Early Detection of Diabetes ESSAY

Early Detection of Diabetes

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Table of Contents

Introduction. 3

Significance of the Problem.. 4

Quality Measures. 6

Description of the Program/Solution. 9

Theoretical Framework. 13

Literature Review.. 15

Classification and Diagnosis of Diabetes. 15

Early Detection and Treatment of Type 2 Diabetes. 17

Detection and Management of Diabetes during Pregnancy in Low Resource Settings. 18

References. 22

Appendices. 27

Introduction

Diabetes is one of the most common diseases in the world. According to a World Health Organization (WHO) (2018) fact sheet, an average of 422 million people live with diabetes. The prevalence of the disease has been rising at a high rate compared to other common diseases. In this case, the number of people diagnosed with the disease was 108 million in 1980 (WHO, 2018). Based on the estimates of the WHO (2018), the prevalence of the disease among adults has risen from 4.7% to 8.5% across the entire population during the past three and a half decades. This makes it one of the most common diseases worldwide.

Diabetes commonly manifests itself as type one or type two. As explained by Pippitt, Li and Gurgle (2016), diabetes mellitus, manifests itself in the form of hyperglycemia that is caused by either insulin inaction, defects in insulin secretion, or both. This means that the body loses the ability to regulate glucose. In return, this may affect the amount of glucose in the blood as well as the performance of vital organs in the body. Diabetes type 2 is attributed to genetic and environmental factors. As reported by Wu, Ding, Tanaka, and Zhang (2014), a person from a family history of the disease has higher chances of developing it. Additionally, females and older persons are also at a higher risk because they have an immunosuppressed immune system. Further, poor lifestyles, including lack of exercise and poor nutrition, are also associated with the disease (Wu, YDing, Tanaka & Zhang, 2014).

The mortality rates from diabetes can be prevented. Despite the fact that diabetes has been linked to a high number of deaths globally, the number does not exceed the deaths caused by other diseases such as heart complications, stroke, and kidney failure (Zhu, Li, Li, et al., 2015). People can easily get tested for this disease at their local health facilities routinely or after they identify signs and symptoms. Despite the fact that early symptoms of diabetes are easily identifiable, there is a need get routinely for timely intervention to increase the accuracy of diagnosis, early detection, and prevention. In this regard, the Center for Disease Control and Prevention (CDC) recommends that all Americans aged above 40 years get screened every three years (Pippitt, Li & Gurgle, 2016). This assertion is corroborated by a report by the Office of the Assistant Secretary for Planning and Evaluation (2004) which warned that the disease could take as many as ten years before the signs and symptoms can be identified. This type of intervention helps improve the condition of diabetes patients through early diagnosis, detection, management, and treatment to curb the prevalence of diabetes. The major challenge of dealing with diabetes is the lack of identifying risk factors which have slowed down the pace at which relevant government agencies address these risk factors. For this reason, this practice intervention project will focus on   providing recommendation on how to use early intervention as a solution to the problem of diabetes.

Significance of the Problem

According to Pippitt, Li, and Gurgle (2016), diabetes is the most widely diagnosed disease by family physicians across the world. While the disease may be difficult to identify among many patients, some of the most common signs and symptoms include frequent urination, increased thirst, elevated hunger, fatigue, and blurred vision (Pippitt, Li, and Gurgle, 2016). As such, it is common for patients to experience pain, numbness, and tingling. They may also develop patches of dark skin and experience itching that is brought by yeast infections. The lack of early detection of diabetes risk factors and addressing them is a significant problem that requires research to find out the best possible ways of containing the disease and stop new infections through effective diagnosis, treatment, and management.

Early prevention programs are beneficial because the quality of lives of people living with diabetes and healthy ones as well should be constantly monitored. Besides, the early prevention programs is beneficial because it will help addressee the negative impact of diabetes on the quality of lives at individual, societal, national, and global levels as a huge amount of funds are spent on funding care and supporting the affected people. Diabetes has adverse effects on the long run as patients spend the rest of their lives managing the disease. As had been reported earlier, many of these patients are forced to change their lifestyles entirely.

Additionally, these people may also suffer from long-term complications, including disabilities that are associated with loss of eyesight and limb amputations. In this regard, the disease was ranked the sixth on the list of leading causes of years lived with disability in 2015 as it accounted for close to 7% of all disabilities (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2015). This significantly impairs the quality of lives of the patients. Early detection and intervention can greatly help patients to manage their disease and prevent many of the problems associated with it. As such, healthcare agencies should closely monitor the number of people living with disabilities arising from diabetes and the impacts of the disease on the lives of these people as a way of tracking the progress of the program.

As with other practice changes in the healthcare industry, the promotion of early detection would require a high budget than the current allocations from the healthcare budget. While the initial costs may be high, it is important to note that the program will have high cost-benefits in the long run as it will help the nation to limit the costs of care that are estimated to rise by more than 250% by 2030. HHS should work closely with the Office of Management of Budget (OMB) and Congress to ensure that these funds are availed on time.

As had been reported earlier, recent statistics show that 30.3 Americans of all ages and more than 322 million people worldwide have diabetes (CDC, 2017; World Health Organization, 2018). These statistics are worrying as they represent more than 12% American adults and 8.5% of the entire global adult population. Unfortunately, the same statistics show that the prevalence of diabetes almost doubled during the last three and a half decades.

According to CMS, early detection of diabetes conditions can be improved through education and awareness to help the people at risk of diabetes understand their status and the rate of diagnosis (Healthy People 2020, 2019). According to the Center for Disease Control and Prevention (2017), 30.2 million American adults, which is approximately 12.2% of all adults in the nation, had diabetes as of 2015. Unfortunately, more than 23% of this number, which is equivalent to 7.2 million Americans, were unaware of their status or had not reported their status to healthcare providers (CDC, 2017).

Consequently, there is a need to improve the quality of lives and save the government and society the costs of care in the long run. It should revolutionize the healthcare sector by reducing the prevalence of the disease, its mortality rates, and the overall impact of the disease on the patients including direct effects and indirect effects such as those arising from comorbidities. After implementing the change, healthcare organizations and agencies including the Department of Health and Human Services (HHS), the American Diabetes Association, and the World Health Organization, among others, should closely track the changes in the prevalence of the disease

Quality Measures

Healthy People 2020 has set goals the nation’s health that can be achieved by undertaking an early detection of diabetes. The goal is, therefore, to address the early signs to ensure they are managed and the disease is contained to prevent new infections. Since the national goal of the United States as envisioned in the guidelines of Health People 2020 is to improve the health condition of people living with diabetes, ensuring that the signs of diabetes are detected early and then addressed will enable the country to formulate an implementation plan (Healthy People 2020, 2018).

In 1997, diabetes had already penetrated the top ten causes of death as it occupied the sixth position. While the disease is not as common in developing nations, it is among the leading causes of death in many developed nations (Boerma, 1995). This is a clear indication that something needs to be done to reduce the effects of the disease on the lives of humans. Moreover, it is estimated that the number of annual deaths from diabetes in the US will rise by 38% between 2015 and 2030 (Rowley et al., 2017). By monitoring the changes in mortality rates and the rank of diabetes on the leading causes of death, it will be possible for HHS to identify its progress from the early detection program and potential improvements for raise the effectiveness of the program (WHO, 2017).

The standards used to implement early detection programs are provided by the American Diabetes Association (ADA) who proposes that the number of diabetes patients must be tracked and records properly kept in order to improve the early detection of diabetes among all population (ADA, 2018). This record should include demographic data, family history, and history with the disease. However, ADA believes that the number of people at risk of diabetes could be even higher, considering that the prevalence of diabetes among American children was estimated to be 0.1 million as of 2015 (ADA, 2018). Lack of awareness and diagnosis makes it difficult to treat this disease.

To evaluate the effectiveness of this quality measure, the Department of HHS provides guidelines on how the early detection programs can be implemented within the conformity of the health needs (HHS, 2017). These guidelines must be followed by all agencies to continuously monitor the changes in the percentage of Americans who are unaware of their diabetes status and those who have not reported the same as well (HHS, 2017). This proportion will help in identifying the rate of awareness and the reception of early detection health practice/program as well.

The American Academy of Family Physicians (AAFP) notes that the government can help to improve early detection of diabetes by encouraging the clinicians and healthcare professionals to involve the community leaders in the diagnosis and prevention programs at the local level (AAFP, 2018). This will help in identifying the risk exposures thus enhancing the effectiveness and quality of the early detection practice/program. Early detection could be a major boost to the management of the disease and its effects if clinicians and health professionals analyze the prevalence of diabetes.

If sufficient measures are not put in place, the percentage of people living with diabetes could rise to unmanageable rates in the foreseeable future. In 2017, the CDC estimated that 100 million Americans of all ages, including 84.1 million adults, had prediabetes as of 2015 (CDC, 2019). This figure raises concerns about the number of people who are at risk of full-blown diabetes in the foreseeable future. The early detection practice/program seeks to help such people and to ensure that members of the community lead a healthy lifestyle that will protect them from these dangers. As such, the percentage of diagnosed persons and those with prediabetes should be constantly monitored and compared against the values at the beginning of the project so as to identify the progress.

Since diabetes was ranked as one of the diseases in terms with the highest mortality rate, the United States is far from meeting the quality measure. This claim is justified by the data available from the statistics presented in this discussion. It is evident that the United Diabetes is far from meeting the quality measures of detecting the diabetes signs at an early stage and then coming up with plans to manage and contain the condition in order to curb the disease (CMS, 2018). Therefore, this is a clear indication that a program cannot be effective if it cannot focus on comorbidities as they kill way more people than the disease itself. These are some of the measures that should be closely monitored to evaluate the progress of the program and to identify any areas that may need improvement. In fact, these figures should be tracked closely at both global and national levels for best results. In a nation like the US, these figures should also be maintained at the state level as a way of developing a more appropriate intervention.

Description of the Program/Solution

The proposed solution is to promote early detection of diabetes. As has been identified, diabetes is a major concern in developed nations as it affects members of society’s quality of life and their economic stability as well. To justify this choice of solution, it has been noted that more than 23% of all Americans living with a disability are unaware of their disability status while more than three times the number of those living with the disease are already in their prediabetes stage. This is a clear indication that early detection is lacking in the US healthcare and in other healthcare systems throughout the world. Of the two types of diabetes mellitus, type two is the most prevalent. Unfortunately, this disease may take up to ten years for signs and symptoms to manifest. Unlike other common illnesses with lower incubation illnesses that allow patients to detect them early, diabetes manifests itself only in its advanced stages that may be difficult to identify. This means that early detection is the only viable solution for a nation like the US, where the risks are high.

The second involves the creation of a checklist of prediabetes. This checklist should critically define the risks that both children and adults face. According to You and Henneberg (2016), Type 2 diabetes is more commonly diagnosed at older age, which is a chronic illness that results from impaired pancreas to the point that it produces insufficient or no insulin. Since insulin is important in the regulation of blood glucose levels, type 2 diabetes forces adults to rely heavily on synthetic insulin. While the causes of this disease are unknown, it is widely believed that results from an autoimmune system (Wu et al., 2016’ You & Henneberg, 2016).

However, genetic and environmental factors may also raise risks. A prediabetes checklist for children should include these factors in addition to the diabetes status of the mother, viral infections, geographic location, race/ethnicity, autoimmune conditions, and early diets. The recommended weight of the child should also be indicated to enable the physicians to track the risks of the child. While type 2 diabetes is easily identifiable due to its aggressive signs and symptoms, such a checklist could help in better detection and intervention outcomes as those at risk will be monitored more carefully.

A checklist for adults should also be created to necessitate early detection and intervention of diabetes type 2. Research has shown that unhealthy weight, lack of physical exercise, race/ethnicity, genetics, gender, age, pregnancy, and high blood pressure, among others, raise the risks of diabetes in adults (Kyu et al., 2016; Lee et al., 2018; Tripathy, 2016). Formulating such a clear checklist should be important as it will help physicians in identifying at-risk individuals once the program has implemented as well as formulating a relevant education program during the community awareness campaign. The checklist can also be used as an element during routine checkups and during the time of admission of patients.

The third step should be the training of healthcare professionals. The success of a practice implementation project relies heavily on the collaboration of all stakeholders and the ability of each party to accomplish assigned roles. While clinicians’ primary role is to treat patients, they are also expected to advise them on best practices that could help them improve their health. A recent study reported a shortage of diabetes educators and laxity among clinicians in educating the patients about prevention and early intervention of the disease (Burk, Sherr & Lipman, 2014).

This may also explain the high rate of Americans who are unaware of their diabetes health status. This study reported that, for effectiveness in diabetes management, all healthcare professionals and educators should be knowledgeable enough and willing to share this knowledge with patients and other people in need of their support. As such, education and retraining of healthcare professionals should be a priority. In the case of nurses, for instance, it is recommended that they are retrained every two to four years to ensure that they possess up-to-date health information including the changing health issues, patient needs, new interventions, and new technologies (Kabbabe, 2016). The training for this program should be comprehensive to equip the healthcare staff with the necessary skills required for effective early detection, prevention, treatment, and management.

Training of healthcare professionals should be raising community awareness. Lack of awareness has been widely associated with the high rate of diabetes in developed nations due to the lack of knowledge of the prevailing risks and prevention strategies (Nazar, Bojerenu, Safdar & Marwat, 2015). In the same note, Burk, Sherr, and Lipman (2014) recommend increasing the number of certified diabetic educators (CDE) and advanced diabetes managers (ADB), and who should be responsible for tracking the progress of the disease at the community level and engage society. The proposed program targets healthy persons. As such, the program should focus on community awareness, as this will considerably influence its effectiveness. In the US, this practice could help save the lives of the more than 100 million people who are at their prediabetic stage. This process should not only call upon people to be screened, but it should also educate them on what they should do to remain healthy.

The next step should be to improve the program. Many programs often require continuous improvement based due to issues that arise in the course of implementation and other potential improvements that may be identified. In the section above, many of the quality measures that were discussed focused on the evaluation of the program to identify any challenges, weaknesses, and potential areas of improvement. As such, it is expected that the program may need some improvements within the next few years before the healthcare system can eventually perfect it. The program will entirely meet the needs of the people after improvements, after which the health system could consider making it a permanent practice.

The final step will be to make the program permanent. A program will often have come a long way it can be integrated into the health system. Failure to integrate it into the health system and common health practices will only lead to temporary success. There are a series of processes that need to be accomplished before this step is successfully implemented. In the first step, it was suggested that HHS liaises with OMB and Congress to secure funds for the project. However, these funds will only be allocated on a temporary basis. HHS should thus seek to have the allocation secured through a policy change. The agency may thus require to carry out an advocacy campaign which should help create an Act that guarantees an increment in budgetary allocation for the diabetes program for the entire period in which the program is expected to last. Additionally, these programs should be integrated into the healthcare practices and policies at the system and organizational level. A best practice requiring healthcare professionals to promote early detection of diabetes should be included in healthcare standards and in organizational policies. In return, this will help in absorbing the new change into the culture of the healthcare industry.

 The audience for this program are the general public, healthcare providers, families, the community, healthcare organizations, and other stakeholders in the healthcare sector. These audience will be provided with the relevant knowledge, skills, and competence through training, sensitization, and civic education to help them understand the need to participate in the early detection and prevention program. They will also be trained on the effective methods and appropriate intervention measures to ensure that the programs is effective in ensuring that symptoms of diabetes type 2 among adults are detected at an early stage, treated, managed, and prevented from further spreading, thereby reducing the prevalence of the disease.

The venue of the early detection and prevention program will be in primary care setting to increase early detection of type two diabetes. It will therefore be presented in all public areas, all healthcare organization and centers, all social places and gatherings, as well as private entities and public agencies. These venues are selected for the purpose of implementing this program because they would be more accessible to the target audience, thereby facilitate an effective and convenient implementation of the program.

Theoretical Framework

There are many theories and models that relate to the selected program and its implementation. One of these is the Wisconsin Model of Community Education. This is a model that was proposed in the early 1990s, and that provides a list of principles that guide community education. As explained by Wisconsin Department of Public Education (n.d), community education should promote self-determination, self-help, and leadership, localization, optimization of resources, inclusiveness, integrated delivery of services, and lifelong learning, among others. Since community awareness is one of the key concepts of the proposed practice change, Wisconsin Model of Community Education should is highly applicable in the implementation of early detection as a solution for diabetes.

Lack of awareness has been identified as a key challenge in diabetes management. As has been seen in the above analysis, one in three Americans is at risk of getting diabetes. This is not to mention the millions who are unaware that they are living with diabetes. Based on the principles of the Wisconsin Model of Community Education, HHS should localize community education programs with the use of local CDEs and healthcare providers. While the US is a highly multicultural society, the distribution of diabetes and the risk factors are not uniform. HHS should consider formulating community education manuals for each state or local regions by first studying the needs of the distinct communities and the risks that they experience. This process will help in raising the relevance of these community education manuals while also raising the effectiveness of the entire program. Additionally, this program should not be temporary. As had been recommended earlier, HHS should work with Congress, OMB, and other agencies to ensure that the program becomes permanent by securing long-term sources of funds, ensuring sustainability, and formulating policies that integrate the practice into the healthcare sector.

Health promotion is an integral part of early detection. This is a concept that is widely supported by Nola Pender’s Health Promotion Model. In this model, members of society are perceived as individuals who can control their behavior, improve themselves, and sustain change in the long run under the guidance of healthcare professionals (Khodaveisi, Omidi, Farokhi & Soltanian, 2017). The real success of the proposed program lies on its perception by the community and the willingness of both the patients and the healthy persons to embrace it. As per the Health Promotion Model, healthcare professionals and the health system need to understand the need to empower society as a way of improving healthcare outcomes. In fact, community education and advice from healthcare professionals are sufficient to initiate a behavior change among the members of society. Eventually, the program will achieve success by creating a culture where people take control of their health decisions by seeking early detection and intervention without the influence of CDEs and other community educators.

HHS and other agencies can easily succeed in creating a culture of early detection among both patients and physicians. This is a concept that widely features in Bandura’s Social Cognitive Theory. This theory holds that people can learn from one another through observation, imitation, and modeling of their behavior to the point that the acquired behaviors become a routine (Stacey, James, Chapman, Courneya & Lubans, 2017). With regard to diabetes, it means that the community educators and healthcare professionals will not require to raise awareness to the patients forever. Rather, the community will only need to be guided for some time before the new changes become a routine. In fact, future generations can easily learn from the current generation that will have undergone an extensive education process. Social Cognitive Theory has already been demonstrated to work for patients and at-risk communities whose health needs can be addressed through physical activity and nutritional behavior change interventions (Stacey et al., 2017). In this case, positive behavior, including regular exercise and maintaining a healthy weight, can be easily achieved in future generations simply by focusing on the current one.

Humans adopt poor health practices due to a lack of knowledge of the benefits of alternatives. When they are aware of the benefits of a particular behavior, changing becomes easy. These are assertions Didarloo, Shojaeizadeh, Gharaaghaji Asl, Niknami and Khorami (2014) while exploring the psychosocial correlates of diabetic patients using the Theory of Reasoned Action/Planned Behavior. This theory holds that behaviors are linked to beliefs. This theory could be helpful in understanding patients and other individual’s self-control. One of the worrying facts in the healthcare industry is that diabetes and its risk factors are more common than initially thought (Wu, YDing, Tanaka & Zhang, 2014). In addition to ignorance, the concept of unawareness has contributed significantly to the lack of stakeholders such as the health system, healthcare professionals, and patients upholding early detection and intervention. For the past few decades, the government can also be blamed for its laxity owing to the fact that the prevalence of diabetes has continued to rise despite the existence of means of effectively managing it. If early detection and intervention could have been enhanced and integrated into the healthcare industry decades ago, it could have been possible to reduce the mortality rate that results both directly and indirectly from diabetes.

Literature Review

Classification and Diagnosis of Diabetes

According to the (ADA, 2015), diabetes can be grouped into four categories. Type 1 Diabetes results from the destruction of the β-cells. Type 2 Diabetes which results from inadequate insulin secretion. Gestational diabetes mellitus (GDM) is the third category which can be occurs among expectant mothers during the second or third trimester of pregnancy. The fourth category of diabetes has specific types of diabetes due to other causes. An example of such special type diabetes is monogenic diabetes syndrome.

According to the America Diabetes Association (2015), a patient is assigned one of the diabetic categories based on the present circumstances while undertaking a diagnosis. It is challenging to place patients in either type 1 or 2 of diabetes due to the varying clinical presentation and progression. The traditional paradigm explains that type 2 diabetes occurs in adults while type 1 diabetes only occurs in children, though some overlaps have been shown to occur. In this case, the American Diabetes Association (2015) reports that polyuria is hallmark symptoms of type 1 diabetes in children who occasionally have diabetic ketoacidosis (DKA). Diabetic type 2 patients also present diabetic ketoacidosis (DKA).

Diabetes can be diagnosed based on A1C or glycosylated hemoglobin test criteria and the fasting plasma glucose (FPG) testing.  These tests are used to screen and diagnose diabetes.  While performing the A1C test, the POC assay is recommended for diagnostic purposes. A1C criteria are convenient to use and show pre-analytical stability. However, A1C is expensive to purchase and is not easily accessible. A1C testing is only accessible to some developed parts of the world. It also shows an incomplete correlation between the average glucose in some individuals.

The use of A1C to diagnose diabetes is based on variables such as age, race, and hemoglobinopathies (America Diabetes Association, 2015). According to age, A1C is suited to diagnose diabetes in adult populations. It is still unclear whether A1C can be used in children and adolescents. A1C levels vary with ethnicity. For instance, African Americans may have higher A1C levels than the non-Hispanic whites despite similar fasting and post-glucose levels. Hemoglobinopathies presence offers difficulties while interpreting A1C levels. An A1C assay without reference should be used on individuals with sickle cell anemia. During pregnancy, blood transfusion, and erythropoietin therapy, it is recommended that glucose criteria be used to diagnose diabetes.

Fasting Plasma Glucose (FPG) can also be used to diagnose diabetes (America Diabetes Association, 2015). In contrast to AIC, FPG can diagnose more people with diabetes.  FPG is easy to use and also its accessibility is widespread for the purpose of testing diabetes. A new test can be carried out while performing clinical diagnosis for confirmation purposes. When two different tests on the same diabetic patient produce discordant results, it is recommended that the test above the diagnostic cut point be repeated.  A repeat of the test on the same patient can further be done in 3-6 months.

Early Detection and Treatment of Type 2 Diabetes

The Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe) carried out a study on early detection and treatment of Type 2 diabetes (Herman, Ye, Griffin, Simmons … Wareham, 2015).  The study enrolled adults aged between 40-69 years from 342 general practices. The adults enrolled had no cases of diabetes. These were sampled from the U.K, Denmark, and the Netherlands. ADDITION-Europe’s main aim was to estimate the benefits of performing screening and early treatment to type 2 diabetes.  Additionally, the study aimed at ascertaining whether early and intensive treatment of cardiovascular risk factors could reduce the composite cardiovascular outcome of stroke, amputation, and cardiovascular death with routine care.

From the study, it was found that primary-care of type 2 diabetes, when done in a stepwise manner, would turn out feasible (Herman et al., 2015). This means that the individuals who were detected by screening were at high cardiovascular risk. The empirical results of the trial were correctly predicted by the computer simulation model which was programmed with the demographic variables and clinical characteristics of the study population. From the results obtained by ADDITION-Europe, it was ascertained that the simulated absolute risk reduction was greater at 5 years. Comparatively, the simulated absolute risk reductions were better than the 3 or 6 years delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors.

ADDITION-Europe also found that the benefits of performing a stepwise based screening and treatment accrue as a result of the hastening of the treatment of cardiovascular risk factors (Herman et al., 2015). The high quality of routine diabetes care delivered in the general practice explains how the small differences shown by the intensity of cardiovascular risk factors are less important.

ADDITION-Europe concluded that there are major benefits likely to be accrued from early diagnosis and treatment of cardiovascular risk factors in type 2 diabetes. Screening is essential in reducing Type 2 diabetes. Screening reduces the time between diabetes onset and clinical diagnosis where multi-factorial treatment is necessary (Herman et al., 2015). It has not been possible to provide direct observation of the health benefits of screening. Researchers have tried using simulation modeling to assess potential benefits though they are faced with limited precision of the estimates of the benefits of early intensive treatment. The benefits have been reported from a randomized controlled trial which has allowed better quantification of the potential benefits of screening.

Detection and Management of Diabetes during Pregnancy in Low Resource Settings

There is a growing prevalence of diabetes in women in developing countries. Changes in lifestyle have attributed to the increase in cases of diabetes. However, diabetes affecting women during pregnancy is not a major problem. The level of attention to gestational diabetes (GDM) is still low despite the complication associated with GDM such as prolonged labor and preeclampsia. Studies have shown that the prevalence rates to GDM stand between 6% and 14% in East and West Africa while in South Asia the prevalence rates stand at 13% and 18% (Utz, Delamou, Belaid & De Brouwere, 2016). Treating mothers with GDM increases maternal outcomes while reducing perinatal complications. When treatments are done in time, the potential complications that would have arisen are reduced.

The research was done to ascertain the number of publications addressing GDM yielded 973 publications (Utz et al., 2016). Duplicate papers were removed and only 800 publications remained. Only 23 papers addressed GDM. Eight of the publications originated from Sub-Saharan Africa and one from South Africa. The aspect of clinical management to women with GDM was described in 19 articles only while information on screening was provided in 16 publications. It was noted that the earliest publication addressing diabetes in women was published in 1977 while the latest article was published in 2015.

Research done on the publications to detect and manage GDM in low resource settings found out that a majority of patients who are diagnosed with diabetes during pregnancy are referred and treated through higher-level services (Utz et al., 2016). They are then attended to by specialists and multidisciplinary teams available. It was also found that screening is not performed routinely in developing countries but where screening is applied, the approaches are not uniform. The modes of screening vary from one country to the other hence a need for uniform practice standards to the healthcare providers. Nutritional therapy and anti-diabetic medication are some of the therapeutic options that were provided for pregnant women diagnosed with GDM. One of the reasons as to why diabetes is poorly controlled during pregnancy is the potential anxiety by healthcare providers to administer insulin based on a fear of hypoglycemia.

Research on the publication found out that insulin was administered on pregnant women whose diabetes was not controlled by diet alone (Utz et al., 2016). The research was done on the publications also shows that patients were initially admitted for nutritional education and close glucose monitoring through the trend change to ambulatory management (Utz et al., 2016). Pregnant women with diabetes were also advised to take bed rest though the current evidence is missing. Improved monitoring and hospitalization for treatment initiation can be considered in a low-resource setting and where health services are not secured.

The study had some limitations since it only focused on the descriptive approach to the diversity of screening and management procedures that encompassed diabetic mothers during pregnancy (Utz et al., 2016). The identified studies only reflected individual practices in specific hospitals. Some of the publications sampled date back to 40 years. Practices have changed over time hence in the coming years the study would not reflect the actual situation on the ground anymore. Furthermore, the study did not limit its focus on gestational diabetes practices only since most of the publications could not distinguish between the pre-existing categories of diabetes and GDM in their publications.

Self-monitoring of glucose was not considered a feasible option in most of the publications. This was due to the difficulties for patients to buy the necessary equipment. Some publications had reported that ambulatory glucose controls were only performed weakly to fortnightly. Other factors also posed as challenges; women expressed the feeling of not being comfortable to self-monitor and interpret blood sugar results. This has necessitated women to return to the hospitals for monitoring. An alternative should be created to ensure regular monitoring with close proximity to women with diabetes. Support through peers or care providers based within the communities should also be included in addressing pregnant women with diabetes.

Research on the different publications found various challenges had been pointed out in the articles (Utz et al., 2016). There were challenges in the availability of insulin in the low resource setting. Pregnant women could not access insulin easily. Additionally, there were challenges concerning storage of insulin. There were also challenges to the accessibility of regular follow-up as well as inadequate self-testing kits for blood glucose to women with GDM.

References

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American Diabetes Association. (2015). Classification and Diagnosis of Diabetes. Diabetes Care, 38(1), 8-16.

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Didarloo, A., Shojaeizadeh, D., Gharaaghaji Asl, R., Niknami, S., & Khorami, A. (2014). Psychosocial correlates of dietary behaviour in type 2 diabetic women, using a behaviour change theory. Journal of health, population, and nutrition, 32(2), 335–341.

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Appendices

Appendix A: Leading causes of deaths in 2016

Source: Heron & Anderson (2018)

Appendix B: Leading causes of death among older adults in 2016

Source: Heron & Anderson (2018)