Table of Contents
Introduction
Diabetes is a condition that reflects low production of insulin, elevated blood sugar, and resistance to insulin. Diabetes occurs in two categories, type 1 and type 2 and both cases; they result from obesity, poor diet and lack of exercise resulting in metabolic syndrome. Diabetes is an expensive disease in the United States and consumes a significant percentage of the healthcare resources in addition to lost productivity. The United States and other first world countries have succeeded in preventing and postponing the implications of the disease by implementing excellent healthcare. However, delaying and preventing the disease covers the ever-persistent high incidences of diabetes itself in homes and expanding globally.
Diabetes affects over twenty million United States citizens and is a burden to the state and personal finances. With these worrying facts, there has been some decline in the diabetic related complications among the people with diabetes. Mortality rates have dropped for both men and women with diabetes in the United States significantly in the period of 1997 and 2006 (Gulliford& Charlton, 2009). Incidences of myocardial infarction, death from the hyperglycemic crisis, end stage renal disease and amputation and other complications related to diabetes have dropped significantly (Centers for Disease Control and Prevention, 2014). These declines in diabetes-related complications are because of improved healthcare facilities. Though the health sector is improving and reducing the implications of diabetes, the disease has become an epidemic in the United States.
In the United States, diabetes is increasingly ubiquitous in the recent years. According to the Center for Disease Control and Prevention, the diabetes rates will rise significantly (Centers for Disease Control and Prevention, 2014). Diabetes has increased to the level of an epidemic as it affects people from across the globe. According to CDC, 9.3% of the United States population has diabetes, and the undiagnosed people with diabetes stands at 27.8% (Centers for Disease Control and Prevention, 2014). Based on the statistical standings, the prevalence of the disease is worrisome, and an intervention is of great urgency. Therefore, the aim of this article is to offer a three-phase intervention to mitigate the prevalence of diabetes. The responses include coalition formation and training of healthcare personnel and patients on management, prevention, and treatment of diabetes. The second phase is information collection analysis and implementations of the results. The last step is community development and recommendation of family action against the disease.
Coalition Formation and Training
Coalitions are developed to address different community-related problems. The first step towards agent intervention to the growing diabetes epidemic is the formation of alliances and training of a sample group on the implications of the disease. This is because coalitions often sponsor a strengthened expertise, set of abilities and capability in the communities in which they are enacted (Miller, Rhema, Faul, D’Ambrosio, Yankeelov, Amer, & Clark, 2012 432). Additionally, community coalitions provide participatory tactic able to relate to an assorted group in developing efficient community pinpointing proposals. The coalition framework produces a platform to exchange ideas, pool assets, foster sustainable systems, empower individuals and groups in dealing with diabetes (Miller et al., 2012 433). Therefore, the formation of community coalitions and training is essential in preventing and delaying the diabetes epidemic.
This research reports on the use of community coalitions to avert and manage the diabetes epidemic in a community in Kentucky. The coalition formation was an integrated process that included brainstorming, group discussions, statement analysis, interviews and literature review. The study aimed at developing a long-term solution in reducing the implications of diabetes in the American population (Miller et al., 2012). Formation of the group was edicted by a host of distinct factors. The factors included member knowledge; disease infected and affected members, resources and skill set. Simply put, the coalition requires people who share a common problem and collaborate to address and reduce its effects from spreading across (Miller et al., 2012). The community that creates defines the coalition and in this case, the society of diabetes patients, community, church members, and the community hospital, local area municipality formed the coalition. The primary objective of the group was to educate people and provide a sustainable mechanism for dealing with diabetes as an epidemic.
The community coalition strategy was to target all age groups who had encountered diabetes. According to the national diabetes report, in 2009-2012, adults aged twenty years or older had pre-diabetes 51% of those aged 65 years or older (Centers for Disease Control and Prevention, 2014). When employing this percentage to the entire United States population in 2012, it results to approximately 86 million Americans has pre-diabetes. Therefore, there was a need to include all age groups in the formation of the coalition-training program. Additionally, though uncommon, the rates of new cases of diabetes were greater among the ten to nineteen-year-olds as compared to younger children (Centers for Disease Control and Prevention, 2014). Members of the coalition group were from all races because diabetes is prevalent in the minority groups especially those of Indian origin.
Formation of relationship with the community’s stakeholders was essential in the realization of the coalition’s objective. Members of the coalition included physicians from the community hospital students, religious leaders, the county legislatures and even the law enforcement agencies. The coalition’s strategy focused on the two types of diabetes, type one caused by the destruction of insulin generating cells by the immune system. Additionally, type 1 of diabetes is triggered by viral infection, chemical toxins in the food and unidentified elements rooting autoimmune reaction. The second area of discussion was the type 2 diabetes that has multi-factorial causes. The most cause of type 2 diabetes are the family related, but there are trigger factors that include obesity, poor diet, growing old and leading a sedentary lifestyle. On discussing these areas, the primary objective of the coalition is to empower the coalition members on handling and managing diabetes.
The physicians from the community hospital acted as educators while other community stakeholders served as leaders. Doctors worked as teachers because they possessed considerable knowledge on management and treatment of diabetes. Secondly, the community stakeholders that include religious leaders, law enforcement agents acted as leaders because they knew and understood the community (Chutuape, Willard, Sanchez, Straub, Ochoa, Howell, & Ellen 2010). With the leadership structures in place, volunteers came forth to represent the families and members of the community in the study. Participants in this group were around 30, 18 women and 12 men. Additionally, the study group was racially diverse because it consisted of Indians, Hispanics, African Americans, and Native Americans. Furthermore, the group sampled from all ages because diabetes was disproportionate age and racial wise.
Coalitions strengthen the focus of the community in handling a particular problem. If resources and strategies effectively address the diabetes problem, the coalition results can significantly reduce the diabetes complications (Butterfoss, Gilmore, Krieger, Lachance, Lara, Meurer & Rosenthal, 2006, p. 40). Furthermore, the sustainability of coalition programs and member groups is fostered when the expected outcomes are achieved. In this case, if increased awareness on management and treatment of diabetes improves and people start leading a healthy lifestyle the coalition can further undertake other projects. With preliminary positive outcomes, the progress of the coalition ameliorating the diabetes epidemic in a small group can expand and address the problem on a larger scale (Butterfoss et al., 2006). For instance, if a small community took steps towards leading a healthy lifestyle and managing diabetes triggers that in turn reduce diabetes-related complications can influence the community to make similar healthy decisions.
Data Collection, Analysis, and Dissemination of Results
During the study, researchers divided members of the community into focus groups based on the religion race, age and ethnicity where participants felt comfortable. The methodology of focus groups was relevant for this study because the needed information was sensitive and complicated and is consistent when used orally (Zwaanswijk & van Dulmen, 2014). Each focus group was assigned a facilitator who took notes during the discussions and interviews. During the study session, the facilitators asked the participants to describe the effects of diabetes and obesity in their respective families. Additionally, the respondents discussed some of the hindrances towards practicing a healthy lifestyle, why some people have diabetes, and yet they are not diagnosed. After the interviews, the facilitators under the instructions of the leading researcher reviewed the responses of the focus groups where certain themes emerged. Through qualitative analysis, it was evident that diabetes is associated with sedentary lifestyle, fast food advertisement, and cost of fresh produce, expensive medication and lack of awareness. Additionally, the perceptions of family members towards diabetic and obese people were stigmatizing. Some participants stated that when their loved ones suffered from diabetes, they used the internet and books to educate themselves on diabetes. Based on the findings of the study, it was essential for the team to review the information and develop a family and community plan of action.
Development of Family and Community Action Plans
The number of diabetes patients is increasing rapidly across the United States. Increased diabetes prevalence directly increases chances of contracting other diabetes-related complications. Diabetes contributes to vascular complications such as heart failure. Vascular-related complications are the leading causes of economic and social burden among patients and society more broadly (Jakus, Sándorová, Kalninová & Krahulec, 2014). Based on the current statistics, it is projected that I n the near future, the numbers of people with diabetes type 2 will double as well as those with impaired glucose tolerance. According to medical research, diabetes is one of the leading causes of premature mortality that is underestimated and fifty percent of patients with diabetes type 2 suffer the premature death of cardiovascular and ten percent of the patients die from renal failure. However, these medical complications are preventable or at least can be delayed if the proper community and family action plans are implemented.
Empirical evidence from previous studies reveals that a significant proportion of diabetes type 2 and type 1 can be prevented or at least postpones related complications by undertaking simple activities such as physical exercise (Balk, Earley, Raman, Avendano, Pittas & Remington, 2015). Additionally, studies have shown that through comprehensive medical treatment and support, the complications of both type 1 and type 2 can be avoided or delayed by making it possible people with diabetes to live longer and healthier lives. Availability of essential drugs to manage and treat diabetes with the available technology that assists in monitoring the prevalence of diabetes can help in mitigating the related complications such as vascular or renal failures. Implementation of community and family action plans are affordable and can save thousands of lives, alleviating misery and cutting the future costs and impoverishment that diabetes imposes on individuals, family, community and states. In fact, diabetes is an epidemic because it affects all aspects of humanity from health, economic, social and environment.
Improving health outcomes for people with diabetes can significantly reduce or prevent diabetes-related complications. Enhancing health and other qualities of life outcomes of people with diabetes starts by cutting on the social and personal costs and the adverse implications start with improving the efficacy of the cores of diabetes care. In this case, the basics of diabetes care include fostering self-management and support, improved clinical treatment and, monitoring to achieve glycemic and metabolic control and prevention of modifiable complications. Availability of essential medication and technologies in the community health facilities can help in treating and management of blood pressure and lipid disorders that characterize diabetes and result in other related complication (Balk, Earley, Raman, Avendano, Pittas & Remington, 2015). Availability of such medications can minimize complications such as heart attacks or strokes and other fatal complications. These medications include insulin used by people with diabetes type 1 and type 2, oral blood glucose reducing agents and blood pressure reducing agents.
Additionally, the outcomes of individuals with diabetes can be improved by the availability of essential technologies. These technologies include diagnostic and monitoring equipment, supplies and reagents. Such technologies are simple and relatively inexpensive. The government can invest in theme and make them available to all the people in the community especially those in the lower income classes. Based on the findings of the study, a majority of the participants are not diagnosed because the accessibility of treatment is expensive. Making such, technologies available to the people or at least in the community facility can significantly reduce the diabetes-related complications particularly the modifiable ones. With the availability of necessary technologies, it is easier to diagnose diabetes, offer initial evaluation and treatment and to follow-up on ongoing clinical monitoring. Additionally, the technologies can facilitate timely and appropriate self-management and early screening and detection of related complications of diabetes.
Secondly, prevention of development of diabetes type 2 can help reduce the epidemic. According to research findings, the families were consistent with finding it hard to maintain a healthy lifestyle because of the financial and social pressures (American Diabetes Association. 2013). The inability to undertake simple physical exercise or lead a healthy lifestyle increases the chances of contracting diabetes type 2 (Balk, Earley, Raman, Avendano, Pittas & Remington, 2015). The advantage is that practicing a healthy diet and taking simple physical exercise significantly reduces chances of contracting diabetes, particularly type 2. In the United States, the numbers of obese citizens are significantly increasing, and this is because of availability of fast foods and carbonated beverages. Additionally, the changes in social and technological arrangements have contributed to people being inert increasing their chances of contracting diabetes. To combat such challenges first formulation of health in all policies, secondly availability of nutrition and finally foster physical activities in schools and at home.
Disease prevention and health are all rooted in good nutrition. Both excess and poor nutrition elevate the chances of type 2 diabetes and diabetes itself intensified by poor diet. Poor nutrition is common in social-economically challenged people while over nutrition can occur in the privileged groups if not well monitored. A healthy diet can be promoted through maternal child health nutrition, regulation to cut on fat, sugar and salt content in processed foods and beverages and public education (Feinman, Pogozelski, Astrup, Bernstein, Fine, Westman & Nielsen, 2015). Additionally, the government can consider health in all its policy formulation and implementations. For instance, the government can formulate policies that govern food production, working environment, food storage, advertisement and pricing of foodstuffs. Finally, implementation of policies that foster physical activities and discourage sedentary lifestyle in correct settings such as schools and workplaces can help prevent diabetes type 2. Physical activities reduce the risk of obesity, which in turn reduces chances of contracting diabetes type 2.
Lastly, reduce stigmatization of people with diabetes by promoting and protecting their rights. Protection of individuals with diabetes can be achieved through the formulation of policies that enable people with diabetes to access insurance, employment, and education. Additionally, an active community and family plan can ensure that people with diabetes play a leading role in the formulation of diabetes-related policies. Active engagement of people with diabetes in leadership positions can help in securing funds and commitment from the government in battling the disease. Furthermore, active participation in diabetes campaigns can improve awareness and self-management break down stigma. In this sense, the involvement of the community, family, and community as a whole can help reduce the prevalence of diabetes and reduce the related complications at large.
Conclusion
Patently, with all the adverse complications related to diabetes the disease is manageable with appropriate intervention measures. From the manuscript, it is evident that implementation of the three phased program can significantly modify the outcomes of the disease. For instance, from the findings of the study it is evident that fifty percent of the mortality rates are due to lack of information and education. Educating people on self-management of diabetes and the need to practice a healthy lifestyle can significantly reduce the epidemic of diabetes.
Finally, with an effective family and community plan of action with appropriate resources and support, diabetes can be prevented and the, mortalities reduced by elongating the lives of people with diabetes. Therefore, diabetes is a manageable and preventable epidemic if individuals, families, community and country play their respective roles.
Notes
- Always use abbreviations for well-known compound words, particularly those that identify a country or organization e.g CDC and US/USA in the case of this paper. Using the full names iteratively is poor writing as instructors describe this as using filler words to make the word count without actually communicating anything.Additionally, there are several instances of intext-listings of all of the surnames of contributors of a given source e.g. Balk et al., 2015, adding extra words to the paper. Avoid such instances of word padding.
- Instances of colloquialism
- Minimize the use of passive voice. This paper features numerous instances of passive voice that I couldn’t expunge because of time.
- American Diabetes Association. (2013). Economic costs of diabetes in the US in 2012. Diabetes care, 36(4), 1033-1046.
- Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L. (2015). Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Annals of internal medicine, 163(6), 437-451.
- Butterfoss, F. D., Gilmore, L. A., Krieger, J. W., Lachance, L. L., Lara, M., Meurer, J. R., … & Rosenthal, M. P. (2006). From formation to action: How Allies Against Asthma coalitions are getting the job done. Health Promotion Practice, 7(2 suppl), 34S-43S.
- Chutuape, K. S., Willard, N., Sanchez, K., Straub, D. M., Ochoa, T. N., Howell, K., … & Ellen, J. M. (2010). Mobilizing communities around HIV prevention for youth: How three coalitions applied key strategies to bring about structural changes. AIDS Education & Prevention, 22(1), 15-27.
- Centers for Disease Control and Prevention. (2014). National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services, 2014.
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- Jakus, V., Sándorová, E., Kalninová, J. A. N. A., & Krahulec, B. O. R. I. S. (2014). Monitoring of glycation, oxidative stress and inflammation in relation to the occurrence of vascular complications in patients with type 2 diabetes mellitus. Physiological Research, 63(3), 297.
- Miller, J. J., Rhema, S., Faul, A., D’Ambrosio, J., Yankeelov, P., Amer, R., & Clark, R. (2012). Strength in process: Using concept mapping to inform community coalition development. Journal of Community Practice, 20(4), 432-456.
- Zwaanswijk, M., & van Dulmen, S. (2014). Advantages of asynchronous online focus groups and face-to-face focus groups as perceived by child, adolescent and adult participants: a survey study. BMC research notes, 7(1), 756.