Diabetes and its Types 4 Research Paper
Abstract
Purpose
The researchers aim to understand the real life experience of nurses, specialists and healthcare practitioners in the management of hypoglycaemia and its impact on cognitive state of older patients.
Methodology
This study is a qualitative research study because it draws on various theoretical frameworks related to diabetes and hypoglycaemia as well as dementia. This research study will be using a qualitative research methodology because the researchers aim to understand the real life experience of nurses, specialists and healthcare practitioners in the management of hypoglycaemia and its impact on cognitive state of older patients. The study’s aim will be to construct case study on the basis of understanding and evaluation of the experiences of various individuals in a shared setting. This approach is known as Phenomenological approach and the authors have deemed it the most appropriate and suitable for this study.
Findings
The research findings will be able to provide insight for the caring and nursing as well as management of hypoglycaemic episodes n older patients at risk of dementia.
Practical implication
The research findings will assist National Health Service Primary Care Trust to reduce costs on unnecessary hospital admissions on occurrences of hypoglycaemia. The research findings will be able to provide insight for the caring and nursing as well as management of hypoglycaemic episodes in older patients at risk of dementia.
Conclusion
The research findings will be able to provide insight for the caring and nursing as well as management of hypoglycaemic episodes in older patients at risk of dementia. In addition to this the study will be able to provide information about the challenges involved n taking care of hypoglycaemic older patients at risk of dementia
Background of the Research
The development of medical industry throughout the world has led to introduction of several diseases and medical conditions that poses challenges for both the doctors and the patients. One such condition includes diabetes and hypoglycaemia as well as dementia in older patients. With advancements in medical sciences and healthcare industry an increasing trend can be seen in patient centred management strategies which not only treat diseases but also prevent them. However, there are still cases of complex medical conditions that are so interlocked and have an age related complexity that it becomes extremely difficult for treating and preventing these conditions unless the relationship between the conditions can be examined carefully.
With growing concern to a healthy lifestyle, it becomes extremely important to understand and treat the presence of cognitive dys-functionality known as dementia in diabetic patients because it is known to affect the diabetes management of these old age patients. The world medical records show that the rate of spread of diabetes has been rising exponentially all around the globe over the last few decades.
Diabetes and its Types
Diabetes is a chronic disease which may occur when a person‘s body lacks the ability to use the complete produced insulin in the body (WHO, 2008). Due to this inability to utilise the produced insulin, the blood sugar levels rise resulting in diagnosis of diabetes (Holt and Kumar, 2010). Medical research shows that there are two non-types of diabetes karma type one is the condition which others due to total deficiency of insulin produced by the body is known as diabetes mellitus. This is commonly categorised as an autoimmune disease which leads to degeneration and destruction of insulin secreting cells in the pancreas. On the other hand, another condition where there is a partial deficiency in insulin produced by the body is known as Type II Diabetes Mellitus. Type II diabetes has various levels of insulin deficiency that is usually managed through a continuous diet control, physical exercise, weight loss management and insulin maintenance medicine. The increased deficiency of insulin in body of a type II diabetic patient over a longer period of time may lead to insulin doses administered daily.
Projections of Diabetes
There is a projected increase in the number of diabetic patients all across the world by year 2030. It is estimated that today diabetic patients across the globe sum up to around 290 million adults however, due to the continuous increase in the prevalence of this disease, the number of diabetic patients is set to rise up to a whopping 440 million by the end of next decade. Medical research supports the fact that around 75% of the patients who have been diagnosed with dementia have also been diagnosed to be type II diabetic. As mentioned in literature review section, the type II diabetes is known to have a link with the onset of cognitive problems like dementia and Alzheimer’s in adult patients. (Ojo and Brooke 2015). In recent years, the role of diabetes in the development of cognitive decline and dementia has been the subject of research studies and discussion.
Relationship Between Hypoglycaemia And Dementia In Older People With Diabetes
Prior research on the issue of relationship between hypoglycaemia and dementia in older people with diabetes have shown that there is about directional Association between occurrences of low blood glucose in patients who also suffer from old age dementia. Research brides going evidence that diabetes in old age people has a high probability of increasing the risk of developing several of the cognitive impairment which include Alzheimer disease and vascular dementia (Fisher, 2010). This connection between hypoglycaemia older patients with dementia and diabetes has led to several research interests in this subject area so that various treatments can be initiated to prevent the onset of cognitive decline in form of severe dementia and this suggests that when blood sugar lowers to extremely low levels, can affect the cognitive functionality of a patient and it is impaired and longer episodes of Hypoglycaemia may end up resulting in neural damage.
Bidirectional Relationship
Research by other authors shows that the relationship between hypocalcaemia in patients with dementia and diabetes is a bidirectional relationship because it has been seen that low blood sugar usually occurs in patients with Diabetes Mellitus which ends up negatively impacting the cognitive ability and lead to dementia. On the other hand, this situation of dementia in turn can have a negative impact on the management of Diabetes Mellitus making it difficult to maintain steady blood sugar levels and hypoglycaemia may occur.
The relationship between these two variables is further signified by the evidence that diabetic patients who have suffered from a hypoglycaemic occurrence usually have a two-fold increased risk of developing early onset of dementia as compared to the diabetic patients who never experience hypoglycaemia. The evidence is substantial as medical records show that 34.4 percent versus 17.6 percent. This calls for a preventive treatment technique that prevents diabetic old age patients with episodes of hypoglycaemia from developing dementia as well.
Evidence from medical records of old age diabetic patients with dementia show that such patients are at higher risks of suffering from hypoglycaemic occurrence compared to patients with diabetes who were not suffering from dementia. 14.2 percent versus 6.3 percent also calls for new management techniques of healthcare services for patients with dementia. Such evidence calls for preventive treatment measures that can limit and prevent the onset of dementia in patients with diabetes Mellitus. In addition to this, healthcare for older patients with dementia should be managed to make sure they do not suffer from episodes of hypoglycaemia which may worsen their cognitive decline. The major aim is to devise practices and policies that are going to work on reducing this bidirectional relationship between hypoglycaemia and dementia in old age diabetic patients and its impacts.
Not only are these patients at risk of developing dementia but hypoglycaemia can further threaten and worsen the cognitive ability of older patients with Diabetes Mellitus (DM) and lead to Alzheimer’s disease and other severe forms of dementia. The risk factors increase even more and preventive treatment measure become more pertinent when the medical and theoretical evidence also suggests that older patients diagnosed with both diabetes and dementia have a higher probability of having hypoglycaemic episodes where the blood glucose levels drop dangerously low. Hypoglycaemia episodes may vary in nature and severity from mid dizziness to hospitalisation. With the world at risk for increasing prevalence of type II diabetes, the risk for hypoglycaemia and dementia among older diabetic patients also increases potentially. Therefore it is extremely important to recognise, understand and evaluate the relationship between these two conditions.
Rationale of the Research
The major concern of this study is to understand how hypoglycaemic patients can impact their cognitive skills due to repeated low blood sugar. In a community care setting of diabetes it the ability of the care giver to make choices and decisions about managing their lives as a diabetic patient (Feil et al. 2011). The major concern that this research study is going to focus on is that hypoglycaemia is a common occurrence in patients who are diagnosed with diabetes Mellitus and medical records and studies have shown that hypoglycaemic episodes in old age patients may lead to a negative impact on the cognitive functionality leading to dementia.
On the other hand, the cognitive impairment like Dementia can make it extremely difficult to manage the blood sugar levels in old age patients with type II diabetes leading to severe occurrences of hypoglycaemia. It becomes extremely important to understand the role and relationship between hypoglycaemia and Dementia in adult diabetic patients because this relationship and connection between the two variables is the only way through which management systems can be assembled that prevent cognitive impairment as well as hypoglycaemic episodes in old age patients with diabetes (Whitmer et al, 2009). The results of various medical studies on the relationship and impacts of Hypoglycaemia in older diabetic patients with dementia have shown that these two conditions can lead to the creation of a vicious cycle in which continuous and regular episodes of low blood sugar continue to damage the brain over a period of time leading to their inability to be able to manage their diabetes which in turn results in repeated occurrences of hypoglycaemia.
Research shows that the careful management of diabetes can help the patients in preventing memory decline. However, the risk factor that increase the chances of dementia in patients is that hypoglycaemia is a common occurrence for patients who take insulin shots or medicine to regulate or lower their blood sugar. On the other hand, people who suffer from dementia may not be cognitively active enough to maintain healthy blood sugar levels leading to complications like hypoglycaemia (McAulay, Deary and Frier, 2002). It is important to understand that there are certain medicines in the market that are used to regulate blood sugar but have been revealed to have a high risk of suffering from hypoglycaemia and are not suitable for older diabetic patients with diagnosed dementia or patients at risk for dementia.
It becomes extremely important to study the possible effect of diabetes on the cognitive state of the older patients because of hypoglycaemia’s relationship with onset of dementia and other cognitive ailments. In addition to this, there is an important consideration of reverse effect of dementia on the repeat episodes of hypoglycaemia because the patients lose their cognitive ability to maintain and regulate their blood sugar levels. There is a need to maintain healthcare systems for patients with dementia or with hypoglycaemia so that their blood sugar levels can be regulated and monitored carefully. This study will focus on the extent to which nursing specialist practitioners assist in the management of hypoglycaemia pregnancy in older patients with dementia and vice versa.
Research Aim
The research study will aim to explore the extent to which nursing specialist practitioners assist in the management of hypoglycaemia in adults patients with dementia in the community.
Objectives of the Research
A. To explore the extent to which the experiences of nurses and specialist practitioners have contributed in the management of cognitively impaired diabetic cases in the community.
B. To explore the extent to which the challenges nursing professionals face inhibits/impact on the care of cognitively impaired patients already diagnosed with hypoglycaemia.
C. To highlight and suggest possibly ways of alleviating these challenges
Literature Review
Vast amount of research has been carried out to understand the relationship between hypoglycaemia and dementia in diabetic patients. Although the precise mechanism through which diabetes and hypoglycaemia leads to cognitive impartial like dementia is not yet confirmed but a vast amount of evidence through medical studies has led to this belief that there is a bidirectional relationship between the two variables. Research shows that there has been a rise in the prevalence of cognitive degenerative disorders like dementia, Alzheimer’s and the steady increase is a major cause of concern. Various important medical studies by practitioners have convulsed that type II diabetes plays a major role in substantially increasing the risk of dementia in diabetic patients of old age (Rhee, 2017). In addition to just dementia, there are several other cognitive functionality disorders that occur because of type II diabetic.
Management of type II older diabetic patients therefore gains excessive importance because hypoglycaemia that is a conditions of extremely low blood sugar level is a leading cause that has a direct relationship with the onset of dementia in older diabetic patients. A study carried out by Korean National Diabetic Program (KNDP) showed evidence that presence of Hypoglycaemic episodes in patients younger than 50 years old was only limited to 3.7 cases per 1000 patients however, the results showed an exponential increase to 25.7 cases per 1000 patients in the older age group above 50. This shows that indeed hypoglycaemia has a negative impact on the cognitive ability of older diabetic patients and can cause dementia. Study by KNDP showed an acute increase in cognitive impairment (Dementia) in patients who experienced hypoglycaemia (Yaffe et al, 2013). The results of this study showed that the risk and severity of dementia increased proportionally to the increase in hypoglycaemic events.
Research also shows that older patients are much more vulnerable to hypoglycaemic episodes due to various other factor as compared to younger patients. It becomes increasingly difficult for older patients to manage their blood sugar levels in a moderated manner because their lifestyle, diet plan, exercise and medicine is very different comparatively to younger diabetic patients. When older patients suffer from hypoglycaemic episodes, impairment of cognitive abilities can lead to hypoglycaemic encephalopathy which is a condition of repeated hypoglycaemic occurrences (Meneilly and Tessier, 2016). Research shows that even though the exact mechanism is not fully understood by the researchers, type II diabetes and hypoglycaemia are found to be an important cause of dementia and cognitive impairment in the form of severe functional disorders.
Research shows that diabetes mellitus is one of the major chronic diseases that are prevalent throughout the world. The fact that glucose is the major fuel for human brain, makes it extremely important to maintain and regulate the level of glucose that travels through the brain. It has to be maintained with zero chance for error so that the normal brain activity can be maintained without any impairment (Morrison, J., 2004). Past research and literature shows that unregulated levels of glucose be it too high or too low can have a negative impact of the brain structure and its activity and functionality leading to cognitive impairment like dementia.
Albeit as opposed to the trust that hypoglycaemia could prompt dementia in diabetic patients as connoted by different scientists, Kosiborod et al. (2009) figured that hypoglycaemia can’t be the immediate reason for dementia all alone. He contended that it is conceivable that others neglected to recognize hypoglycaemia that came about because of different disease from those that happen from glucose lowering solutions. The author prescribed that, that when hypoglycaemia finding is done, that restorative issues and way of life by and large should be viewed as well, for example, past history of hypoglycaemia, escalated glycaemic control, undetected night-time hypoglycaemia, poor infusion system, long length of diabetes, impeded attention to hypoglycaemia, debilitated renal capacity, polypharmacy and terminal ailment. Way of life issues, for example, lacking nourishment consumption, mal-ingestion of sustenance, unpredictable eating design, expanding age, knotty over utilized infusion locales (lipo hypertrophy) and insufficient blood glucose checking should be thought about as well (NHS, Diabetes, 2010).
Another important study by Robin et al (2001) attempted to promote the preventative strategies with regard to hypoglycaemia and diabetes concluded that social and economic factors challenge the maintenance of a healthy lifestyle in diabetic patients. They authors argued that decreasing disposable income levels and educational achievements, could increase the risk of developing diabetes and also lead to hypoglycaemia. Another important literature evidence was provided by Biessel, et al, (2006) concluded that there is a higher and increased risk of dementia are in 1.5 to 2 fold increase in older people with type 2 diabetes mellitus.
Another important research study that focuses on the cognitive dysfunction of older diabetic patients concluded that the cognitive impairment is also closely associated to the self-care awareness and routine of diabetic patients in old age (Mielke, Taghibiglou and Lui, 2006). The appropriate use of health and social services are important for maintaining a healthy cognitive state. The results of this study revealed that patients who are diagnosed with a permanent type II diabetes mellitus showed a greater risk at having cognitive dysfunction and important in form of dementia which was result of a poor self-care awareness in diabetic patients and higher dependence on other for care and look after (Sylar et al, 2009). Patients who suffer hypoglycaemia may enter in early stages of dementia and may become dependent on others because they are no longer able to undertake their daily routine activities in a steady manner. As the cognitive impairment and decline continues, these patients may need 24 hour care round the clock with nurses and other professionals of the healthcare industry. Such patients are no longer adequate for taking proper care of their self and can mess up their medicine routine leading to major and severe episodes of hypoglycaemia.
Methodology
This study is a qualitative research study because it draws on various theoretical frameworks related to diabetes and hypoglycaemia as well as dementia. This research study will make use of literature with longitudinal prospective as well as few cross sectional studies aimed at evaluating the relationship between hypoglycaemia and cognitive impairment (dementia) in older diabetic patients. The purpose of selecting these studies will also be to understand the possible impact of cognitive functionality disorders on the ability of diabetic patients to manage their disease. Even though the literature may be able to evaluate the relationship that the authors sought, further evidence will be taken from the primary data collected using semi-structure interviews from nurses, specialists and healthcare practitioners in order to manage the hypoglycaemia’s effect on patients’ cognitive state.
Research Approach
This research study will be using a qualitative research methodology because the researchers aim to understand the real life experience of nurses, specialists and healthcare practitioners in the management of hypoglycaemia and its impact on cognitive state of older patients. The study’s aim will be to construct case study on the basis of understanding and evaluation of the experiences of various individuals in a shared setting. This approach is known as Phenomenological approach and the authors have deemed it the most appropriate and suitable for this study. The authors contemplated choosing a different method like evaluation research method or using surveys to collect data but rather than focusing on getting information directly from patients who have experienced hypoglycaemia and are diagnosed with dementia, the authors found it more important to understand the techniques that can be used to manage the condition in older diabetic patients.
The major reason for reaching out to nursing professionals is because they have a better understanding of the causes behind the repeated occurrences of hypoglycaemic episodes and they are well aware of possible preventive and treatment strategies that can be used to regulate the blood sugar levels in hypoglycaemic patients at risk of dementia. The time limitations make it extremely inappropriate for the authors to make use of an experimental approach. With collecting experiences from real life professionals in the healthcare industry, it is natural to use a qualitative and interpretive approach to focus on the individual responses and bring out a holistic output from the overall collected information through interviews.
Research Design and Data Collection
The interviews will be semi structured with a series of open ended questions aimed at gaining rich details from nurses and other professionals. For the purpose of capturing all the relevant information, the interviews will be tape recorded with the permission pf the respondents.
Later on these tapes will be documented into interview transcripts. Notes will be constructed out of these transcripts to observe common details and new aspects in the subject area. The questions of the research will be devised after careful study of the prevalent literature because the research available will provide insight and give direction to this research study.
Sampling
The sample will be selected purposefully. With this in mind, the authors will select nurses and professionals that have the rich amount of experience in the field of diabetic patient management. Nurses with more than five years of experience in managing and caring for patients with hypoglycaemia in type II diabetes will be selected. Nurses who do not have sufficient experience or are not directly involved in taking care of patients with hypoglycaemia in type II diabetes will not be made part of the sample. The participants will be selected from a nursing home or homes of NHS Trust to be chosen. All the experienced nurses will be given invitation letters for participation in the study. Positive response and willingness of the nurses in the study will be acknowledged and appreciated. Selected nurses will be given time for interviews and their consent paper will be signed on the day of the interviews.
Proposed Data Analysis
The interview tapes will be documented into interview transcripts. Notes will be constructed out of these transcripts to observe common details and new aspects in the subject area. Transcribed reports of the recorded interviews will be sent to the respondents for a final check to see if they have provided all the relevant information. If any changes are required, these changes will be made after confirmation from the interviewees. A holistic and selective approach will be used to make sure that important meanings are captured from all the collected data by highlighting the impotent statements and phrases from the interviews. The purpose of this study will be to record all the important discussion and ideas from the nurses’ experience of caring for hypoglycaemic older diabetic patients. The impregnated terms will be used as “in vitro codes”. The data will be interpreted using interpretive approach. The first part of the analysis will be based on description of all the important details and the second part of the analysis will be interpretation of the important details in a holistic manner to gather key themes and present them in a meaningful manner.
Ethical Considerations
This research study will keep in mind all the improvements ethical principles to maintain the validity and quality of this research study. No participants will be coerced or forced into taking part in interviews. The accuracy of the data will be maintained by not changing wording or meaning of the interviewee’s answers. To maintain confidentiality and anonymity, the names and designation of the nurses will be kept confidential and will not be used in the research report. Without the consent of any participant, their personal data will not be used as part of the research.
References
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