Good Research Paper About Diabetes
A patient with diabetes is mainly at risk of kidney and heart failure. With glucose levels above the normal range (70-105 mg/dl), even though it is not specified if the patient’s glucose measurement is the fast measurement of after a meal, the patient seems to not be able to fully control their glucose levels (The Center for Family Medicine, 2007).
Potassium and sodium that are both controlled by the kidneys are within the normal range (normal range 3.5-5.1 mEq/L), which shows no kidney failure related to diabetes. The same applies to calcium measurement that do not suggest any malfunction of the kidneys or the parathyroid glands. Also, their creatinine levels are normal (0.7-1.3 mg/dl), which also signifies no kidney failure. However, the increased BUN levels (normal range 7-18mg/dl) is an indicator that the kidneys may not be functioning as supposed, or it could be because of the patient’s strenuous exercise and/or high in protein diet. The carbon dioxide measurement should also be taken into consideration, since it high levels relate to uncontrolled diabetes (The Center for Family Medicine, 2007)
The patient also seems to be well-hydrated with no signs of dehydration or acid-base imbalance (Chloride normal range 98-110 mmol/L). If the patient takes diuretics, then they do not seem to have caused any problem whatsoever. However, they may cause complications in the future, which is why the patient should be closely monitored and checked regularly. The liver appears to be functioning well, with LFT within normal levels (The Center for Family Medicine, 2007).
The Action of Drugs Prescribed to Patients with Diabetes
The goal of managing Type 2 diabetes is to maintain the blood sugar level in the normal range. For that reason, the first drug prescribed is Metformin (e.g. Glucophage, Formet, Doabex, Genepharm, etc.) that lowers the levels of blood sugar by lowering the amount of glucose released by the liver, which in turns helps the small intestine absorb glucose at slower paces, and allows the fat and muscle cells to take up glucose from the blood much easier (Diabetes Australia Vic, 2014). Other drugs prescribed is sulphonylureas (e.g. Glyade, Oziclide, Daonil, Amaryl, etc) and glitazones (Thiazolidinediones) (e.g. Rosiglitazone) that lower blood sugar by increasing the amount of insulin produced by the pancreas and by reducing the amount of glucose that the liver releases into the bloodstream, helping the patient’s own insulin work better in fat and muscle cells, respectively. In addition, alpha-glucosidase inhibitors (e.g. Glucobay), and the relatively new Dipeptidyl peptidase 4 (DDP-4) inhibitors (e.g. Galvus, Nesina, and Onglyza) are often prescribed that lower the blood glucose levels by slowing down the digestion of complex sugars (carbohydrates) in the intestine, and increase the hormone produced by the intestine that stimulates the pancreas to release more insulin when the patient’s blood sugar levels are higher than normal respectively. Another new class of drugs is also used, called incretin mimetics (e.g. Byetta) that is injected and slows down the emptying of the intestine, decrease the amount of glucose the liver releases into the bloodstream, and helps the patient feel full. Finally, sodium-glucose transporter inhibitors or SGLT2 (e.g. Invokana) is a new class of drugs that helps reduce the amount of glucose that the patient’s kidneys reabsorb so that glucose does not remain in the blood for long, but is excreted through the urine (Diabetes Australia Vic, 2014)
For patients with diabetes (both type 1 and type 2) that also have hypertension, ACE (Angiotensin-converting enzyme) inhibitors are, usually, the first-line antihypertensive agents prescribed that either delay or prevent the macrovascular and microvascular complication of diabetes, slowing down the progression of diabetes-related kidney disease to patients that are in stages 1-4 chronic kidney disease (Whalen & steward, 2008). Also, Angiotensin Receptor Blockers (ARBs) (e.g. Micardis) help decrease the various diabetes-related complications, delay the onset of kidney failure, and manage hypertension, through achieving a greater antiproteinuric effect (Whalen & Steward, 2008).
Opioid analgesics are prescribed to patients with diabetes also suffering from moderate to severe neuropathies, while serotonin-norepinephrine reuptake inhibitors (e.g. Duloxetine), among others, have also been evidenced to help relieve the patient from chronic pain, by increasing the activity of norepinephrine and serotonin (brain chemicals). However, it is not yet known exactly how this enhances the symptoms of chronic pain (Poinier, 2014).
The pharmacological and non-pharmacological interventions related to the management of diabetes and the national clinical practice guidelines
Clinical interventions and non-pharmacological interventions related to the management of diabetes include lifestyle management, psychological factors, and pharmacological therapies that help prevent cardiovascular and kidney disease, control blood pressure, provide effective glycaemia control, prevent visual impairment, and foot disease. As per the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services, the major outcomes considered is the prevalence of complications related to diabetes, and the efficacy of management strategies, secondary prevention strategies, and treatments on factors, as well as the patient’s well-being (Agency for Healthcare Research and Quality, 2015). Considering all the above, all interventions recommended to patients with diabetes aim at improving the quality of life of the patient, inform the patient of hazards related to untreated or therapeutic pharmacological non-compliance, focus on lifestyle changes to prevent diabetes-related complications, and mind the patient’s psychological well-being; hence, are in compliance with the national clinical practice guidelines.
The pathophysiological changes that would take place if this patient does not adhere to the prescribed medication treatment plan.
Therapeutic non-compliance can have serious clinical consequences and affect the treatment outcomes. Patients with diabetes have poor treatment outcomes and uncontrolled blood pressure, which directly increases the risk of renal impairment, myocardial infarction, and stroke (Jing et.al, 2008). Therapeutic non-compliance has also been associated with increased urgent hospitalizations, care visits, and treatment costs. In addition, it relates to loss of productivity and a significant diminishment of the patient’s quality of life (Jing et.al, 2008). Other than that, unreported therapeutic non-compliance may lead to an increase of the treatment’s complexity, given that physicians may opt for a different regimen. Needless to say, if the patient does not adhere to the prescribed medication treatment plan, diabetes, combined with hypertension and dyslipidemia will mathematically lead to the many complications related, including kidney failure, neuropathy, heart failure, and potential loss of extremities.
Agency for Healthcare Research and Quality (2015). Management of diabetes. A National Clinical Guideline. U.S. Department of Health & Human Services. Retrieved Jan. 22, 2015 from: http://www.guideline.gov/content.aspx?id=16394
Diabetes Australia Vic (2014). Medicines for type 2 Diabetes. Retrieved Jan. 22, 2015 from: http://www.diabetesvic.org.au/type-2-diabetes/medication-and-insulin/medications-for-type-2-diabetes
Jing, Jin, Grant, Edward, Vernon, Min Sen Oh, Shu Chuen, Li (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag. Feb 2008; 4(1): 269–286. PMCID: PMC2503662
Poinier, Anne (2014). Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) for Chronic Pain. WebMd. Retrieved Jan. 22, 2015 from: http://www.webmd.com/pain-management/serotonin-and-norepinephrine-reuptake-inhibitors-snris-for-chronic-pain
The Center for Family Medicine (2007). Common Laboratory Values. Retrieved Jan. 22, 2015 from: http://centerforfamilymedicine.net/pdf/LabResultGuide.pdf
Whalen, Karen, Steward, Robert (2008). Pharmacologic Management of Hypertension in Patients with Diabetes. Am Fam Physician. 2008 Dec 1; 78(11):1277-1282.
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