Public Health and Type-2 Diabetes

Introduction

The essay is going to focus on type-2 diabetes as the health condition and for this purpose; health and well-being related to type-2 diabetes are to be discussed. The determinant of health and the national policy regarding type-2 diabetes is to be analysed to determine the way they are used at the local level to assist individually. Moreover, role of the nurse in relation to the NMC code of Practice to be played for managing type- diabetes is to be discussed, highlighting the importance of healthcare dissertation help in understanding these complexities.

The type-2 diabetes is a chronic health condition caused by inability of the body cells to respond to insulin to use blood sugar as energy for the body (Sharma et al. 2016). In the UK, 6% of the population that is 1 in 16 individuals are reported to be suffering from diagnosed and undiagnosed diabetes (diabetes.co.uk, 2019). In 2019, nearly 3.9 million UK people are diagnosed with diabetes compared to 2018 where 3.8 million UK people are informed to be suffering from the illness. There are no existing figures that indicate number of type-2 diabetes patients compared to other forms of diabetes but the Diabetes UK organisation reports that in the UK population majority of diabetes cases is type-2 diabetes (diabetes.org.uk, 2019a). These figures indicate that type-2 diabetes is one of the major health condition faced by the UK population which is going to create hindered impact on their health.

The prediction mentions by 2030 total number of UK people affected by diabetes (majority will be type-2 diabetes) will be 9.3% of the entire population (express.co.uk, 2018). This indicates that people in the UK suffering from type-2 diabetes is predicted to grow exponentially. Thus, discussion regarding the topic is essential so that the cause and impact of the disease can be identified to determine the strategies to be taken for avoiding its exponential growth as a major health issue in the country.

Discussing public health, well-being and disability

According to the World Health Organisation (WHO), the health and well-being is referred to physiological, psychological and social well-being of living a productive life. It is not only the absence of any disease but also ability of individuals to recover and manage their health to overcome illness and its associated problems (Mohammed and Ghebreyesus, 2018). As mentioned by Eryd et al. (2016), the increased blood sugar level due to type-2 diabetes damages the nerves and blood vessels which lead to greater constriction of the blood vessels. It causes less amount of oxygenated blood to be transported to the heart and rest of the body making the person suffer cardiovascular issues as physical health problem. As argued by Ryan et al. (2018), slower movement of blood as a result of damaged blood vessels by high blood sugar concentration in type-2 diabetes leads to slower delivery of nutrients over the body. This leads to raise hindered wound healing capability as physical issue among the type-2 diabetic individuals that make the person to suffer leg ulcer and skin problems.

The high blood sugar concentration in type-2 diabetes causes damage to the nerves which sends signals from hands and legs leading the individuals suffering from the disease to face diabetic neuropathy as physical health issues (Alkhatatbeh and Abdul-Razzak, 2019). In contrast, the fluctuations and high blood sugar level in the type-2 diabetic patients psychologically affect them to face sudden alteration in mood and other emotional symptoms such as troubled thinking, fatigue, anxiety and depression (Feng and Astell-Burt, 2017). Moreover, presence of type-2 diabetes as a long-term condition where the patient continuously suffers and have to access medication regarding the disease develop distress in them regarding the disease (Garcia et al. 2017). This causes expression of mental issues such as depression and stress by the patients which adversely affects their health.

The people suffering from type-2 diabetes develop social issues such as inability to bear healthcare cost and maintain employment. This is because the health condition leads people to develop hindered health condition for which they have to invest increased amount of money for long-term to cope with the issues (Feng and Astell-Burt, 2017). Thus, public health and well-being regarding type-2 diabetes is leading individuals suffering from the disease to be mentally, socially and physically stable as well as has the ability to recover the associated problems regarding the illness. According to the Equality Act 2010, disability is referred to any physical or mental impairment which has substantial long-term adverse impact on the ability of an individual to execute everyday activities (legislation.gov.uk, 2010). Type-2 diabetes in the UK in certain condition is regarded as a disability as in adversely affected individuals it is seen to cause hindered physical impairment for long-term which makes the people unable to lead a normal life (thorntons-law.co.uk, 2017).

Determinants of Health

The social status and income determinant of health is seen to act as major health determinant which influences health inequality related to type-2 diabetes in the UK. This is evident as poorest individuals in the UK who belong from lower social status and lives in deprived areas are found to be 2.5 times more likely to face type-2 diabetes at any age compared to individuals living in least deprived areas and of higher social class (diabetes.org.uk, 2018b). This is because people in deprived areas and of lower social class lack access to proper services and awareness regarding type-2 diabetes in the UK. Moreover, their lower income makes them unable to bear continuing costs required for managing type-2 diabetes in long-term condition in turn leading to suffer adversely from the disease. In contrast, lower health education among people leads to inequality in prevalence of type-2 diabetes. This is because without proper awareness and education regarding causes and way to avoid type-2 diabetes leads people to maintain hindered lifestyle which contributes to the increased impact of type-2 diabetes on health of individuals (Thomas et al. 2019).

The lifestyle condition is seen to create health inequality regarding type-2 diabetes. This is because people who are involved in taking increased amount of sugar and fatty foods along with maintain sedentary lifestyle compared to healthy lifestyle face adverse effects of type-2 diabetes (Neuenschwander et al. 2019). It is evident from the study Lau et al. (2018) where researchers concluded that high amount of fatty foods in diet increases the fatty acids that hinder insulin-producing cells to stop stimulating production of Foxa1 and Hnf1A protein. These proteins are responsible to switch formation of GnT-4a protein and glucose-sensing protein in the cell surface to use sugar in the blood to be used as energy to maintain normal glucose level. (Refer to Appendix). In comparison, the study of Ding et al. (2018) mentions that genetic condition leads to create inequality for prevalence of type-2 diabetes among individuals. This is because people with damaged TCF7L2, CAPN10, ABCC8 and other genes which promote insulin and glucose production are seen to develop type-2 diabetes compared to normal individuals. The mutated or damaged genes are found to be passed from the parental generation making type-2 diabetes to be hereditary disease (Welter et al. 2016).

Discussing the national health policy related to type-2 diabetes

The understanding regarding the health behaviour of the people is important for controlling prevalence of disease and developing health policy regarding it because behaviour informs the way a person or people manages or conducts themselves. This understanding informs the parts to be focussed in the health policy so that such acts and conducts related to lifestyle are changed to thwart the disease from occurring among the population (Shan et al. 2018). In case of type-2 diabetes, it is seen that sedentary behaviour of the people along with improper diet and improper continuation of medications leads to uncontrolled type-2 diabetes among people (Hagiwara et al. 2018). Thus, focussing on strategies to ensure better behaviour and lifestyle of the people would help in controlling the disease expression among population as the key causes of type-2 diabetes can be tackled.

On the basis of understanding of health behaviour of people, the NHS Diabetes Prevention Programme (NHS DPP) which is a joint commissioning public health policy is developed by the Diabetes UK, NHS England and Public Health England. The NHS DPP ensures to deliver behavioural intervention at a large scale for individuals who are at risk of facing type-2 diabetes. In the policy, the key aim is to lower long-term condition and risky health impact of type-2 diabetes along with reduce health inequalities related to the disease (gov.uk, 2018). The health policy program developed by the NHS and others has the goal of allowing people achieve healthy weight, develop proper recommendation of diet and achieve effective physical activity information that is to be followed in daily life for controlling type-2 diabetes (gov.uk, 2018). This is because healthy weight and effective activity behaviour lead individuals to ensure proper use of glucose in the body avoiding its accumulation in raising the blood sugar level and it can be achieved through proper dietary intake.

In Staffordshire, England, the Health and Well-being Board is seen to have joined the third drive of NHS DPP to implement behaviour change policy suggested at the national in the area for promoting health of type-2 diabetes patients (moderngov.staffordshire.gov.uk, 2018). This is evident as the Health and Well-being Board in Staffordshire is seen to have developed weight management plan, along with willing to provide recommended diet chart for type-2 diabetic patients in the area to promote their health. Moreover, based on the NHS DPP they have understood the importance of physical activity in relation to type-2 diabetes and have performed survey to identify to what extent the physical activity services are to be promoted so that health and well-being of the people at risk of type-2 diabetes in the area can be ensured (moderngov.staffordshire.gov.uk, 2015). In addition, the locality of Leicester, Rutland and Leicestershire are also seen to follow the policy mentioned in the NHS DPP. This is evident as following the national policy program they are accordingly taking similar steps like weight management, intake of proper diet and promotion of physical activity to offer opportunity to the people in the locality to overcome risk of type-2 diabetes (leicesterdiabetescentre.org.uk, 2019).

Discussing the role of nurse

The section 3 in NMC Code of Practice informs that it is the duty of the nurses to ensure physical, mental and social needs of the patients are proper met through the care services. This is to be achieved by acting in partnership with patients and offering them advocacy of care (NMC, 2018). Thus, the codes inform that the nurses have the role for type-2 diabetes patient to develop partnership with them to understand their needs and offer them advocacy in making shared decision regarding their care to ensure satisfactory care that promotes health and well-being. The section 6 of NMC Code of Practice informs nurses are to practice in line with the most appropriate evidence available to deliver care (NMC, 2018). This indicates that nurses for treating type-2 diabetes patients have the role to identify and use best evidence available for treatment of the disease to ensure person-centred care is provided that resolves the individual’s health complication. For instance, the nurses are to ensure what dosage of Metformin (diabetic medication recommended by NHS) is to be used for treatment if specific type-2 diabetes based on their health condition to ensure normalising their blood sugar level (NHS, 2018c).

The section 7 of NMC Code of Practice informs that effective communication is to be established by nurses with patients and colleagues (NMC, 2018). This is because nurses by communicating with patients compassionately and politely would be able to determine their needs and inform them regarding importance of care services to be provided to make them comply with care. It is evident as communication with patients helps to resolve confusion and misunderstanding as well as leads the nurses to develop proper rapport with the patients (NMC, 2018). Thus, nurses in caring for type-2 diabetic patients are to develop communication with them to make them understand importance of care services being provided to them and make them comply with care. In NMC Code of Practice, section 8 informs nurses to work collaboratively and section 9 informs nurses are to share skills and knowledge for improving the care for service users (NMC, 2018). This is required for treatment of type-2 diabetes patients as the nurses through collaborative approach and sharing of skills would be able to implement innovative care services that can provide improved and quicker management and control of the condition (Furler et al.. 2017).

Conclusion

The above discussion informs that type-2 diabetes is growing at an exponential rate in the UK and effective actions are to be taken to control it so that health well-being of individuals can be promoted. In this purpose, the health policy in NHS DPP is found to be abided at the local level in Staffordshire, Leicester and others to ensure controlling type-2 diabetes among individuals. The section 3, 6, 7 and 8 of NMC Code of Practice is followed for offering effective nursing intervention for managing people with type-2 diabetes. Thus, it is suggested the NMC code and NHS DPP is to be followed while managing type-2 diabetes in the UK.

References

Alkhatatbeh, M. and Abdul-Razzak, K.K., 2019. Neuropathic pain is not associated with serum vitamin D but is associated with female gender in patients with type 2 diabetes mellitus. BMJ Open Diabetes Research and Care, 7(1), p.e000690.

Ding, W., Xu, L., Zhang, L., Han, Z., Jiang, Q., Wang, Z. and Jin, S., 2018. Meta-analysis of association between TCF7L2 polymorphism rs7903146 and type 2 diabetes mellitus. BMC medical genetics, 19(1), p.38.

Eryd, S.A., Gudbjörnsdottir, S., Manhem, K., Rosengren, A., Svensson, A.M., Miftaraj, M., Franzén, S. and Björck, S., 2016. Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study. bmj, 354, p.i4070.

Feng, X. and Astell-Burt, T., 2017. Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a longitudinal study. BMJ Open Diabetes Research and Care, 5(1), p.e000198.

Furler, J., O’Neal, D., Speight, J., Manski-Nankervis, J.A., Gorelik, A., Holmes-Truscott, E., Ginnivan, L., Young, D., Best, J., Patterson, E. and Liew, D., 2017. Supporting insulin initiation in type 2 diabetes in primary care: results of the Stepping Up pragmatic cluster randomised controlled clinical trial. bmj, 356, p.j783.

Garcia, J.M., Cox, D. and Rice, D.J., 2017. Association of physiological and psychological health outcomes with physical activity and sedentary behavior in adults with type 2 diabetes. BMJ Open Diabetes Research and Care, 5(1), p.e000306.

Hagiwara, N., Mezuk, B., Lafata, J.E., Vrana, S.R. and Fetters, M.D., 2018. Study protocol for investigating physician communication behaviours that link physician implicit racial bias and patient outcomes in Black patients with type 2 diabetes using an exploratory sequential mixed methods design. BMJ open, 8(10), p.e022623.

Lau, H.H., Ng, N.H.J., Loo, L.S.W., Jasmen, J.B. and Teo, A.K.K., 2018. The molecular functions of hepatocyte nuclear factors–In and beyond the liver. Journal of hepatology, 68(5), pp.1033-1048.

Mohammed, A.J. and Ghebreyesus, T.A., 2018. Healthy living, well-being and the sustainable development goals. Bulletin of the World Health Organization, 96(9), p.590.

Neuenschwander, M., Ballon, A., Weber, K.S., Norat, T., Aune, D., Schwingshackl, L. and Schlesinger, S., 2019. Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. bmj, 366, p.l2368.

Ryan, A., Heath, S. and Cook, P., 2018. Managing dyslipidaemia for the primary prevention of cardiovascular disease. Bmj, 360, p.k946.

Shan, Z., Li, Y., Zong, G., Guo, Y., Li, J., Manson, J.E., Hu, F.B., Willett, W.C., Schernhammer, E.S. and Bhupathiraju, S.N., 2018. Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses. bmj, 363.

Sharma, M., Nazareth, I. and Petersen, I., 2016. Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study. BMJ open, 6(1), p.e010210.

Thomas, F., Thomas, C., Hooper, L., Rosenberg, G., Vohra, J. and Bauld, L., 2019. Area deprivation, screen time and consumption of food and drink high in fat salt and sugar (HFSS) in young people: results from a cross-sectional study in the UK. BMJ open, 9(6), p.e027333.

Welter, M., Frigeri, H.R. and Souza, E.M., 2016. Polymorphisms in the Fat Mass and Obesity Associated (FTO) and Transcription factor 7-like 2 (TCF7L2) genes in Euro-Brazilian individuals with type 2 diabetes. Diab obes Metab Diso OA, 2, pp.1-6.