia, smoking and alcohol consumption while aiming at a more philanthropic condition.

Hypertension Management

Hypertension is a significant cause of cardiovascular morbidity and mortality in diabetes. However, as per NICE and ADA recommendations, Diabetic patients' blood pressure should be kept at less than 130/80 mmHg if tolerated. Danny's current 148/92 mmHg blood pressure does not meet this criterion (Einarson et al., 2018). Appropriate blood pressure control minimises the risks of stroke, heart failure, and nephropathy, which are common manifestations of diabetes.

Initial pharmacological treatment of hypertension in diabetic patients consists of ACE inhibitors Ramipril or Lisinopril and Angiotensin II receptor blockers Losartan or Valsartan (Einarson et al., 2018). They afford cardiovascular and renal protection and should, therefore, be prescribed for clients with hypertension associated with diabetes. In cases of further blood pressure lowering, closer monitoring can be performed, and calcium channel blockers like amlodipine or diltiazem can be given. Chlorthalidone or Indapamide, Thiazide-like diuretics, are also used in patients with high blood pressure, which is challenging to manage. Habit modification strategies are essential in patients’ blood pressure management. Danny needs to avoid taking Sodium and have a potassium intake of less than 2.3 grams in a day, and he should embrace the DASH diet as it also lowers high blood pressure (Diabetes UK, 2017).

Alcohol Reduction

Alcohol consumption is a significant cause of hypertension, dyslipidaemia and insulin resistance, which, in conjunction with the diseases, also increases the risk of cardiovascular diseases. According to NICE guidelines, men should not drink more than 14 units of alcohol in a week, and the recommended amount should be divided into more than one day. Danny consumes 10-20 units per week on weekends, which is more than the recommended unit and falls under this category (Diabetes UK, 2017).

Some of the aspects that pertain to it are as follows:

Exercise is a significant key to decreasing cardiovascular risk in diabetic patients. Lifestyle changes include exercising, reducing blood pressure, preventing dyslipidaemia, and increasing insulin sensitivity (Ross et al., 2010). NICE has suggested 150 minutes of moderate-intensity weekly exercise, such as walking, swimming, or cycling. Resistance training should also be done at least three days a week to strengthen muscles and enhance the metabolism of the body system (Holder et al., 2014).

Management of Care for Diabetes, Particularly the Follow-Up

A patient with highly increased cardiovascular risk, such as Danny, needs continuous care and follow-up with the recommended treatment measures. A lipid panel and the Risk score carried out annually, are essential for measuring progress in cardiovascular risk reduction (Hu, 2004). Even in normotensive patients, blood pressure has to be checked at least every 3-6 months. Eye and foot checkups are also advised regularly to diagnose other complications resulting from diabetes.

History-Taking and Clinical Assessment

Patient Background and Cardiovascular Risk Evaluation

In Danny's evaluation of cardiovascular risk, essential components include the evaluation of modifiable risk factors likely to enhance CVD. The assessment of Danny's case points to the need to determine the duration of his diabetes, the treatment he has received and whether he had complications in the past or currently (Kifle et al., 2022). Because of his HbA1c of 52 mmol/mol, he does not present severe glycaemic control issues, although 13% of moderate QRisk suggests that he will be at risk of CVD within the next ten years, requiring urgent and more intense intervention (International Diabetes Federation, 2019). Additional comorbidities, including hypertension (148/92 mmHg), dyslipidaemia (total cholesterol: 5. He is 92 years of age, with an average BMI of 25.2 kg/m2, takes no medication, abstains from alcohol and is a smoker with a BP of 128/82 mmHg, total cholesterol of 5.2 mmol/L; HDL 1.5 mmol/L, LDL 1.0 mmol/L. Hypertension and diabetes are modifiable risk factors that should be addressed as early as possible to prevent cardiovascular adverse effects.

A chest pain, palpitation, or shortness of breath, which may suggest ischemic heart disease or peripheral arterial disease, should be explicitly assessed regarding the Heart (Jenum et al., 2012). In addition, index events should be screened for the history of prior cardiovascular events such as angina, stroke, or transient ischemic attack to better understand the current management strategies. It is recommended that Danny be assessed for complications of his hypertension, which may include left ventricular hypertrophy or hypertensive kidney disease, among others, as declared by the International Diabetes Federation (2019).

Lifestyle and Behavioural History

Promoting behavioural changes is basic to minimising Danny's risk of cardiovascular diseases. Ascertaining his smoking status is central to the assessment; the manner, extent and frequency of smoking will describe the quitting plan that combines the use of behavioural therapy and pharmacological treatment where necessary (Isomaa et al., 2001). The number of units of alcohol per week is 10-20. These are considered during the weekends and fall under binge drinking, which is detrimental to hypertension and dyslipidaemia (Inkster et al., 2006). These risks can nevertheless be prevented using gradual reduction strategies and alcohol education. The nutritional behaviours and the physical exercises involving Danny also need assessment. His caloric requirement, the distribution of the macronutrients, the use of salt, and physical activity should be checked to provide dietary advice and exercise information. Physical inactivity is another recognised determinant of cardiovascular mortality in diabetes, and this has to be reduced through the engagement of specific exercise prescription, which takes into account his disability and interest (NHS Digital, 2017). Time, strength, motivation and other related behavioural constraints are also necessary and must be handled. Furthermore, sleep durations, perceived stress, or depressive and anxious symptoms must be assessed because these factors contribute to cardiovascular risk.

Investigations of Metabolism and Laboratory Tests

Danny's assessment should include cardiovascular and metabolic assessments. This is why successive blood pressure readings under different circumstances are needed to diagnose hypertension (NHS Digital, 2017). Fundoscopy is necessary to look for signs of Diabetic Retinopathy that point towards microvascular disease.

Labs must perform lipid assays to guide statin use, fasting blood glucose, and HbA1c assays for glycaemic control (Paolisso and Sinclair, 2010). Serum creatinine, eGFR and Urinary A/C ratio should be used to monitor kidney function since diabetes, hypertension and nephropathy are highly associated. Liver enzymes should be checked before the commencement and during any alteration of statin treatment (Hex et al., 2012). Other assays like HS-CRP can give information on inflammation and cardiovascular disease. Investigations that may be used to look for heart dysfunction and exclude ischemic heart disease may include ECG and echocardiogram (Stenstrom et al., 2005).

Evaluation of Compliance and Patient’s Knowledge

Monitoring Danny’s compliance with the medications that have been prescribed and the dietary changes that have been advised is essential in ensuring the best long-term results (Stenstrom et al., 2005). It is for this reason, for proper and sound long-term risk control, that Danny must undergo a frequent assessment of compliance with lifestyle modifications and MD-prescribed drugs. A specific component of health learning that should be taught is structured teaching on high blood pressure, cholesterol and blood sugar. The interventions should thus centre on getting Danny to stop smoking, eat the right foods, and exercise regularly. They suggested that intervention components to ensure compliance would be as follows: It will be essential to remove any existing barriers to compliance, including medication side effects or lack of knowledge (Stenstrom et al., 2005).

Impact of Diabetes Diagnosis on the Patient and Family

Cardiovascular disease and implementing the requisite lifestyle changes may be complex for Danny despite his satisfactory glycemic control (HbA1c of 52 mmol/mol) with normal or near-normal renal and hepatic function (Zaccardi et al., 2016).

Psychologically, when a person is diagnosed with diabetes, stress, anxiety, and even depression result from it because the management has to be for the entire life. Smoking and alcohol consumption are still in place; therefore, this may be a result of coping mechanisms or refusal to cease behavioural practices (WHO, 2021). These measures, which include self-monitoring of blood glucose levels, restricted diets, medication adherence, and compliance to lifestyle changes, could lead to frustration and emotional exhaustion, leading to a less motivated patient interested or willing to participate in defining and managing his care (Marchasson et al. 2012).

In the case of a patient with diabetes, relatives are usually the ones who monitor compliance with dietary and lifestyle changes, and this results in rivalry at home. Suppose his family is not aware of the dangers of his CVD profile; in that case, they cannot be fully supportive or encourage those changes that will aid Danny in adhering to the recommended treatment. Also, community perceptions, attitudes towards the disease, and social regarding having diabetes may affect his self-care practices and seeking help (Isomaa et al., 2001).

Another significant worry to consider is financial pressure. Since Danny is not experiencing significant problems in his health that warrant high technological consideration, there are costs put into his medications, side from changing his diet, and constant visits to the hospital (Isomaa et al., 2001). The long-term consequences, including chances of repeat hospitalisation for cardiovascular issues, a possibility of disability, and lowered work capacity, may also unfavourably affect his economic status and health (Jenum et al., 2012).

Diabetes self-management addresses the enduring principles that apply to the coordination of care for diabetic patients, which include the importance of a supportive family environment that encourages compliance with the recommended healthy lifestyles, shared decision-making, and communication (Jenum et al., 2012). Treatment with education and counselling for Danny and his family may reduce concerns, increase self-efficacy, and promote lifestyle change. Therefore, employing a psychologically and socially permissive and supportive household and providing proper knowledge and information about the illness reduces and likely eradicates the disease's psychological and social burdens, thus improving the lifetime prognosis (Hu, 2004).

Role of Healthcare Professionals in Patient Support

One of the roles of a healthcare worker is to ensure that the patient gives comprehensive information on the disease process of diabetes, cardiovascular disease risk factors, treatment compliance and behaviour change, respectively. For this reason, Danny necessitates a clear understanding of how his modifiable QRisk score of 13% and hypertension (148/92 mmHg) risk factors – smoking, alcohol, diet and physical activity affect his cardiovascular risk (NHS, 2019). Diabetes self-management education (DSME) type structured education programs give patients up-to-date knowledge and practical skills to boost compliance and prospects of high-quality diabetes care (Kao et al., 2020).

Other important behavioural counselling components include barriers to promoting lifestyle changes (Kao et al., 2020). Danny's smoking and continued use of alcohol suggest that behavioural changes that are best addressed by specific behaviour therapy may present themselves. He should be given motivational interviewing approaches so that healthcare professionals can establish his stages of change and plan for change goal setting. In the case of smoking cessation, he should be referred to smoking cessation programs, nicotine replacement therapy, varenicline or bupropion treatment.

Medication management is one of the most critical aspects of patient care; the other is medication adherence (Griffin and Greenhalgh, 1998). The need for antihypertensive therapy (ACE inhibitors or ARBs), the need for statin therapy for lipid control, and the possible need for antiplatelets must be fully explained to Danny by healthcare professionals. Follow-up should include an evaluation of the patient's tolerance to the medicines, side effects, if any, and any challenges that impact the use of medicines to allow for modifications as necessary (Diabetestimes.co.uk/, 2018).

It is important to observe individuals after some time; hence, follow-up consultations assist in tracking the results and sustainability of the changes (Diabetes UK, 2023). To assess the effect of the interventions developed by healthcare professionals, the following tests should be conducted: blood pressure tests, lipid profile tests, and evaluation of cardiovascular risk factors.

The other important aspect of patient care is psychosocial support. Self-organisation of diabetes is influenced by the person's emotional and mental health (Nursing Times, 2011). HC professionals should constantly assess for diabetes distress or depression/anxiety, as distress increases non-adherence and unhealthy coping and results in deterioration of health. Patients suffering from the psychological effects of diabetes may find help with referrals to those who deal with mental health, support groups or perhaps cognitive behavioural therapy (CBT) (NHS Digital, 2011).

Integrating medical advice from various fields would be essential in treating cases like Danny's. The combined teamwork of general practitioners, endocrinologists, cardiologists, dietitians, physiotherapists, psychologists, and diabetes educators guarantees comprehensive and individualised approaches. Using an interdisciplinary approach, the patients get personalised treatment that considers their medical and behavioural problems.

Challenges and Limitations in Implementing Interventions

Interventions of cardiovascular risks in patients suffering from T2D have various barriers and limitations that may hinder the programs. Despite the broad recommendations given by guidelines in managing diseases like hypertension, dyslipidaemia, and other aspects of life, various individual, systemic, and societal barriers may affect compliance and impact.

Another limitation that was identified is the patient’s compliance and behavioural noncompliance. Even if doctors recommend specific treatments, clients can overcome them by failing to follow prescribed changes in behaviour throughout their lives, including quitting smoking, modifying their diet, and exercising regularly. They prove that conative and psychologic barriers remain evident, making it challenging to prevent Danny from smoking and drinking (NMC, 2018).

The fourth challenge relates to medication adherence, where patients find it hard to take several pills at once and perceive side effects. The elderly diabetic patients often take several drugs, antihypertensive, antilipidemic, and possibly antifibrinolytic. Side effects, drug interactions, and complications of the medicines may discourage patients from using them as prescribed (NICE, 2020). Danny has a delay in starting or continuing long-term pharmacotherapy, especially if the benefits are not entirely clear to him. Personalised communication and patient education can enhance compliance by addressing the patient's concerns and helping them make decisions.

It also revealed that lack of funds and access to financial resources hampers the successful implementation of interventions. Another factor that could slow down implementation is accessibility to healthcare (Boon et al., 2014). For underlying reasons for quitting smoking, healthier food choices, medications, and yearly health checkups may result in huge sums for those with low-income earners. Many patients may not be able to afford insurance or may not have access to specialised healthcare services and, therefore, cannot observe structured interventional programs (Weeks et al., 2016). Through government policies, community support programs and subsidised health care programs, it is possible to limit the barriers stated above. Still, they remain a key issue regarding healthcare disparity.

Stress, mental illness, lack of social support or negative social interactions are also other factors that can worsen adherence. Depression, anxiety or diabetes distress could interfere with self-management practices, utilisation of health care services and motivation towards good healthy practices (NICE, 2022). Increase recommendation's chances of success in the social environment and family Danny holds fundamental to the execution of regimen (NICE, 2022). Even in this case, if his family does not support him to quit smoking or change his diet, it will be hard for him to adhere to changes most of the time. Some forms of psychological intervention using CBT, MI and or peer support groups may help.

Conclusion

Danny's diagnosis of Type 2 Diabetes, along with the elevated cardiovascular risk factors, emphasises the need for a comprehensive treatment plan that requires comprehensive management by making changes in the lifestyle through medical management and continuous monitoring. Even though hisglycemia is well controlled, he has hypertension, dyslipidaemia, smokes, and drinks alcohol, which increases his risk of cardiovascular disease, stroke, nephropathy, and other complications of diabetes.

Today, precise attention is paid to a complex approach to addressing cardiovascular risk factors, which includes hypertension, lipids, smoking, alcohol, exercise and patient consultation. The delivery of these interventions needs to be grounded in medical management, behavioural counselling, follow-up visits, and support.

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