Diabetes and Screening
Great work with your post! Your post was very insightful. I agree that being a nursing practitioner mandates us to provide quality care and promote health initiatives to enhance patient health outcomes. Diabetes, being a common illness in practice, requires nurses to observe outlined guidelines regarding the testing and ruling out of diabetics in patients to promote quality care for such patients (Ackerman et al. 2018). People with diabetes require constant care provision and patient self-management techniques, which requires nurses to educate such patients on the appropriate measures.
The prevalence of diabetics among populations necessitates the implementation of appropriate screening. You have noted that the common complications associated with diabetes include loss of vision in adults and accelerated pathological processes within the cardiovascular system. People with diabetes also cause an increase in the number of reported cases of non-alcoholic liver diseases. These statistics are essential in implementing effective diagnosis and prevention of diabetics. Your proposed intervention involves universal screening for prediabetes and diabetes for patients above 45 years, regardless of the existing risk factors, as long as at least one symptom of diabetes in the patient.
After three years, the screening process should be repeated if the test results reveal negative results to affirm the examination. For the case of prediabetes and type 2 diabetes, ADA and AACE recommend fasting glucose testing for glucose tolerance in elderly patients (Arslanian et al., 2018). There is little evidence on the best intervals for testing glucose levels to determine initial glucose levels; however, the testing after three years may help those with normal glucose levels in the blood. Repeat testing facilitates the diagnosis of type 2 diabetes. Early screening prevents the progression of prediabetes to diabetes and thus can reduce complications when appropriate interventions are employed in the early stages.
Arslanian, S., Bacha, F., Grey, M., Marcus, M. D., White, N. H., & Zeitler, P. (2018). Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes care, 41(12), 2648-2668.
Ackerman, N., Benchekroun, G., Bourne, D., Caney, S., Cannon, M., Daminet, S., … & Petrie, G. (2018). Diabetes mellitus: Guidance for managing diabetes in practice. Companion Animal, 23(3), 143-151.
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Diabetes is a common illness seen in primary care. Using evidence-based practice, what screening would you need to ensure these patients get adequate care and health promotion?
As a nurse practitioner, my primary responsibility is to ensure that patients get adequate care and health promotion services for their illnesses. I agree that diabetes and hypertension are common illnesses seen in a primary care setting. Therefore, when treating patients with diabetes or having tests to rule out diabetes, it is imperative to be familiar with the guidance concerning diabetes care in your work setting to provide safe patient care. In addition, diabetes requires constant medical care and patient self-management education to prevent acute complications and reduce the risk of long-term complications; therefore, screening can be beneficial for patients to diagnose diabetes early and prevent further complications.
Diabetes Screening Recommendations:
About 50% of the United States population (ages 18 and over) are diagnosed with either prediabetes (34.5%) or diabetes (13%), with prevalence amongst the geriatric population. Complications of diabetes include loss of vision in adults in the United States and an elevated possibility of pathological processes of the cardiovascular system, non-alcoholic fatty liver disease, and a rate of death (Davidson et al., 2021). Before the pandemic, diabetes was the seventh leading cause of death in the United States (Ahmad & Anderson, 2021).
The United States Preventive Services Task Force (USPSTF) states that current proof shows that assessing for prediabetes and type 2 diabetes and giving or directing patients to viable preventative therapies offers moderate certainty and an effective and positive health outcome.
The American Diabetes Association (ADA) suggests universal assessment for prediabetes and diabetes for all adults 45 years and older, regardless of risk factors. Regardless of age, the evaluation of adults with a BMI over 22 (over 23 in Asian Americans) should be done if there is more than one risk factor present. Screening can be repeated in three years if the findings are normal (Davidson et al., 2021). Universal screening is also recommended by the American Association of Clinical Endocrinology (AACE) for persons over 45, irrespective of factors that increase risks. Persons with present causative factors should be screened despite age(Davidson et al., 2021).
ADA and AACE recommend fasting blood glucose testing, a 75-gram oral glucose tolerance test, and HbA1c test. USPSTF recommends fasting plasma glucose or HbA1c levels and an oral glucose tolerance test as various measurements that can be used to identify prediabetes and type 2 diabetes.
Prediabetes is defined as a fasting plasma glucose level of:
100 – 125 mg/dL (5.55-6.94 mmol/L)
HbA1c level of 5.7 to 6.4 %
A 2-hour postprandial glucose level of 140 – 199 mg/dL (7.77-11.04 mmol/L) (Davidson et al., 2021, Screening tests section).
Repeat testing is recommended to confirm the diagnosis of type 2 diabetes. There is inadequate information on the best screening interval for persons’ initiatory glucose levels within range. Adults with normal blood glucose levels may benefit from screening every three years (Davidson et al., 2021).
While the USPSTF believes that more studies are needed to directly link early screening for type 2 diabetes with heart disease and early death, the present studies support early screening to prevent the progression of prediabetes to diabetes. In addition, cardiovascular and mortality events are reduced when early detection leads to appropriate and timely interventions (Davidson et al., 2021).
Ahmad, F. B., & Anderson, R. N. (2021). The leading causes of death in us for 2020. JAMA, 325(18), 1829–1830. https://doi.org/10.1001/jama.2021.5469
Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Owens, D. K., Robert, L., Silverstein, M., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for prediabetes and type 2 diabetes. JAMA, 326(8), 736– 743. https://doi.org/10.1001/jama.2021.12531
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