Diabetes Mellitus Type 2 (Type 2 DM) is a chronic, but often preventable disease which continues to be on the rise in spite of all the available information, medications, education, and interventions (Alvarez, 2014; Dunphy, Winland-Brown, Porter, & Thomas, 2015).
In the United States alone, Type 2 DM is reported to be the fifth leading cause of death, not counting the deaths attributable to other causes but which were most probably a result of the presence of Type 2 DM as a co-morbidity (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
Feinman et al. (2105) stated that ?The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with Type 2 diabetes is glycemic control (HbA1c)? (Pg. 9). The complications which occur in Type 2 DM, have been shown by multiple clinical trials to be significantly reduced or even delayed in the presence of careful glycemic control (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Hemoglobin A1c (HbA1c) levels show a patient?s average blood glucose level over a three-month period, which subsequently reveals how well the patient is doing with glycemic control (Dunphy, Winland-Brown, Porter, & Thomas, 2015; Feinman et al., 2015). The purpose of this paper is to discuss how the care and interventions provided by a Family Nurse Practitioner (FNP) could lead to the achievement of better HbA1c results in adult patients with Type 2 DM which would ultimately lead to better outcomes for the patient.
Identification of outcome
Type 2 DM is a disease with astronomical costs in the United States. The American Diabetes Association (ADA) shares the following statistics related to the cost of this disease:
? Nearly 30 million Americans have diabetes
? $1 in $3 Medicare dollars is spent caring for people with diabetes
? Diabetes and prediabetes cost America $322 billion per year
? 86 million Americans have prediabetes
? $1 in $5 health care dollars is spent caring for people with diabetes
? Today, 3,835 Americans will be diagnosed with diabetes. Today, diabetes will cause 200 Americans to undergo an amputation, 136 to enter end-stage kidney disease treatment and 1,795 to develop severe retinopathy that can lead to vision loss and blindness (American Diabetes Association, n.d.).
Kleinpell (2013), identified clinical outcomes such as ?symptom control and health status indicators? as some of the outcomes which can be measured (p. 5). Based on Kleinpell?s suggestion, one of the patient/client outcomes which can be measured in diabetes management is Hemoglobin A1c levels. As earlier stated, HbA1c control has a direct impact on the clinical outcomes of patients with diabetes. In order to put a lid on the rising cost of this disease, primary health care providers will have to devise practical and effective means of helping diabetic patients achieve better glycemic control.
Patient variables affecting outcome
Chaudoir, Dugan, and Barr (2013) stated that ?Patient-level variables are important to examine as predictors, because they inevitably impact the outcomes of implementation efforts? (p. 3). Some of the patient variables which could contribute to achievement of better A1c results in the management of diabetes are:
Severity of presentation of problem. The severity of the disease when the patient first presents to the clinic is one of the things listed as a patient variable by Irvine, Sidani, & Hall,1998. For instance, if the patient?s A1c is around 6.3 or 6.4, they are not considered diabetic but pre-diabetic (Dunphy, Winland-Brown, Porter, & Thomas, 2015). However, this pre-diabetic phase could very well be a harbinger of actual Type 2 DM if the right education and intervention is not instituted in a timely manner. This pre-diabetic stage would be a good time to start talking to the patient about lifestyle modifications which could prevent them from going from a pre-diabetic patient to a diabetic patient. If the patient is presented with the facts about the disease early enough and they are compliant with their management plan, the desired outcome of lower HbA1c and possible diabetes prevention could invariably be achieved. Also, even if a patient has already been diagnosed with the Type 2 DM, discussing with the patient about how their blood glucose can be better controlled in order to prevent it from becoming more severe, could lead to achieving better outcomes such as preventing or delaying the development of chronic complications.
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