Multidisciplinary Diabetes Care Essay

Paper Instructions

1) There should be an overview of the size of the problem and the current body of knowledge regarding aetiology, diagnosis, prognosis and therapy of these conditions as relevant to the topic. Multidisciplinary Diabetes Care Essay

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While the dissertation topic is the main focus of discussion, there should be brief mentioning of other aspects for introduction and conclusion purposes.

2) You should aim to review critically current evidence relating to these topics which may lead to changes in clinical practice and comment areas of controversies which require further evidence to improve understanding. Multidisciplinary Diabetes Care Essay

3) To improve clarity of presentation, students should organize their dissertation under headings and subheadings and use diagrams, tables and flowcharts whenever appropriate. -Citing of references is required.

References in single line spacing. Please use the Vancouver style to cite references: Author (Jones, JM …..cite all authors, if more than 12 authors, cite the first 6 authors followed by et al), title, journal, year, volume, page range

• The word count should also be indicated on the last page of the dissertation

The Nursing Management of Type 2 Diabetes Mellitus
Type 2 diabetes mellitus – referred to throughout this paper as ‘Type 2 diabetes’ – is a
chronic condition involving the insufficient production of insulin (Robbins, Shaw and Lewis,
2007). It occurs due to the exhaustion of insulin-producing β-cells in the pancreas (Robbins,
Shaw and Lewis, 2007). Insulin is a hormone which has the effect of maintaining a stable Multidisciplinary Diabetes Care Essay
blood glucose level, within the range of approximately 3.9 to 6.7mMol/L (Robbins, Shaw and
Lewis, 2007). Type 2 diabetes causes hyperglycaemia, or excessive blood glucose (Robbins,
Shaw and Lewis, 2007; National Institute for Heath and Care Excellence [NICE], 2015a).
When it is poorly controlled, hyperglycaemia results in a variety of complications,
underpinned by micro- and macro-vascular disease (Goldstein and Muller-Wieland, 2007;
World Health Organisation [WHO], 2018).
Type 2 diabetes is common in the United Kingdom (UK); indeed, in 2017 there were nearly
3.7 million people diagnosed with Type 2 diabetes in the UK (Diabetes UK, 2017). Diabetes
UK (2017), the peak national body for diabetes in the UK, estimates that there are an
additional 1 million people in the UK who have undiagnosed Type 2 diabetes. Because of the
prevalence of Type 2 diabetes, nurses in every clinical setting are likely to care for patients
with this condition; it is therefore essential that nurses understand the correct nursing
management of Type 2 diabetes. This paper critically analyses the nursing management of
Type 2 diabetes.
The fundamental goal of Type 2 diabetes management is to achieve adequate glycaemic
control, measured by blood concentration of glycosylated haemoglobin (HbA1c).
Glycosylated haemoglobin is an objective indicator of long-term glycaemic control and,
subsequently, of the risk of a person’s Type 2 diabetes progressing, and their development
of diabetes-related complications (Zhang et al., 2012). Research suggests that although the
holistic, multidisciplinary management of a person with Type 2 diabetes is important, nurses
have a key role in Type 2 diabetes management, and particularly in relation to supporting a
person with Type 2 diabetes to achieve long-term glycaemic control (Richardson et al.,
2014). Multidisciplinary Diabetes Care Essay
There is a large volume of evidence about the effective nursing management of Type 2
diabetes. Indeed, the Royal College of Nursing (RCN) identify no fewer than eleven discrete
roles for nurses in relation to the nursing management of Type 2 diabetes. Ultimately,
however, the literature advises nurses to follow the recommendations in the most current
NICE guidelines (Nair, 2007). For this reason, the strategies discussed here are based on the
NICE (2015a) Type 2 Diabetes in Adults: Management guideline, the primary guideline for
practice in the UK.
Strategy #1 – Patient education: The NICE (2015a) guideline recommends that all patients
with Type 2 diabetes are offered structured, evidence-based and resource-effective education
to enable their self-management of the condition. This education must focus on dietary advice
(refer to Strategy #2 following), and also related lifestyle changes such as exercise for weight
control (Lawrence, Conrad and Moore, 2012). A recent systematic review and meta-analysis
concluded that nurse-led education for people with diabetes can improve glycaemic control to
a statistically-significant degree, and that this improvement is often sustained over time
(Tshiananga et al., 2011). However, currently there is a paucity of conclusive evidence about
the most effective design for patient education for Type 2 diabetes – including in terms of
frequency and timing, delivery strategies and content (Tshiananga et al., 2011) – and nurses
should therefore be guided by local policies and / or those of their healthcare organisation.
Strategy #2 – Dietary advice: Patient education, as outlined in Strategy #1 above, must focus
on dietary advice, as dietary intake is the fundamental factor in the development and
management of Type 2 diabetes (Ley et al., 2014). The NICE (2015a) guideline emphasises
the importance of providing ongoing, individualised dietary advice to people with Type 2
diabetes, particularly in relation to the intake of high fibre, low glycaemic index (GI)
carbohydrates. In addition to the types of foods people with Type 2 diabetes consume, nurses
should also provide advice about correct eating patterns to achieve glycaemic control:
specifically, consuming three balanced meals plus appropriate between-meal snacks each day Multidisciplinary Diabetes Care Essay
(Lawrence, Conrad and Moore, 2012). Although nurses have “expertise and responsibility” in
relation to dietary intake (Xu et al., 2017), they are required to refer to a dietician or
nutritionist if a patient’s needs are beyond their scope.
Strategy #3 – Blood pressure management: As noted, people with Type 2 diabetes are at
increased risk of vascular disease (Goldstein and Muller-Wieland, 2007; WHO, 2018); this
may cause new, or complicate existing, hypertension. Thus, the NICE (2015a) guideline
recommends the monitoring of blood pressure at least every 2 months in people with Type 2
diabetes and, where necessary, its management using anti-hypertensive medication/s. The
NICE (2015a) guideline sets specific blood pressure targets for people with Type 2 diabetes:
<140/80mmHg, and <130/80mmHg for people with vascular disease. However, there is a
growing body of literature which challenges the use of universal blood pressure targets in
Type 2 diabetes management because of the lack of supporting evidence and, thus, their
inconsistent use (Grossman and Grossman, 2017; Kai, 2017). Individualised targets may be
more appropriate.
Strategy #4 – Drug treatment: Where the above strategies fail to enable a person with Type 2
diabetes to achieve adequate glycaemic control, the NICE (2015a) guideline recommends that
drug therapy is commenced. The first-line anti-hyperglycaemic medication recommended for
use in Type 2 diabetes in the UK is metformin, which prevents gluconeogenesis, or the
production of excess glucose by the liver (Downis, 2015). Metformin may be combined with
one or more of a variety of second-line medications, including (but not limited to)
sulphonylureas or thiazolidinediones, and, if the condition continues to progress, insulin
(Downis, 2015). Unless they are independent prescribers competent in relation to medication
for the management of Type 2 diabetes (RCN, 2018b), the nurse’s role in the use of
medications for Type 2 diabetes management may be limited to tasks involving education
and monitoring, as described.

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As noted earlier, the fundamental goal of Type 2 diabetes management is to achieve adequate
glycaemic control. However, perhaps surprisingly, the NICE (2015a) guideline recommends Multidisciplinary Diabetes Care Essay
that nurses do not encourage people with Type 2 diabetes to routinely self-monitor their
blood glucose levels. A meta-analysis undertaken to inform the NICE (2015a) guideline
provides the reasons for this recommendation: specifically, although self-monitoring of blood
glucose levels improves glycaemic control in people with Type 2 diabetes (when measured
by glycosylated haemoglobin, as described earlier), this improvement is insignificant and
excessively costly to achieve (NICE, 2015b). Instead of regular self-monitoring, therefore,
the NICE (2015a) guideline recommends individualised HbA1c targets and at least bi-annual,
formal HbA1c measurements.
Strategy #5 – Managing complications: As noted earlier, people with Type 2 diabetes are at
increased risk of a variety of complications, underpinned by vascular disease (Goldstein and
Muller-Wieland, 2007; WHO, 2018). The complications of Type 2 diabetes, even if they are
acute, often cause no symptoms; however, if they are not rapidly identified and treated, can
lead to a hyperosmolar hyperglycaemic state and serious morbidity and / or rapid mortality
(Downis, 2015). The NICE (2015a) guideline therefore identifies the management of
complications as a key nursing role. Nurses must be aware that patients with Type 2 diabetes-
related complications may present with these as an overt primary complaint, or as an
underlying secondary complaint. In conducting their standard clinical assessments, nurses
must be adept at recognising and interpreting the often subtle signs of diabetes complications
(Alfadda and Abdulrahman, 2006). Multidisciplinary Diabetes Care Essay
In the majority of cases, the development of Type 2 diabetes is underpinned by modifiable
lifestyle factors and it is, therefore, an entirely preventable condition (Jermendy, 2005). In
addition to managing Type 2 diabetes, nurses have a fundamentally important role in the
prevention of Type 2 diabetes in at-risk people (Downis, 2015). Indeed, the RCN (2018a)
identifies education for prevention to be the nurse’s primary role in relation to Type 2
diabetes, secondary to management. Although nurse-led strategies to prevent Type 2 diabetes
are beyond the scope of this paper, they are similar to the simple management strategies, such
as education and monitoring (Downis, 2015), described above. By applying these strategies
with people at risk of Type 2 diabetes, nurses can contribute to reducing the diabetes burden. Multidisciplinary Diabetes Care Essay

Type 2 diabetes mellitus is a growing disease in the United States. When developing a care management plan for new diabetic patient, several areas of education and resources should be considered. The purpose of this paper is to describe a hypothetical care plan for a newly diagnosed diabetic, including case management model used, initial and ongoing educational needs, and data collection and evaluation. Multidisciplinary Diabetes Care Essay

Case Management Model

Jane Doe has been diagnosed with type 2 diabetes postpartum. In order to provide continuous high quality care across the continuum, a diabetic case management plan will be needed. The plan will be the center of a diabetic case management team that adheres to a specific set of predetermined protocols and clinical care pathways (Cohen & Cesta, 2005). Members of the team will include a physician, nurse case manager, with the potential to consult a dietician, diabetic educator, and a social worker. This nonunit based multidisciplinary team approach ensures Jane Doe will receive care from experts in diabetes throughout her hospital stay as well as post discharge. The nurse case manager, along with the physician, will be responsible for developing an individualized plan of care. In addition, the nurse case manager will coordinate the recommendations from any additional team members that are consulted in a timely manner (Cohen & Cesta, 2005). The ultimate key to appropriate disease management is patient education; this is the tool that will empower Jane Doe to manage her diabetes successfully and to live a healthy, productive life. Multidisciplinary Diabetes Care Essay

Plan for Education

Initial

As with any new diagnosis, information about the disease process and treatment can be overwhelming for the patient…Multidisciplinary Diabetes Care Essay