Treatment /Management
According to the American Diabetes Association (ADA, 2015), the goal of
managing diabetes is to restore normoglycemic control and prevent the development
of target organ dysfunction. In protecting target organ damage, emphases must be
placed on preventing microvascular (eyes, kidneys), macrovascular (coronary,
vascular), metabolic and neurologic complications (ADA, 2015). The Center for
Disease Control and Prevention (CDC, 2015) recommends healthy lifestyle practices
(healthy diet, exercise, and smoking cessation) to be included in the treatment plan.
The patient must be involved in the decision making process to enhance compliance.
According to the American Association of Clinical Endocrinologist
(AACE, 2015) if unable to achieve euglycemia with lifestyle modification in Type II
diabetes, metformin (a Biguanide) as a monotherapy agent must be initiated. AACE
(2015), indicates that a second agent such as glyburide (sulfonuylurea) should be
added if unable to attain normoglycemic control or if metformin is contraindicated.
The goal A1C level for ADA is less than 7.0mg/dl (ADA, 2015). Both AACE (2015)
and ADA (2015) recommend early initiation of insulin therapy in complicated adult
onset diabetes to prevent target organ damage. The family nurse practitioner must
collaborate with an endocrinologist and other interdisciplinary team members in
managing type I and complicated type II diabetes to ensure optimal client outcome.
According to the Texas state department of health (2014), more than one
million Texans have been diagnosed with diabetes and another half million are
believed to have undiagnosed diabetes. Over the past 10 years, the United States
Census Bureau (2015), shows increasing growth in population rates for both
Baltimore City, Maryland and Houston City, Texas. As shown in the first table below,
Houston continued to report over 20, 000 cases of adult onset diabetes annually,
seeing a gradual decline from 2012 through 2014. However, in Baltimore annual
cases of adult onset diabetes remained steady at just over 5,000 also seeing a decline
from 2012 through 2014. The second table illustrates the morbidity rates as compared
Houston, TX
30,000
27,213
25,371
25,193
25,000
23,468
21,769
21,403
20,883
20,806
19,474
20,000
18,273
17,273
15,000
10,000
5,5205,5555,8355,8355,8255,4455,6135,633
4,6394,2263,956
5,000
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Morbidity Rates
1400
1200
1000
800
600
400
200
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Baltimore
Houston
Conclusion
Diabetes, whether type 1 or 2, is a condition affecting the life of many
Americans (McCarthy, 2014). Millions of individuals are suffering from diabetes
because of a lack of healthcare and costly resources (CDC, 2015). CDC, (2015)
estimates that the cost of managing clients with diabetes is 2.5 times more compared
to people without diabetes. The mortality rate of individuals with diabetes is 1.5 times
more compared to those without diabetes (CDC, 2015). Advanced treatment is
available to help decrease the effects of diabetes on various body systems, including
the eyes, kidneys, and the heart (ADA, 2015). With the current treatment now
available, morbidity rates are slowly declining to enhance the quality of life.