Diabetes Mellitus Term Paper

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Diabetes Mellitus

In this report, Diabetes Mellitus will be discussed, since there are many factors that influence how patients handle the care and the managing of it due to the physical and emotional need of it. Furthermore, the paper will go through the many factors that influence diabetes self-management. It will be shown that some models have not been tested among veterans, which is a unique population with high rates of diabetes. However it will also that despite any demographic an individual's "readiness to change," their confidence in being able to make change (or self-efficacy), in addition to appropriate advice from medical providers, may impact diabetes self-management behavior. Interventions are designed to increase self-efficacy have improved quality of life, patient satisfaction, and glycemic control, and recent studies validate readiness to change as an important predictor of dietary behavior, physical activity and improved glycemic control" (Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control 2007). Along with that, this paper will prove people who have diabetes have many factors of it influencing their diabetes care and their lifestyles.

1.2 Problem Statement

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Within this dissertation, the purpose is show that there strategies that can be implemented by a practice to promote patient empowerment and self-management, which involve creating patient-centered practices and providing active, ongoing self-management support. This is accomplished through a team approach to care (Funnell and Anderson 2004). This will show patients different ways to take care of their diabetes without hurting their productive lifestyles. The following lists some strategies that can help to lead a healthy life with Diabetes Mellitus, living in any demographic range

Link patient self-management support with provider support (e.g., system changes, patient flow, logistics).

Supplement self-management support with information technology.

TOPIC: Term Paper on Diabetes Mellitus in This Report, Diabetes Mellitus Assignment

Incorporate self-management support into practical interventions, coordinated by nurse case managers or other staff members.

Create a team with other health care professionals in your system or area who have additional experience or training in the clinical, educational, and behavioral or psychosocial aspects of diabetes care.

Replace individual visits with group or cluster visits to provide efficient and effective self-management support.

Assist patients in selecting one area of self-management on which to concentrate that can be reinforced by all team members.


Furthermore, the need of this paper is that patients must watch their HbA1c levels because they are a better measure of glycemia than values on the OGTT for two reasons. First, they reflect months of prevailing glucose concentrations rather than one instance of time (Davidson 2007). For the past six or seven years, there have been five studies in several thousand diabetic patients that have related to the average HbA1c level to the development and progression of the microvascular complications of diabetes.19-24. They all have demonstrated that if the average HbA1c level were <1% above the upper limit of normal (ULN) for the assay used (e.g., <7% for the assay used in the Diabetes Control and Complications Trial, in which the ULN was 6.0%), development or progression of diabetic retinopathy or nephropathy were not occurring.. If the average HbA1c levels were between 1 and 2 percentage points above the ULN, an increase in the development and progression of these complications occurred.. Average values >2% above the ULN were associated with much higher risks for the microvascular complications (Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control 2007). Therefore, the up keep of diabetes is highly important because HbA1c levels can be a contributing factor to the care of the disease rather it improves or declines the health of the patients who help with their care.. The follow chart shows that the importance of the management of this for diabetes patients.

Table 3. Distribution (%) of HbA1c Levels


MRG Data Set

Glucose (mg/dl)

No. Of Subjects (%)a

HbA1c (%)b

No. Of Subjects (%)c

HbA1c (%)d


2-h OGTT


In this study, it will be shown that social support is related to healthier functioning patients. Support, as a construct, has been defined as a sense of belonging, specifically among peers, teammates, community or family members. Patients reporting strong social support/low isolation exhibit higher levels of resilience and lower levels of depression. Patients are also less likely to be depressed if they perceive their family, friends, and peers to be more accepting, and if they have more positive friendships. Those who feel supported by counselors, parents, or peers exhibit healthier coping mechanisms and maintain a more positive outlook about their future. In contrast, patients who lack social support and experience isolation may behave in self-injurious ways (Rutter 2004).

This study provides additional data on health services utilization in depressed individuals with diabetes. In a recent study (3), we showed that compared with nondepressed individuals with diabetes, depressed individuals with diabetes had increased health care use and expenditure. Akin to our earlier finding, this study found that depressed individuals with diabetes were more likely to have primary care and emergency room visits compared with their depressed counterparts without diabetes. In addition, depressed individuals with diabetes were more likely to report visits to a psychiatrist or mental health professional. It is noteworthy that the proportion of patients who visited a psychiatrist was not significantly different. This suggests that the pattern of visits to psychiatrists or mental health professionals did not differ by diabetes status (Egede and Zheng 2003).

Diabetes (n = 176, N = 969, 599)

No diabetes (n = 1,873, N = 11,141,509) value






Age (years)



High school education

Poverty ratio (% of federal poverty level)





Health status




Obesity status (kg/m2)


BMI <18.5

BMI 18.5-24.9

BMI 25.0-29.9

BMI >=30.0


Major complications -- Yes


Visited a primary care physician


Visited a psychiatrist or mental health professional

Visited an emergency room

Source: Egede and Zheng 2003

When affirming a client's thoughts and feelings, it does not mean the counselor is accepting their feelings by default. It only means he or she is trying to get the client to open up with their feelings in order to get them resolved so that the blame will not be put on others. This approach is taking by a humanistic counselor so that the client can see that he or she is blaming others for their problems. From there, affirming the issues does not mean the counselor is accepting their feelings. They are just trying to get them out in the open to correct them.

In Table 4, the characteristics of individuals with major depressive disorder by diabetes status are compared. Among individuals with major depressive disorder, those with diabetes were more likely to be of Hispanic ethnicity, to be aged >50 years, to have less than High school education, and to have household income <124% of the federal poverty level and were less likely to be employed. Individuals with diabetes were more likely to report worsening of their health status and to have BMI 25.0 kg/m2, major complications, primary care physician visits, and emergency room visits, but they were less likely to smoke than individuals without diabetes (Egede and Zheng 2003).

From there, the counselor should not push society's values on the client until the appropriate moment time in the session when they are relax and accepting of further insight into the situation even when it is about anti-Semitism. When a client is not pressured to accept a new way of thinking, they are more open to take the counselor's insights and corrections to their views by listening during the session. From there, the counselor can help the client to rehabilitate themselves, which will help them to accept society's norms for their own.

Rogers' strong belief in the positive nature of human beings is based on his many years of clinical experience, working with a wide variety of individuals (1961, 1965, 1977). The theory of person-centered therapy suggests any client, no matter what the problem, can improve without being taught anything specific by the therapist, once he/she accepts and respects themselves (Shaffer, 1978). The resources all lie within the client. While this may be so, this type of therapy many not be effective for severe psychopathologies such as schizophrenia (which today is considered to have strong biological component) or other disorders such as phobias, obsessive-compulsive disorder or even depression (currently effectively treated with drugs and cognitive therapy). In one meta-analysis of psychotherapy effectiveness that looked at 400 studies, person-centered therapy was found least effective. In fact, it was no more effective than the placebo condition (Glass 1983; cited in Krebs & Blackman, 1988) (Pescitelli).

Research has revealed that the experiences of diabetes can be a lonely and stressful time when compared to experiences of other minorities in the same age group. Young individuals who identify themselves as a part of a minority group often discusses their status with families who affirm their minority identity. Patients are over-represented in homeless populations and many turn to alcohol, drugs, or suicide to escape their hostile environments.

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