Assessment
and Management of Patients With Diabetes Mellitus
Diabetes mellitus is a group of metabolic
diseases character-ized by elevated levels of glucose in the blood (hyperglycemia) resulting from defects
in insulin secretion, insulin action, or both (American Diabetes Association
[ADA], Expert Committee on the Diagnosis and Classification of Diabetes
Mellitus, 2003). Normally a certain amount of glucose circulates in the blood.
The major sources of this glucose are absorption of ingested food in the
gastrointestinal (GI) tract and formation of glucose by the liver from food
substances.
Insulin, a hormone produced by the pancreas,
controls thelevel of glucose in the blood by regulating the production and
storage of glucose. In the diabetic state, the cells may stop re-sponding to
insulin or the pancreas may stop producing insulin entirely. This leads to
hyperglycemia, which may result in acute metabolic complications such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic
syndrome (HHNS).Long-term effects of hyperglycemia contribute to
macrovascular complications (coronary artery disease, cerebrovascular disease,
and peripheral vascular disease), chronic microvascular compli-cations (kidney
and eye disease), and neuropathic complications (diseases of the nerves).
Diabetes
mellitus affects about 17 million people, 5.9 million of whom are undiagnosed.
In the United States, approximately 800,000 new cases of diabetes are diagnosed
yearly (Mokdad et al.,2000). Diabetes is especially prevalent in the elderly,
with up to 50% of people older than 65 suffering some degree of glucose
intolerance. Among adults in the United States, diagnosed cases of diabetes increased
49% from 1990 to 2000, and similar in-creases are expected to continue (Centers
for Disease Control and Prevention [CDC], 2002).
Minority
groups share a disproportionate burden of diabetes compared to non-minority
groups. African-Americans and other racial and ethnic groups (Native Americans
and persons of His-panic origin) are more likely than Caucasians to develop
diabetes and are at greater risk for many of the complications and higher death
rates due to diabetes than Caucasians (U.S. Public Health Service [USPHS],
2000; CDC, 2002). Chart 41-1 summarizes other risk factors for diabetes
mellitus.
The
far-reaching and devastating physical, social, and eco-nomic consequences of
diabetes are as follows:
•
In the United States, diabetes is the leading cause
of non-traumatic amputations, blindness among working-age adults, and end-stage
renal disease (USPHS, 2000).
• Diabetes is the third leading cause of death by disease, pri-marily because of the high rate of cardiovascular disease (myocardial infarction, stroke, and peripheral vascular dis-ease) among people with diabetes.
•
Hospitalization rates for people with diabetes are
2.4 times greater for adults and 5.3 times greater for children than for the
general population.
The
economic cost of diabetes continues to rise because of in-creasing health care
costs and an aging population. Half of all people who have diabetes and who are
older than 65 are hospi-talized each year, and severe and life-threatening
complications often contribute to the increased rates of hospitalization. Costs
related to diabetes are estimated to be almost $100 billion annu-ally,
including direct medical care expenses and indirect costs attributable to
disability and premature death (CDC, 2002).
The primary
goals of treatment for patients with diabetes in-clude controlling blood
glucose levels and preventing acute and long-term complications. Thus, the
nurse who cares for diabetic patients must assist them to develop self-care
management skills.
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