What is it? diabetes is defined by wikipedia as a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. diabetes statistics american diabetes association page 1 of 3 información en español local offices message boards about us help join ada search find more books diabetes basics living with diabetes food amp fitness donate shop in my community connect with. In this review we have used both hard copy library based access and internet search facilities, to derive appropriate material. This was done at both the local university library and the local post graduate medical centre library. Initial searches were made under the heading of type ii diabetes mellitus nutritional management. Because it was important to provide a firm evidence base for the review, the searches were restricted solely to peer reviewed publications which, it was hoped, would make the selection process more efficient. Berwick d 2005 this highlighted more than enough good quality material for our initial examination of the literature.

This is partially a coincidence, as over thirty different articles in twelve different publications were assessed in the preparation of this piece. The final decision that was made to include articles was based, not only on their relevance to the issue, but also on the fact that they were on aspects of diabetic nutritional management that was not more commonly covered in some of the more ldquo routine rdquo articles. Many of the articles examined were discarded because they had obvious methodological flaws in their construction. Many were effectively opinion pieces which had little in the way of cited references to validate their findings. Others were trials which may have had a number of potentially confounding sources of bias.

There are a great many authoritative sources in the modern literature on the subject of dietary management of the diabetic state. In any meaningful review of these resources one must always be mindful of the need for a strong evidence base. It is therefore vital to be dispassionately critical in one rsquo s review of any literature presented. We know, from established evidence, lean me 2005 , that obesity is an independent risk factor in the aetiology of type ii diabetes mellitus and that obesity management is a vital ingredient for good control of the diabetic state. Hsg 1997 this correlates with evidence that the incidence of long term side effects of diabetes is inversely proportional to the hba1 readings. Stratton i et al 20 a good place to start our review is a recent review paper by hitchcock amp pugh 2002. This is a tour de force in the management of obesity in general terms, but, for the reasons outlined above, it is very pertinent to our discussions in this piece.

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The review itself is cited here because it provides a particularly comprehensive overview of other work in the area together with some personal observations of patients who are both diabetic and involved in the weight management process. The paper also highlights the often overlooked problems of the need to reduce hypoglycaemic medication in conditions of both weight loss and unaccustomed exercise to minimise the risks associated with hypoglycaemic episodes. There is a particularly pertinent set of comments relating to pharmacotherapeutics and obesity related surgery. This paper sets itself apart from many other similar papers with comments relating to the long term strategies associated with successful weight maintenance. A critical assessment of this review would have to conclude that although written by uk based authors, there are some comments in it which are aimed at the usa and this may well be a reflection of the fact that it was supported by the usa veterans association. On the positive side, the references cited are wide ranging and authoritative, giving a balanced overview of the current situation relating to obesity control. Again, this article is a general piece, but it has distinct relevance to the management of the type ii diabetic.

This piece is particularly relevant to our considerations because apart from providing an authoritative statement on the current evidence base for aspartame, it points to the fact that current dietary recommendations for type ii diabetes mellitus include the fact that up to 10% of total metabolic energy can safely come from sugars. It also produces an authoritative opinion on the argument that increasing the carbohydrate component of a diet tends to displace the fat content, bolton smith c et al 19 with the associated health benefits there. Nutritional management in diabetes mellitus was traditionally part of the almost exclusive remit of either the specialist diabetic nurse or the dietician. More modern considerations have included the concept of patient empowerment and education howe and anderson 2003 , which can now come from independent web based sources.

The first eyesenbach g et al 2004 , produces an extremely comprehensive review of the availability, accuracy and effect of this phenomenon. It provides an authoritative assessment of the literature available on this topic. Of particular relevance to our considerations was their findings that, of the five peer reviewed studies examined that gave dietetic advice and also measured the clinical outcome by hba1 , only one showed a statistically significant improvement.

It has to be noted that the particular study was not a controlled reference study, and therefore has a great potential for experimental bias. Gary tl et al.2003 a more qualitative approach was taken by the second of the two papers ralston jd et al 2004. This paper looked at the patient rsquo s experiences with the use of the web based advice facilities. The study design was ambitious, but used the semi structured interview technique which again introduces the possibility of observer bias. Parker and lawton 2003 despite being both authoritative and informative, careful reading of the article shows that the authors only used a small cohort nine.

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One of the most significant findings of this particular study is, arguably, the demonstration that web based interventions have the potential not only to work and to support the patients in general terms but advice, such as dietetic advice, is actively sought and implemented by some patients. The authors conclude that the most important pre requisite to obtaining a successful outcome, was the fact that the patients had the opportunity to discuss the shortcomings of the project before they entered it. Diabetes and nutrition study group dnsg of the european association for the study of diabetes. Recommendations for the nutritional management of patients with diabetes mellitus. Eysenbach g, john powell, marina englesakis, carlos rizo, and anita stern 2004 health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions gary tl, genkinger jm, guallar e, peyrot m, brancati fl.

2003 meta analysis of randomized educational and behavioral interventions in type 2 diabetes. Hitchcock p, pugh n amp ja 2002 management of overweight and obese adults bmj, oct 2002 325: 757 761 involving patients in medical education bmj, aug 2003 327: 326 328. Key features of a good diabetes service department of health document knowler wc, barrett connor e, fowler se, hamman rf, lachin jm, walker ea, et al.2002 reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N engl j med 2002 346: 393 403 aspartame and its effects on health bmj, oct 2004 329: 755 756 prognosis in obesity: author's reply ludwig ds, peterson, gortmaker sl. 2001 relation between consumption of sugar sweetened drinks and childhood obesity: a prospective, observational analysis.

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Mohammed, d braunholtz, and t p hofer 2003 the measurement of active errors: methodological issues qual. Psychological contribution to the understanding of adverse events in health care qual. Ralston jd, debra revere, lynne s robins, and harold i goldberg 2004 patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study doing the right thing right: is evidence based medicine the answer? ann intern med, jul 1996 127: 91 94. 20 association of glycaemia with macrovascular and microvascular complications of type 2 diabetes ukpds 35 prospective observational study.

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In this assignment i am going to talk about someone was diagnosed with type 2 diabetes in 2007, the effect their lifestyle has had on their condition and what exactly the healthcare provision is doing to help. I will be changing the names of all people and places in line with the nmc 2008 code of conduct. I am doing my report on a 47 year old female who i will be referring to as mrs x, she received the diagnosis of type 2 diabetes 5 years ago. Mrs x is currently classed as obese, very rarely exercises, drinks excessive alcohol and smokes around 20 30 cigarettes a day, so was at a high risk of developing type 2 diabetes, also she was 42 at the time of diagnosis and studies show that ‘’type 2 diabetes occurs mainly in people over 40 nice 2008 .

When she was younger mrs x exercised regularly, ate healthily, very rarely drank alcohol and before being diagnosed with type 2 diabetes never had any health problems. However after having children it became hard for mrs x to make time to exercise and she also took to eating ready meals and fast food as it was quicker and easier. It is likely that her change in lifestyle gradually contributed towards developing type 2 diabetes. Recent statistics nhs 2008 show that of all people aged 35 and over, classified as having a raised waist circumference, men were twice as likely and women four times as likely to have type 2 diabetes. Eating unhealthily and being inactive are contributory factors when it comes to diagnosing diabetes type 2, it has been proven that muscle cells have more insulin receptors than fat cells therefore a person can decrease insulin resistance by exercising. Being active also lowers blood sugar levels by helping insulin be more effective, therefore someone with type 2 diabetes would benefit greatly from being active.

Reference other lifestyle factors of mrs x that may have contributed to developing type 2 diabetes are excessive alcohol intake and smoking. Our writers can help get your essay back on track, take a look at our services to learn more about how we can help. Essay writing service essay marking service place an order in scotland diabetic patients aged 17 or more than 17 are 67.5% of total diabetic population in which 23% are hypertensive. 5.8% are with coronary heart diseases chd and 3.8% are with chd and hypertension as well pti and qof 2008. Diabetes self management education has been considered as an important part of the clinical management of individuals with diabetes since the 1930s bartlett 1986. Approximately 40years before donnell etzwiler first time established an out patient education centre to provide basic diabetic information and self management education to the diabetic patients.