HEALTH PSYCHOLOGY 13
Type 2 Diabetes
Description and Justification
Diabetes is a non-communicable illness that causes blood glucose torise above normal. This report focuses on type 2 diabetes, which ismore common among Americans and hence requires attention fromQueensland Health. The disease occurs when the body is incapable ofusing insulin as it should, a condition referred to as insulinresistance (American Diabetes Association, 2016). It affectsthe capability of the body to metabolize sugar or glucose, which actsas a crucial source of fuel in the body. When an individual has type2 diabetes, the body may fail to produce the required amount ofinsulin to balance glucose level, or resist the functions of insulin.
Insulin refers to a hormone produced by the pancreas (MayoClinic, 2016). The hormone is released into the bloodstream bythe pancreas. Insulin makes it possible for sugar to enter bodycells, and also controls these sugar levels. Glucose is the mainsource of energy for the body, and it is produced by the food peopleconsume, as well as the liver (Mayo Clinic, 2016). Glucose,concentrated in the bloodstream, enters the cells with the assistanceof insulin. In individuals with type 2 diabetes, the glucose andinsulin process do not work well (Mayo Clinic, 2016). Thismeans that glucose becomes concentrated in the bloodstream and failsto move into cells. Excessive build up of blood sugar compels theinsulin’s beta cells to release excess insulin. In due course, thecells become damaged resulting in their inability to produce theneeded amount of insulin by the body.
The symptoms of the disease develop slowly and it may take years foran individual to realize that he or she has type 2 diabetes. Theyinclude frequent urination accompanied by increased thirst, hunger,loss of weight, skin darkening in some body parts, fatigue andinjuries that heal slowly (Mayo Clinic 2016). When excess sugarconcentrates in the bloodstream, fluids are drawn from tissues,causing thirst. Hence, one urinates and drinks water unusually. Theinefficiency of insulin required to move glucose in the cells, causesa depletion of energy from other body organs, which in turn causeshunger. Depletion of energy from other organs also results in loss ofbody weight, because the body is compelled to rely on fat and muscleas alternative sources of fuel. Some individuals may develop darkpatches referred to as acanthosis nigricans, which are a sign ofinsulin resistance (Mayo Clinic, 2016).
Queensland Health should focus on type 2 diabetes due to its currentand projected high prevalence and negative impact on humanity.According to the World Health Organization (2016), the figureof individuals with diabetes has increased. While only 108 peoplewere diagnosed with the illness in 1980, as at 2014, 422 millionindividuals were living with the disease. The Centers for DiseaseControl and Prevention, CDC (2014) further notes that in America,above 29 million inhabitants have diabetes, which is a rise from 26million recorded in 2010. One in every ten adults aged 20 years andabove has diabetes, while the rate in seniors increases to one inevery four 65 year old and above. In specific, 90 to 95% of all newlydiagnosed incidences of the illness are type 2 diabetes(Santos-Longhurst, 2014).
It is anticipated that the number of individuals diagnosed with type2 diabetes will continue to increase. The American DiabetesAssociation (2016) notes, 1.4 million U.S. civilians arediagnosed with the illness yearly. In addition, “another 86 millionadults, more than one in three U.S. adults, have prediabetes, wherethere blood sugar levels are higher than normal but not high enoughto be classified as type 2 diabetes” (CDC, 2014). Without propermanagement of the high blood sugar, it is projected that “15percent to 30 percent of people with prediabetes will develop type 2diabetes within five years” (CDC, 2014). The new findings areworsened by the fact that many people with prediabetes are unaware oftheir condition. Hence, they are less likely to take any measures toprevent the development of the illness.
More alarming is the fact that diabetes causes economic burdens onAmerican states because of the money spent in treating the illnessand its associated complications. Research shows that U.S. spent “anestimated 245 billion dollars in 2012 due to increased use of healthresources and lost productivity” (Menke, Casagrande, Geiss &Cowie, 2015). It also reduces the quality of life of an individualwith type 2 diabetes due to problems linked with the illness. Theseinclude neuropathy of the nerve and kidney, foot and eye damage,diseases affecting the blood and heart vessel and hearing impairment(Mayo Clinic, 2016).
Unwanted sugar is likely to harm capillaries, which nourish nerves.This can eventually lead to loss of senses in some body parts, likethe legs. Diabetes also damages the kidney’s filtering system,which explains why people with severe diabetes experience kidneyfailure necessitating dialysis or transplant. It enhances thelikelihood that an individual will also suffer from cardiovasculardiseases, like heart attack, hypertension and coronary artery. Theillness might result in blindness by harming blood vessels in theretina, while injuries on the foot may become seriously infectedleading to amputation. These complications are likely to contributeto diabetes related deaths. Research notes that diabetes is theseventh major cause of death in America (American DiabetesAssociation, 2016).
Health Enhancing Behavior and Justification
Physical activity, described as any form of body movement that isproduced by skeletal muscles, is a health enhancing behavior that iseffective in minimizing the negative impacts of type 2 diabetes forindividuals diagnosed with the illness. The behavior should beimplemented through national guidelines. For instance, the “NationalInstitute of Diabetes and Digestive and Kidney Diseases” can beused in implementing physical activity. The institute providesrelevant information on the illness and explains how individuals canexercise as an approach to ensuring that they control diabetesrelated complications.
Research indicates that lifestyle intervention is the most effectiveapproach in reducing type 2 diabetes complications (Lindstrom et al.,2013). This is because the illness is highly prevalent in people whodo not exercise frequently. Over the years, lifestyle changes havehad a negative impact on the health of Americans (Ali et al., 2013).Many people rarely engage in physical activity, which has beendetermined as a major predictor of preventable health conditions,such as diabetes (Dunkley et al., 2014). Furthermore, exercisingregularly seems to safeguard against the disease (Lemos, Nunes,Teixeira & Reis, 2011).
Hordern et al (2012) explains that there is a rapid increase in“type 2 diabetes mellitus and pre-diabetic conditions such asimpaired fasting glucose and/or impaired glucose tolerance” inpeople who rarely engage in physical activity. The authors also notethat exercise training is helpful in enhancing glycaemic control inindividuals with type 2 diabetes. In addition, “exercise trainingimproves cardiovascular risk profile, body composition andcardio-respiratory fitness, all strongly related to better healthoutcomes” (Hordern et al., 2012). As a result, the researchersrecommend that patients with the illness should engage in a minimumof 210 minutes of exercise weekly. The exercise should be bothmoderate and vigorous, although high intensity exercise has beenproven to be more effective in the management of diabetes.
In a study conducted by Lemos et al (2011), to determine the impactof exercise on adults with type 2 diabetes, the authors concludedthat physical activity is effective in avoiding cardiovascularillnesses, which are complications associated with diabetes. This isbecause, the objective of type 2 diabetes treatment is to controlhyperglycaemia, as an approach to minimizing persistent diabeticcomplications, which are cardiovascular in nature (Gregg et al.,2012). Lemos et al (2011) note that hyperglycaemia is avoided throughexercise and results in reduced insulin resistance.
In a different meta-analysis study that involved the review ofresearches relating to exercise intervention for 8 weeks in peoplewith type 2 diabetes, “regular aerobic exercise showed astatistically and clinically significant effect on HbA1c, suggestingthat this non-pharmacological intervention improves glycaemiccontrol” (Lemos et al., 2011). The improvement in glucosemetabolism through physical activity might occur basically via threedifferent methods. These are “stimulation of glucose transport tomuscle, increased in insulin action on cells of the organs involvedin the exercise, positive regulation of signaling stimulated byinsulin as a result of regular exercise” (Lemos et al., 2011). Thisimplies that exercise is viewed as an “insulin-like activity” dueto its ability to enhance muscle capacity needed to capture glucose.
Another research conducted by The Look AHEAD Research Group(2013), notes that type 2 diabetes patients are encouraged to loseweight. This is because there are many “benefits of weight loss,including improvements in glycemic control, cardiovascular diseaserisk factors, quality of life and other obesity related comorbidities” (The Look AHEAD Research Group, 2013). Therelationship between weight loss and type 2 diabetes derives from thefact that, obesity in patients enhances the risk of cardiovascularillnesses. Hence, the researchers conclude that physical activityreduces cardiovascular death in overweight adults, who have type 2diabetes.
The studies discussed above, justify the need for physical activityas an effective behavior in reducing the possibility of occurrence,of problems associated with type 2 diabetes. While it is easy tomanage diabetes through medication, it is important that patients arephysically active to ensure that their blood glucose remains at agood range.
Mobile Phone Messaging
The current interventions targeting the minimization of the problemsassociated with type 2 diabetes are expensive, in addition to beinglabor intensive. Hence, this paper proposes the use of mobile phonemessaging as an intervention targeting adherence to physicalactivity, which is inexpensive. The intervention will target patientswho are at risk of developing other diabetes related problems. Inspecific, patients that have type 2 diabetes and are also obese. Thisis because, research shows that although there are numerous riskfactors for the illness, like stress, age and genetics, obesity isthe leading cause (Rejeski, Ip & Bertoni, 2012). Close to 90% ofindividuals diagnosed with type 2 diabetes are obese (ObesitySociety, 2015). In addition, obesity is caused by physicalinactivity. Hence, the intervention will encourage patients to becomephysically active.
In order for the intervention to be implemented, the first stepinvolves having records of all individuals diagnosed with thedisease. The records can be accessed from hospitals. Using theinformation, the patients will be informed about the new interventionand asked to provide their mobile phone numbers. Once the targetpatients have been identified, text messages will be sent to theirmobile phones. The messages will begin by informing the patients whythey need to exercise. It will also remind them of the risks theyexpose themselves to, as obese and diabetic individuals.
The second step entails ensuring that all target patients havereceived the messages, so as to ensure nobody is left out. During thepatients’ hospital visit, each individual will be provided with atimetable that schedules how and when they should exercise. Thetimetable will also include the types of exercises the patientsshould engage in. Their body weights will be measured and recorded.The records will be important in determining if the patients arefollowing the timetable as reminded using text messaging. Since theintervention is supposed to be inexpensive, the physical activitiessuggested will entail those that can easily be performed at home.Once the patients have been oriented and provided with the timetable,they will be required to exercise on a daily basis. In order toenhance adherence to physical activity, text messages will be sent tothe patients on a daily basis. The message will involve informationon what time they exercise and the type of exercise.
Barriers to Implementation
The barriers to implementing the intervention derive from the factthat some patients may be unwilling to receive the messages. Hence,it becomes impossible for such patients to be involved in theprogram. Another barrier is that some of these patients comprise ofchildren who do not own mobile phones. This means that they can onlyreceive the messages through their parents’ phones. Assuming thatthe parents work full time and are not at home when the children needto exercise, it will become impossible for physical activity to beencouraged among such individuals. In addition, children need to beguided by their parents on how to follow the timetable and performthe suggested exercises. In cases where the parents are unwilling toassist their children, the intervention becomes ineffective. Anotherbarrier is that the intervention requires patients to strictly adhereto the information sent via text message concerning physicalexercise. There is no guarantee that they will do as instructed.
The intervention will be evaluated based on the weight lost by thepatients. During the second stage of implementation, the patients’weights were recorded. The weight of every patient will be measuredon a weekly basis. It is anticipated that within a week, everypatient will have lost a significant amount of weight. The immediateimpact on behavior is that every individual receiving the textmessage will become physically active. In the long run, the patientswill not be overweight. As a result, they will be able to manage theillness and avoid problems, such as hypertension, kidneycomplications and cardiovascular illnesses.
The suggested intervention, mobile phone messaging, is based on thetheory of reasoned action. The theory argues that an individual’sbehavior is determined based on three aspects. These are “thesubjective norms associated with the behavior, defined as whether ornot people important to the individual believe they should performthe behavior or not the individual’s attitude toward the behaviorand an individual’s intention to engage in a behavior” (Smillieet al., 2014). The theory is applicable to the proposed interventionbecause it is based on the three aspects. In the case of type 2diabetes, medical practitioners have already identified the need forobese and diabetic patient to engage in physical exercise. Hence, thehealth care providers through mobile phone messaging intend to changethe attitudes of patients, from physical inactivity to becomingphysically active.
The intervention is highly likely to be successful. Although it hasnot been implemented in the treatment of diabetes, research supportsits effectiveness in improving adherence to HIV/AIDS medication, andreducing the spread of HIV and sexually transmitted illnesses. In aqualitative research conducted by Smilllie et al (2014), theresearchers aim at determining the effectiveness of mobile phonemessages aimed at enhancing HIV adherence and care retention. Theresearchers collect and analyze data directed by the theory ofreasoned action. The study concluded that text message reminders wereeffective in enhancing adherence to medication. A different studycompiled by Jemmott (2015), on the use of messaging as an effectiveintervention in preventing African American males from engaging inrisky sexual behaviors, notes that there exists a gap in behaviorinterventions. Thus, text messaging is an effective intervention inreducing risky sexual behavior. Other studies by Guse et al. (2012)and Saw, Mitchell, Welch and Williamson (2015) also support behaviorintervention as effective approaches in changing unwanted behaviors.
In conclusion, these studies support text messaging as an effectivetechnique in ensuring that patients suffering from type 2 diabetesreduce the possibility of developing diabetes related problems. Themessages have been effective in enhancing adherence to medication andhave encouraged behavior change. The same will happen with obesediabetic patients, as it is anticipated they will become physicallyactive.
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