Diabetesarises as a result of an abnormal increase in the blood glucoselevels, also referred to as hyperglycemia. Two main types of diabetesare present, the first one being type 1 diabetes while the second iscalled type 2 diabetes. The number of people suffering from diabetesin America is 29.1 million. Over twenty-one, million people have beendiagnosed while slightly over eight million people are undiagnosed(2014 National Diabetes Statistics Report, 2015). Type 2 diabetesarises when the body becomes resistant to insulin. The liver andmuscle cells respond incorrectly to insulin leading to the lack ofblood sugar in these cells. High level of blood sugar buildup inthese cells` referred to as hyperglycemia. Symptoms develop slowlyhence contributing to the late diagnosis. However, some of the earlysigns have been outlined as the same urge to drink water, inabilityto see properly, frequent urination, feeling of tiredness, erectiledysfunction and hunger (, 2016). Aging is one of therisk factors involved in metabolic disorders such as type 2 diabetes.
Themost affected population with regards to type 2 diabetes are theelderly particularly the 75-year-old males. Age is one of the factorsthat plays a role in contributing to the risks involved in developingtype 2 diabetes. Other factors with potential risk include familyhistory, age, and ethnicity. Typical age-related changes are frequentin the older generation even in those individuals who are notsuffering from diabetes. These changes have the ability to lower thephysiological capacities of these individuals. Older people are atmore risk of the side effects of diabetic medication (AmericanDiabetes Association, 2015).
Disease-associatedcomplications linked with other age-related changes have greaterimpacts on the elderly patients as it affects their ability toconduct daily activities impacting negatively on disease managementand self-care. Type 2 diabetes has a greater impact on males aged 75years and above as it is a contributory factor in causing erectiledysfunction. This condition commences gradually and later resultingin the inability to achieve an erection. Medications such asantihypertensive drugs pose a significant risk to men with diabetesdue to the concurrent treatment of hypertension (Diabetes and Men’ssexual function, 2016). Advanced age contributes to the increasecases associated with type 2 diabetes.
Thereis a disparity with regards to access to health. The most affectedare the non-white populations. Most affected groups are AfricanAmericans and Mexican Americans as compared to older males above 75years old from non-Hispanic whites. Other ethnic groups affectedinclude Asian Americans and other Native American tribes. Most ofthese ethnically diverse groups lack access to proper healthcareservices, most of them live in poverty and also the existence ofenvironmental hazards within their surroundings.
Cultureintersects in a variety of ways with issues concerning poverty,equity in health care and lack of competence of the health careproviders with regards to cultural matters. The difference in incomebetween these culturally diverse communities plays a significant rolewhen it comes to seeking treatment for type 2 diabetes. The income ofMexican Americans is significantly low as compared to that of Anglos,a major barrier to seeking treatment. Most states have stringentMedicaid eligibility criteria that are out of reach for mostcommunities. Complications arise in the management of type 2 diabetesand most cease out of insulin therapy. Management of type 2 diabeteshas an impact diet. Some of the culturally accepted foods withinthese communities will be a long gone option(Schellenberg et.al.,2013).
Themajority of costs related to type 2 diabetes result from chroniccomplications. Type 2 diabetes contributes to substantially highmedical expenditure both to the economy and individual families witha diabetic patient. Caregivers of these diabetic patients alsocontribute to the indirect costs implicated in diabetes as some maybe absent from work to provide care. Reduced productivity at theworkplace and home will be inevitable.
Thelegal consequences that exist between these elderly populations withregards to type 2 diabetes management involve their interaction withmedical practitioners, especially where a patient makes an accusationof negligence or breach of privacy and confidentiality. Some drugsused for management of the condition such as Actos linked to variousrisks such as bladder cancer and heart failure hence many lawsuitshave been filed as a result of the severe side effects (Hargreaves,2013).
Medicalpractitioners have an ethical obligation for providing truthfulinformation to this population with regards to their condition. Theyshould give an honest appraisal of the person’s status, they shouldmaintain confidentiality, should be discreet and trustworthy to theirpatients (Hargreaves,2013).
Ethicalimplications involved in the care for this category of populationranges from a broader range of concerns such as appropriate agingbehaviors and tender elder care. Other ethical issues arising withregards to type 2 diabetes is the genetic susceptibility testing and75 years male population are not an exemption. The severity of type 2diabetes has various implications with regards to ethical evaluationfor testing susceptibility. Genetic susceptibility is currently onthe rise however it is yet to be fully acceptable as a means ofdiabetes management. The existing options must have a balance withregards to the potential medical benefits against the possible moralwrongs and mental harm. The risk for diabetes goes up when a familymember becomes diagnosed with the disease. 75-year-old males withdiabetes prompt the need to screen family members related to thediagnosed individual. Issues of genetic counselling which mighttarget children related to the diagnosed adult might arise.Currently, there is no sufficient evidence to support geneticsusceptibility tests conducted on children (Hargreaves,2013).
Variousresponses exist on how to manage type 2 diabetes among 75-year-oldmale population despite the lack of a cure. Management of thecondition encompasses taking of proper diet, having a schedule forphysical activities and weight balance. Balanced diet contributessignificantly to the management of this condition. Physicalactivities allow the body to utilize glucose for energy increasingthe sensitivity of cells to insulin. Overweight individuals have ahigher chance of having this condition as their cells becomeresistant to insulin due to more fatty tissues (Schellenberget.al.,2013).
Otheroptions involved in the management of blood sugar requires the use ofdiabetes medications. The extended intervention implies the use ofdrugs to help control glucose levels in the blood. These may includetablets and also insulin or other injectable medicines. One of thedrugs used to treat type 2 diabetes is metformin which works byreducing glucose level that the liver releases into the bloodstream. Sulphonylureas lead to an increased production of insulin by thepancreas. Thiazolidinediones increase the sensitivity of the body’scells hence more glucose taken from the blood. Gliptins inhibit thebreakdown of GLP-1 hormone which usually helps the body to releaseinsulin in response to high levels of glucose. Acarbose prevents theincrease in blood glucose level after meal consumption. Nateglinideand repaglinide do stimulation of insulin release from the pancreas. Glycemic control and blood pressure control are also additioninterventions to address the problem.
Managementof diabetes in this group of individuals does not differ so much withthat of the younger population. Various resources have been outlinedtargeting the management of type 2 diabetes. These include assessmentof older patients, medical nutrition therapy, exercise programs,pharmacotherapy, patient education and monitoring.
Theelderly are candidates considered for diabetes screening given thatsymptoms can be atypical. Functional assessment plays a significantrole in the evaluation of older individuals. Activities of dailyliving (ADL) is one of the more commonly applied tools. The otherassessment tool is the instrumental activities of daily living (IADL)that encompasses more rigorous activities than ADL. Psychologicalevaluation is also performed to assess the mental capability.Mini-Mental Status Examination (MMSE) is the tool of choice for thisassessment. Geriatric Depression Scale (GDS) is the tool of choicefor depression analysis. Geriatric assessment for this populationcategory involves clinical assessment, functional assessment,nutritional assessment, psychological assessment, gait and balanceevaluation and diagnostic testing (Schellenberget.al.,2013).
Theother resource available for the management of type 2 diabetesinvolves medical, nutritional therapy. A four-step model commencingwith assessment, set goals, plan for intervention, and lastlyevaluation and problem solving apply in the management of type 2diabetes. Exercise tolerance testing on the elderly individualsbefore exercise initiation is an important tool for consideration.These patients are usually advised to begin with lighter exercisesand proceed as tolerated.
Pharmacotherapyis the other essential resource that should be instituted for theolder population when lifestyle and diet changes prove insufficientto achieve glycemic control. More Elderly patients have a widevariety of insulin injection aids that allow for self-management ofdiabetes.
Theinterventions related to type 2 diabetes relate to higher medicalexpenditure despite aim at controlling the condition. One of theinterventions involves lifestyle changes mainly focusing on physicalactivity and dietary modification. Diabetic patients have to follow astrict nutritional balance which might be costly at times.
Managementof type 2 diabetes correlates with significant financial costs.Medications are costly, and families of patients have to makefinancial sacrifices to incur treatment costs. The health authoritiesalso feel the impact financially (Diabetes: the cost of diabetes,2016). Costs incurred directly by the families of those affectedinclude drugs, medical care, and insulin among other supplies. Otherpersonal costs incurred by the suffering individuals include paymentsfor life, health, and automobile insurance.
Indirectcosts include loss of productivity especially from the caregivers ofthe ill patients who have to be absent from work. Intangible costsincurred by this target population include anxiety, pain, andinconveniences which decrease the quality of life of the affectedpeople. Treatment particularly insulin injection and self-monitoringcan be uncomfortable at times.
Sustainabilityof the interventions
Mostof the interventions aimed at regulating type 2 diabetes aresustainable. The most basic interventions such as dietary balance andphysical exercise are activities that majority of patients can getinvolved in without too much strain. However, interventions involvingmedications will in the meanwhile continue to be a matter of concernfor diabetic drugs are costly and also the cost of insulin injectionsis quite high for most of this target population. Some drugs have ledto serious side effects in the target patients. The recentdiscoveries of oral antidiabetic agents have led to renewed hope forthe management of hyperglycemia with reduced adverse events.
Type2 diabetes is more prevalent in the elderly population as compared totype 1. Some of these reasons include decreased lean muscle mass,shifting dietary habits, reduced physical activity and increasedadiposity resulting to insulin resistance. Decline in the function ofbeta cells due to aging is also listed as a contributory factor.Despite the adverse effects of type 2 diabetes especially on theolder populations, it is positive to realize that this condition ispreventable. Also to note, a lot has been emphasized on theimportance of lifestyle modification among type 2 diabetes patients.However, not much is known about the essential benefits ofprimary-care based strategies in the fulfillment of both dietary andphysical activity changes aimed at with regards to the management ofthis condition. Provision of self-management education and targetedpatient care are the other major components with regards to effectivemanagement of this condition. Family members of individuals with type2 diabetes often play an important role in the management of thecondition. Families usually share similar lifestyles that predisposethe non-diabetic individuals to develop the conditions and increasestheir chance for development of cardiovascular diseases.
2014National Diabetes Statistic Report. 2015. Centersfor Disease Control and Prevention.Retrieved fromhttp://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html.
AmericanDiabetes Association. (2015). Standards of medical care indiabetes—2015 abridged for primary care providers. ClinicalDiabetes,33(2),97-111.
Diabetesand Men’s Sexual Function. 2016. Onetouch.Retrieved from http://www.onetouch.com/articles/mensexualfunction.
Diabetes:the cost of diabetes. 2016. WorldHealth Organization.Fact sheet No. 236. Retrieved fromhttp://www.who.int/mediacentre/factsheets/fs236/en/
Hargreaves,J. (2013). Hook line and sinker: Legal and ethical issues in diabetescare.
Schellenberg,E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C.(2013). Lifestyle interventions for patients with and at risk fortype 2 diabetes: a systematic review and meta-analysis. Annalsof internal medicine,159(8),543-551.
Type2 Diabetes. 2016. Medlineplus.Retrieved fromhttps://www.nlm.nih.gov/medlineplus/ency/article/000313.htm.