The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces" (World Health Organisation on-line 2008a). It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries. The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tollerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.

 

 

There are several types of Diabetes. Historically, Diabetes Mellitus tended to be classified by depending on insulin administration or the lack of it. In more recent times, it is accepted the disease is more complex. Type 1 Diabetes refers to

 

Type 2 refers to where insulin is produce which

 

This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus. The latter name has been challenged as the number of individuals under 16 is now significantly

 

 

 

Because the symptoms of Diabetes Mellitus type 2, individuals may be going undetected. On a global scale, this could include

 

In the United Kingdom, the "missing Million" is the subject of some debate. This, until now, could have included Jack.

 

This could have many implication as individuals may not have any idea that, as they have no symptoms,

that they are do not have the disease and so do not feel that they need to alter any

 

Pre-diabetis, also referred to Metabolic Syndrome and formally called Glucose Intolerance in now the subject of much research.

 

Diabetes Insidus is a condition which is not related to insulin production and is

 

 

 

 

 

The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia. As the large ammounts of glucose can not enter cells as insulin is not fascilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness, and less commonly genital itching, frequent Thrush infections and blurred vision

 

 

 

 

Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience. Smoking tabacco can result in vascular compromiseation can compund the changes which are caused by Diabetes Mellitus

 

 

 

The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.

 

 

1. explain how the particular health need has been identified using demographic and epidemiological data to support your discussion

2. apply health promotion theory to explore possible health promoting activities

3. identify possible evaluation methods to demonstrate the effectiveness of health promotion interventions

 

 

Intro: Identify the scenario and outline the particular aspects you will be exploring (250 words)

This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.

Three degrees of helath promotion have been identified. Primary health promotion pertains to that which is undertaken

 

to prevention of the commencement of health consequense occuring. This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes (). Secondary health promotional activity aims to prevent any adverse health consequence from deteriating further. This would include teaching foot care techniques to newly diagnosed diabetics. Tertiary health promotion is concerned with

 

DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program taylored for individuals with Diabetes type 2. Being primarily pioloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scotish PCTs.

Taking its lead from the National Institute for Health and Clinicle Excelence guidance

 

Jack is affected by several National Service frameworks. These include those for Elderly People,

Body Mass index (BMI), the calcuation of weight divided by height squared, has been widely used as an indicator of obsesity, normal weight and under weight. It is one of the factors that is included in several nutritional scores. It can provide a basic analogue of whether any weight management activities need to be implicated. However, it is limited in that it does not take into account any risk factors. Moreover, there is now much research which brings into question the validity of BMI. Waist measurement is now bieing mooted as a more reliable predictor of risk with regard to weight.

The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about prejoritive attitudes of Nurses and other health care professionals.

If

 

The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about prejoritive attitudes of Nurses and other health care professionals

   

Diabetes Mellitus - 09:39

The incidence of diabetes is increasing in all age groups. .... Welcome to DiabetesUK. Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing ...www.patient.co.uk/showdoc/40000914/ - 57k - Cached - Similar pages - Note this

Rising Incidence of Type 2 Diabetes in Children in the U.K....

Rising Incidence of Type 2 Diabetes in Children in the U.K.. Linda Haines, MSC1, Kay Chong Wan, DPHIL1, Richard Lynn, MSC1, Timothy G. Barrett, ...care.diabetesjournals.org/cgi/content/abstract/30/5/1097 - Similar pages - Note this

[PDF]

Diabetes : State of the Nations 2006

File Format: PDF/Adobe Acrobat - View as HTMLareas of Diabetes UK: early identification of. diabetes, psychological and emotional ...... Rising incidence of insulin-dependent diabetes in children ...www.diabetes.org.uk/Documents/Reports/SOTN2006_full.pdf - Similar pages - Note this

NLH - Diabetes - Incidence and prevalence of diabetes

10 Jun 2007 ... Numerous studies have shown that there is a rising incidence of diabetes and it's complications in all age groups, both in the UK and ...www.library.nhs.uk/diabetes/ViewResource.aspx?resID=261624 - 67k - Cached - Similar pages - Note this

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NHS Diabetes

File Format: PDF/Adobe Acrobat - View as HTMLIncidence of new ischaemic heart disease in Type 2. 3.2% per annum. Cardiovascular disease as cause of death. 55%. Number of people with diabetes in UK...nchod.uhce.ox.ac.uk/diabetes.pdf - Similar pages - Note this

ScienceDirect - The Lancet : The rising incidence of childhood ...

The incidence of childhood type 1 diabetes has risen over the past 50 years. ....Diabetes UK and the Wellcome Trust funded the Bart's-Oxford study and ...linkinghub.elsevier.com/retrieve/pii/S0140673604173571 - Similar pages - Note this

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Improving Diabetes Services: The NSF Four Years On

File Format: PDF/Adobe Acrobat - View as HTML8 Mar 2007 ... The Diabetes UK award for outstanding contributions to ..... It was established that the recorded incidence of diabetes was 3.93%, while ...www.diabetes.nhs.uk/downloads/the_way_ahead_the_local_challenge.pdf - Similar pages - Note this

Lifestyle Interventions to Prevent Diabetes [February 2006; 144-5]

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Prevalence and Incidence of Diabetes - WrongDiagnosis .com

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Cancer incidence and mortality in patients with insulin-treated ...

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It goes onto discuss three other phenomena. Type 1 diabetes (formerly known as insulin-dependent) in which the beta cells in the islets of langerhans cell in the pancreas fails to produce the insulin which is essential for survival. The onset of this type of diabetes was more prevelant in childhood or adolesence but this pattern is now changing.

 

 Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's maladaptive response to the action of insulin and accounts for approximately 90% of all diabetes worldwide. The onset of this type of dabetes has also changed in that from being a disease of adults, it is becoming more prevelent in children.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) refer to levels of blood glucose concentration above the normal range, but below those which are diagnostic for diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes and cardiovascular disease than those with normal glucose tolerance. The benefits of clinical intervention in subjects with moderate glucose intolerance is a topic of much current interest.

 

Although not at a level that would constitute diabetes, individuals with Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) demonstrate elevated blood glucose levels which seems to place them at higher risk of developing both cardiovascular disease as well as diabetes.

   

   

   

 

 

 

 

 

 

 

    

 

 

 

It must be noted that jack is a smoker. This could have an impact on his disease experience as nicotine has an

poor

fat and diet...

 

 

dietietic

locus of control

 

 

 

 

 

 

The World Health Organization (World Health Organisation on line (2008), defines diabetes as:

"Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves."

It goes onto describe four phenomena namely type one Diabetes mellitus where little or no insulin is produce, type two which results from the body's maladaptive response to the action of insulin and Impaired Glucose Tollerence and Impaired Fasting Glycaemia where elevated blood glucose levels which seem to place them at higher risk of developing both cardiovascular disease as well as diabetes.

 

It is significant that the incidnece of diabetes type two is increasing.

 

There are seveveral significant dimension to this increase.

 

The overal global incidence has increased.

 

The disease in now presenting at a younger age.

 

This seems to be varying directly with the increase in obesity.

 

 diabetetes fat relationship....

Randomised control tries have ini

 

 

Asseement of health needs

 

 

Randomised controlled trials have shown that (diabetes prevention research group, 2002 Lindström et al, 2003). The diabetes prevention programme found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin (diabetes prevention research group, 2002).

 

The Diabetes Prevention Research Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet. The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin. The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older. More research may bring forth some more answers, especially if it were longitudinal in nature.

Jack, as a man, is both less likely to visit his GP as well as be predisposed to health promotion.

 

 

 

 

 

From a global incidence, Wild et al (2004) have projected that dabetic incidence could more than double from its 2000 level of 171 million to that of 366 million by the year 2030. As the United kingdom as a whole,

 

c

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Three degrees of health promotion have been identified. Primary health promotion

pertains to that which is undertaken to prevention of the commencement of health consequence occurring. This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes (). Secondary health promotional activity aims to prevent any adverse health consequence from deteriorating further. This would include teaching foot care techniques to newly diagnosed diabetics. Tertiary health promotion is concerned with

 

OBESITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The NMC (2008) call for Registrants to be non-judgemental in the Code for

asdfasfsadfs. However, much has been written about pejorative attitudes of Nurses and other health care professionals

 

 

The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about prejoritive attitudes of Nurses and other health care professionals

 

 

There are several types of Diabetes. Historically, Diabetes Mellitus tended to be classified by depending on insulin administration or the lack of it. In more recent times, it is accepted the disease is more complex. Type 1 Diabetes refers to

 

Type 2 refers to where insulin is produce which

 

This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus. The latter name has been challenged as the number of individuals under 16 is now significantly

 

Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience. Smoking tobacco can result in vascular compromisation can compound the changes which are caused by Diabetes Mellitus

 

The risk of the development of type 2 Diabetes is significantly greatened with increasing diabetes especially if this is in the abdominal area (Chan et al 1994, Colditz et al 1995)

The Link between obesity and diabetes has its origins when Vague (1956)

who noted links a "masculine" or "android" obesity phenotype and diabetes

 

 

 

Klien 2004 suggests that of the three types of abdomnial fat, visceral (intraperitoneal fat,) intraagdominal and subcutaneous, it is the former that is most highly related with diabetes type 2.

 

The Link between obesity and diabetes has its origins when Vague (1956)

who noted links a "masculine" or "android" obesity phenotype and diabetes

 

 

 

Klien 2004 suggests that of the three types of abdomnial fat, visceral (intraperitoneal fat,) intraagdominal and subcutaneous, it is the former that is most highly related with diabetes type 2.

 

 

The Link between obesity and diabetes has its origins when Vague (1956) who noted links a "masculine" or "android" obesity phenotype and diabetes

 

 

Klien 2004 suggests that of the three types of abdomnial fat, visceral (intraperitoneal fat,) intraagdominal and subcutaneous, it is the former that is most highly related with diabetes type 2.

 

 

 

 

 

 

 

 

 

 

 

References

 

World Health Organisation [on-line] (2008)a. Programes and Projects: Diabetes. http :// www .who.int/diabetes/en/ visted 24th April 2008

World Health Organisation [on-line] (2008)b. Diabetes Action On-line. http://www.who.int/diabetesactiononline/diabetes/en/ visited 5th May 2008

http://www.framinghamheartstudy.org/index.html

framingham http://www.framinghamheartstudy.org/index.html

Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes. Nusing Standard 21, 25, 37-44

Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes. Nusing Standard 21, 25, 37-44

Brown, I., Stide, C., Psarou, A., Brewins, L., Thompson, J. (2007) Management of obesity in primary care: nurse's practice, belief and attitudes. Journal of Advanced Nursing 59 (4), 329-342

Marieb E. N. and Hoehn, K. (2007) Human Anatomy and Physiology: Pearson International Editional Edition. 7e. San Francisco: Benjamin Cummings

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=128&sectionId=10

 

http://www.eatlas.idf.org/Diabetes_Atlas___Executive_Summary_download/#EN

http://www.eatlas.idf.org/Obesity_and_type_2_diabetes/

Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., et al. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12), 3230–3236

http://care.diabetesjournals.org/cgi/content/full/26/12/3230

 

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393–403.http://content.nejm.org/cgi/content/full/346/6/393

 

Downie, R, Tannahill C Tannahill A (1996) health promotion: models and Values. Oxford Oxford medical publications

DAVIES MJ, HELLER S, SKINNER T C, CAMPBELL MJ, CAREY ME, CRADOCK S, DALLOSSO HM, DALY H, DOHERTY Y, EATON S, FOX C, OLIVER L, RANTELL K, RAYMAN G, KHUNTI K on behalf of The DESMOND Collaborative, 2008. Effectiveness of a structured group education programme on individuals newly diagnosed with Type 2 diabetes: a cluster randomised controlled trial of the DESMOND programme. BMJ published online 14 Feb 2008; doi:10.1136/bmj.39474.922025.BE.

Després JP, Lemieux I, Prud'homme D (2001) Treatment of obesity: need to focus on high risk abdominally obese patients. British Medical Journal. 322, 7288, 716-720

Joint Health Surveys Unit (2003) Health Survey for England 2002. The Stationery Office, Norwich.

Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1994) Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 17, 9, 961-969.

Colditz GA, Willett WC, Rotnitzky A, Manson JE (1995) Weight gain as a risk factor for clinical diabetes mellitus in women. Annals of Internal Medicine. 122, 7, 481-486.

Klein, S. (2004) The case of visceral fat: argurment for the defense. Journal of Clinical Investigation 113(11): 1530-1532

Vague, J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am. J. Clin. Nutr. 1956. 4:20-34. In: Klein, S. (2004) The case of visceral fat: argurment for

the defense. Journal of Clinical Investigation 113(11): 1530-1532