Section 1

Chronic disease-Diabetes Mellitus

Diabetes mellitus DM is a prolongedmetabolic disorder that is identified by increased abnormal sugar levels in the body due to defects in insulin action or secretion of insulin. Insulin is a vital hormone in the body whose role is to regulate carbohydrate metabolism. Impaired secretion of insulin can result from tumors of the pancreas which affects the islet cells of Langerhans. Moreover, decreased number of insulin receptors can also result in hyperglycemia. There are two categories of diabetes mellitus namely type 1 and type 2. Type 1 DM accounts for 5-10% of diagnosed diabetic patients (Kharroubi, 2015). This type of diabetes constitutes 80-90% of diabetes in adolescents and children. As per the International Diabetic Federation IDF, there were 78,900 newly diagnosed cases of type 1 diabetes mellitus in 2013 among the youth. In the united states, it was estimated that 3million teenagers had type 1 diabetes (Kharroubi, 2015). The frequency and predominance of type 2 diabetes mellitus occur in the elderly of approximate age 20-79years. According to IDF, 382 million people had diabetes mellitus type 2 by the year 2013 (Kharroubi, 2015). The prevalence is more in men than women. The same statistics predicted that by 2035, there would be 592million cases of diabetes throughout the world.

The causes of diabetes are dependent on the classification. Type 1 results from immune-mediated destruction of insulin-producing cells of the pancreas, which are cells responsible for insulin secretion. The damage is mediated by activated T-cells. Therefore, diagnosis of type 1 diabetes mellitus depends on the identification of autoantibodies directed at pancreatic islet cells. These autoantibodies are namely protein tyrosine phosphatase(IA2), glutamic acid decarboxylase (GAD65), Insulin Auto-Antibodies (IAA), and zinc transporter protein(ZnT8A) (Kharroubi, 2015). Type 2 DM is caused by insulin resistance in the target tissues. Patients who have type 2 DM are not dependent on insulin. The resistance may result from a decreased number of insulin receptors in the tissues. The predisposing factors include obesity, lack of exercise, poor diet, dyslipidemia, and hypertension. Increasing age also predisposes to type 2 DM. Genetic predisposition is the primary risk factor for type 1 DM. A family history of DM is likely to increase the chances of the children to have the same condition. Young age has also been implicated as a risk factor for type 1 DM. A particular type of diabetes occurs during pregnancy, and it is known as gestational diabetes. This type of DM results from increased body demands and excessive release of gestational hormones.

Treatment of type 1 DM requires patient education on self-glucose monitoring practices and attending regular diabetic clinics. Insulin therapy is also indicated for type 1 DM patients. Patients can administer self-therapy by injecting insulin on a daily basis. Treatment of type 2 DM requires diet modifications, regular exercises, blood sugar monitoring, and insulin therapy may be indicated for severe cases. Metformin has been used widely to treat type 2 DM. Heart diseases are the major complication of DM; and these results from blockage of heart vessels by atheromatous plaques. Diabetic retinopathy is an ophthalmic complication of DM. Increasingly, diabetic foot ulcers result from poorly controlled diabetes. Severe complications of diabetesmay include nephropathy, which, unfortunately, results in kidney failure.

Section 2

Individual/intrapersonal-

Age of an individual-diabetes type 1 occurs in young individuals of less than 14years of age while type 2 diabetes occurs in persons of approximately more than 45 years.

Weight- this is a risk factor for type 2 DM. People with more than 120% of the desirable weight have an increased risk of type 2 DM.

Genetic makeup- individual with genetic mutations of DRB1*0301 gene has an increased susceptibility to acquiring type 1 DM.

Pre-existing medical conditions- these include hypertension and polycystic ovarian syndrome. The two medical conditions increase the risk of type 2 DM. Prevention of disease progression through intrapersonal factors may require early screening and treatment.

Interpersonal

Family diet- poorly balanced family diets rich in fats and sugars predisposed an individual to DM. Prevention of this requires strict follow-up of diet and minimizing food sources with high cholesterol levels.

Organizational

Workplaces- individuals working in places where there are exposed to stress can develop dyslipidemia which can consequently lead to DM. Prevention of stress requires regular team building to enable people to free up their minds and minimize the accumulation of cholesterol.

Community

Social eating habits may encourage overconsumption of food rich in Cholesterol. For example, the Hispanic population has a history of high consumption of fast foods that are rich in fats and sugars.

Public policy

National laws that do not support child screening of DM will make a diagnosis of early stages of the disease difficult. As a result, complications of diabetes will emerge earlier in life and compromise the quality of life. Besides, inadequate incentives on the provision of diabetic drugs can increase the rates of mortality of the patients. To curb these concerns, the government needs to implement policies that support the screening and treatment of diabetes.

Section 3

Due to the increasing incidence and prevalence of DM, the Center for Disease Control and Prevention CDC established the National Diabetes Prevention Program NDPP whose mandate is to prevent type 2 DM within the USA (CDC, 2018).  The government and private organizations support the program. The program has first addressed the impact of diabetes and the statistics show that 30 million Americans have diabetes mellitus (Kharroubi, 2015). The massive number of patients has made diabetes very expensive to the government and the citizens. In 2017, the total expenditure on DM in the whole country was $237billion (Albright & Gregg, 2013). Increasingly, 1 out of four dollars used in healthcare is spent on diabetic patients. Apart from medical expenses, there is reduced productivity due to the hospitalization of economically active people. The government lost $90 billion in 2017 due to diabetic related hospitalizations (Kharroubi, 2015, p. xx). The diabetic patients spent three times more the money spent by patients without diabetes. Based on the impact of DM, the NDPP was initiated.

The design of the program is meant to diagnose patients who are pre-diabetic (almost acquiring diabetes) and taking the patients through lifestyle modifications. The steps that a patient undergoes are intended to reverse the pre-diabetic phase into normal health state. A trained lifestyle coach is assigned to a patient and takes him/her through the program. The program takes one year. The benefits of the initiative include reducing the risks for type 2 DM, stroke, and heart attack. The participants are taught on the best diet practices, conduct routine exercises, and minimize stress.

The program has been a success within the country. In a research done by (Albright & Gregg, 2013), showed that patients who participated in the initiative had reduced their risk of acquiring type 2 DM by 58%. There was also a reduction in the risk of DM in patients with over 60 years by 71%. The obese patients who had enrolled in the program had a decrease in weight of over 5-7% (Albright & Gregg, 2013). Increasingly, participants had adopted healthy eating behaviors, and 150 minutes of exercise every week. The research also predicted that the impact of the program could last for the next ten years. People who had undergone the successful completion of the program had a one-third reduced chance to develop type 2 DM. Moreover, the screening of patients, that is part of the schedule, increased the chances of early diagnosis of DM and treatment and follow up were instituted effectively.

A follow-up on the participants showed improved lifestyle practices in their families. Interviews held on the after successful completion of the program also confirmed that the initiative had a high success rate. A 52-year-old male patient said, “I love having a lifestyle coach. She has given us great information, helped me stay on track and stay positive!”. The participant went on to comment that having a personal couch makes the reduction of weight easierand achievable (CDC, 2018). The teamwork that is experienced in the program also creates motivation for participants and creates a healthy competition to practice good lifestyle habits. A 60-year-oldlady said, “I’ve worked in medical research my entire adult life but always had a difficult time managing my weight. This program has taught me how to eat healthily and find an exercise routine that works for my schedule.” Therefore, the program has been a success in preventing type 2 DM.

Despite its high success rate, there are gaps in the NDPP that have made its implementation unsuccessful. First, the program is unequally distributed, and the people who have access to it are majorly based in urban areas. States like Kentucky that have a high diabetic risk exposure have aweakened implementation of the program. Second, there are few trained personal coaches. Few people are served as the demand is increased. Moreover, the program is weak in combating the risk of type 1 DM. As a result, children are left out in the realization of the scheme. In essence, the NDPP has been weak in achieving equality and combating type 1 DM.

Section 4

I propose the Mobile Phone Diabetic Risk Reduction Education.

The mandate of the program is to educate all people on the risk factors for diabetes and encourage them to go for earlier screening and diagnosis. Due to the increased mobile technology, the program is meant to use social media platforms and messaging services.

The basis of my proposal.

Majority of the existing diabetes prevention programs are focused on type 2 DM while also insisting on practicing of a healthy lifestyle. As a result, type 1 DM has not been addressed regarding its prevention and control. Therefore, the proposed program is meant to educate mothers who are aware of a family history of diabetes type 1 to take their children for screening at an earlier age. Besides, the existing strategies are inequitably distributed. Based on these arguments, mobile phones can be used as a means of improved education for the population concerning diabetic prevention since the majority of citizens own a mobile phone.

The specifications of the program.

The National Diabetic Council NDC will manage the program. They will be responsible for registering people and sending monthly reminders to parents to go and conduct diabetic screening on their children. The places where the prevalence of diabetes is high will be required to register for the program by the law as a requirement for kids to join the junior school. Broadcast messages to the community will create a reminder that encourages people to go for screening. Apart from monthly reminders, the program will also send daily diet and exercise tips to the prescribers. Regular reminders will be accompanied by a checklist to monitor their progress on exercising. Lastly, to make the program a success, people’s whose rating in the subscriptions are high after one month, will be rewarded by the Council through free medical coverage for one month.

Supporting evidence

A 2013 survey in Deloitte Center for Health Solutions found out that the use of mobile applications increased efficiency in the delivery of quality healthcare. There was a 64% increase in productivity by having daily reminders to patients (Ventola, 2014). Therefore, the findings of the study show that using mobile apps can improve the prevention of diabetes mellitus through daily reminders.

Conclusion

Diabetes is a metabolic condition that results in increased body sugar levels. Decreased production of insulin and resistance to insulin are all contributory towards diabetic outcomes. Complicated diabetes can result in stroke, retinopathy, and nephropathy. The strategy that the National Diabetic Prevention Program has instituted is focused on prevention of type 2 DM. Implementation of the Mobile Phone Diabetic Risk Reduction Education, will not only preclude diabetes but also address the risks coupled with diabetes type 1. This will be possible through continuous education to the population by sending them reminders.

SWOT ANALYSIS: Internal assessment table

SWOT ANALYSIS: External assessment table

References

Albright, A. L., & Gregg, E. W. (2013). Preventing Type 2 Diabetes in Communities Across the U.S. American Journal of Preventive Medicine, 44(4), S346-S351. doi:10.1016/j.amepre.2012.12.009

CDC. (2018, May 7). Testimonials from Participants | NDPP | Diabetes | CDC. Retrieved from https://www.cdc.gov/diabetes/prevention/real-people-stories/index.html

Kharroubi, A. T. (2015). Diabetes mellitus: The epidemic of the century. World Journal of Diabetes, 6(6), 850. doi:10.4239/wjd.v6.i6.850

Ventola L. (2014). Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. Journal of Pharmacy and Therapeutics, 39(5), 356-364. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/