Signature Assignment Current-Type 2 Diabetes Mellitus
This paper provides an in-depth examination of the chronic health problem known as type 2 diabetes mellitus. The foundation for this research is two peer-reviewed original research contributions. The paper examines major concepts and viewpoints on chronic health concerns using these resources. The objective is to provide the reader with a deep insight into type 2 diabetes mellitus with regard to clinikc evaluation, symptomatic presentation, evaluation, and management of clinical guidelines
Patient ID: Mr. G.H DOB, 1/1/1957, age 65, is an American white man who has presented himself to the clinic and seems to be a reliable historian.
Chief Complaint: “I am here for an annual checkup.”
History of Present Illness: The patient is a 65-year-old retired firefighter officer. Mr. G.H has a past medical illness of type 2 diabetes mellitus and Hyperlipidemia, and he is currently on medications. The patient’s prescriptions are a daily oral dose of Metformin 500mg and a daily oral dose of Simvastatin 10 mg. He claims he has no complaints and is only here for a checkup because he had blood work done two weeks ago. The laboratory test results reveal that his health has significantly improved regarding glucose and cholesterol levels. At this moment, he denies experiencing an increase in urination. He denies fever, vomiting, diarrhea, constipation, muscle numbness, or pain. He denies loss of appetite or weight loss. He also denies experiencing cardiovascular and respiratory disorders.
Past Medical History
Type 2 diabetes mellitus
Takes Metformin 500mg PO daily for type 2 diabetes control
Takes Simvastatin 10 mg PO daily film-coated tablet for Hyperlipidemia
Allergies: No known allergies
Immunizations: Up to date
Living situation: He lives with his wife and two grandchildren. Denies financial strains.
Occupation: Retired firefighter
Marital Status: Married
Tobacco/Street drugs: Denies
Alcohol: Stopped drinking 10 years ago
Exercise: Occasionally, only once in two weeks
Ability to perform ADLs: Yes
Father: Died, had diabetes
Mother: Alive, has diabetes and Osteoarthritis
Grandfather: Diseased, no known illness
Grandmother: Diseased, no known illness
Review of Systems
General: He denies experiencing fatigue, fever, breathing difficulties, chest pain, muscle pain, nausea, vomiting, or diarrhea, and he states to have a normal appetite. He states he is in good health.
Head: Denies loss of consciousness or head injuries.
Eyes: Denies color blindness, eye pain, dryness, or excessive tears. Uses corrective lenses.
Ears: Denies hearing loss, ringing in ears, discharge, or ear pain.
Nose: Denies nosebleed, loss of smell, nasal congestion, or pain.
Mouth: Denies mouth wounds, bleeding gums, or lesions. No tooth decay. He states Last dental checkup was approximately 6 years ago.
Throat: Denies sore throat, swallowing discomforts, altered taste, or hoarseness.
Skin: Denies skin color change, bruises, rashes, or lesions.
Respiratory: Denies coughing, wheezing, breathing difficulties, or dyspnea at the moment.
Cardiovascular: Denies chest pain, tachycardia or palpitations.
Gastrointestinal: Denies vomiting, odynophagia, constipation, dysphagia, nausea, abdominal discomforts, or diarrhea
Genitourinary: Denies penile abnormal discharge. Denies increase in urine frequency. No burning sensation.
Musculoskeletal: Denies muscle and joint pain, tenderness, swelling, or a reduction in range of motion in the joints.
Heme/Lymph/Endo: Denies swollen gland, history of blood transfusion. Denies excessive sweating.
Neurologic: Denies dizziness, headaches, seizures, transient paralysis, tremors, or syncope.
Psychological: Denies suicidal thoughts, depression, hallucinations, anxiety, or memory loss.
Vital Signs: Temperature: 98.4F, Blood Pressure: 118/77mmHg, Pulse rate: 62 beats per minute. Weight: 176.3 lbs. Height: 6ft, BMI: 23.9
Head: normocephalic, atraumatic, symmetric
Ears: Hearing grossly intact, external auditory canals and tympanic membranes clear.
Eyes: Positive PERRLA. EOMI. Anicteric.
Nose: Moist mucous membranes. Nasal mucosa pink. No bleeding, lesions, or maxillary sinuses.
Throat: No exudate, lesions, inflammation. Pharynx normal. Teeth and gingiva in excellent general condition.
Skin: Smooth, warm, smooth, and dry. No rashes, bruises, or change in skin color.
Cardiovascular: Regular heart rhythm. Normal S1 and S2 sounds.
Gastrointestinal: Soft, non-tender, and non-distended abdomen. No palpable masses.
Respiratory: Auscultation of the lungs reveals no abnormalities.
Genitourinary: Prostate assessed with the digital examination, which reveals no abnormalities.
Musculoskeletal: No swollen, stiff, or tender joints or muscles.
Extremities: No edema.
Neurological: Normal gait and Stable balance. Clear speech and clear voice tone.
Psychiatric: Perfect memory. Cooperative, alert, good mood and behavior. Clear response.
HbA1c test – 8.0%
LDL cholesterol – 186 mg/dL
Type 2 Diabetes mellitus (E11. 9) – this is a disorder in which the body’s ability to control and utilize glucose as energy is impaired (Madhu et al., 2020). This long-lasting illness results in an abnormally high blood sugar level. Without control, it is possible to develop immune system diseases as a result of excessive blood sugar levels (Madhu et al., 2020). According to the lab test results, the diagnosis is ruled in
Hyperlipidemia (E78.5) – this is a condition whereby the blood contains an excessive amount of lipid particles (Saraogi et al., 2022). Hyperlipidemia is an asymptomatic disorder that can be detected with a blood test (Saraogi et al., 2022). In this case, the patient patients LDL cholesterol level is at 186 mg/dL; as a result, we rule in the diagnosis.
Dental complications (K08. 9) – Without proper care for diabetes, a person is more likely to have oral complications (Poudel et al., 2018). The blood sugar could become more difficult to control as a result of gum disease. Occasionally, individuals may start noticing that their gums seem inflamed and bleed during brushing and flossing (Poudel et al., 2018). Others report oral dryness, discomfort, white spots, or having a bad taste (Poudel et al., 2018). Even though the patient did not mention any symptoms in regard to oral complications, visiting a dentist is a good idea for any of these reasons.
DX: Type 2 Diabetes mellitus
Hemoglobin A1C test – The hemoglobin A1C test assesses whether the blood sugar level is too high or too low. HbA1c is also referred to as glycosylated hemoglobin (Madhu et al., 2020). The findings of one-day testing will not give a realistic assessment of how effective the treatment is working; therefore, individuals with diabetes must undergo this test on a frequent basis in order to check their blood sugar levels (Madhu et al., 2020). This also will help to evaluate if the diabetic medications should be modified. In this case, the HbA1c test result is 8.0%. These findings indicate that the medication is effective.
Lipid test – Due to the absence of symptoms, detecting Hyperlipidemia is challenging (Saraogi et al., 2022). But diagnosing Hyperlipidemia can be identified with a lipid profile blood test (Saraogi et al., 2022). As a result of this test, it is found that the patient has a high level of fats in the blood, but there has been a positive improvement.
Treatment Plan: In this case, we will not modify the medications. Therefore the patient will continue taking a daily oral dose of Metformin 500mg for type 2 diabetes and a daily oral dose of Simvastatin 10 mg film-coated tablet for Hyperlipidemia
Referral: Even though the patient did not show any symptoms related to dental disorders, he is recommended to check a dentist for a further dental examination.
Follow-up: The next visit will be in three months, but he is also recommended to visit the clinic as soon as possible if any symptoms arise.
Type 2 diabetes mellitus (T2DM) is a disorder in which the body’s ability to control and utilize glucose as energy is impaired. This long-lasting illness results in an abnormally high blood sugar level. Without control, it is possible to develop immune system diseases as a result of excessive blood sugar levels. According to the lab test results, the diagnosis was ruled in. Therefore, the following are the two research-based resources I have chosen for this case study:
Article 1: Madhu, S. V., Chawla, R., Makkar, B. M., Ghosh, S., Saboo, B., & Kalra, S. (2020). RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian Journal of Endocrinology and Metabolism, 24(1), 1. https://doi.org/10.4103/ijem.ijem_225_20
Article 2: Gnesin, F., Thuesen, A. C. B., Kähler, L. K. A., Madsbad, S., & Hemmingsen, B. (2020). Metformin monotherapy for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD012906.pub2
Similarities of these Articles
These articles discuss how type 2 diabetes is diagnosed and managed. By contrast, these articles highlight the necessity of adhering to established clinical recommendations for disease treatment and educating patients about the critical role they can play in treatment decisions and lifestyle modifications. The primary focus of Madhu et al. (2020) article is on screening for type 2 diabetes before it becomes uncontrollable. The Gnesin et al. (2020) article has also shown that metformin can be used to treat people with type 2 diabetes in other research.
Review for Article 1
Madhu et al. (2020) article focuses on the detection and monitoring of diabetes mellitus. The article provides an explanation of why screenings are advised for individuals of all ages who may be at risk of developing acute diabetic symptoms. Although end-organ damage chances remain unchanged, persons screened for DM illness are more likely to receive early diagnosis and therapy. Low fasting glucose or hyperglycemia patients can reduce the risk of developing diabetes when lifestyle and medications are employed. It was because of this relationship that I decided to use this publication in this circumstance.
The results of the tests reveal that indeed patient’s blood glucose levels are higher than normal, indicating the patient has type 2 diabetes (Madhu et al., 2020). According to the tests, his HgbA1c level was 8.0%. In this case, the patient had stated have been following the treatment guidelines; as a result, there has been a greater improvement. At this visit, the patient claims to have no complaints.
Review for Article 2
Gnesin et al. (2020) article contain recommendations for treating type 2 diabetes with pharmaceutical formulations. When choosing or prescribing a certain treatment plan, all aspects of patient-centered programs must be taken into consideration (Gnesin et al., 2020). For example, the type of medication chosen must directly address concerns related to controlling blood glucose levels as well as risks related to cardiovascular. Some other factors patients with diabetes have to consider are how much they pay for treatment, how much they can handle, and how effective the treatment is. For instance, US T2DM recommendations place a high priority and consideration on preventing hypoglycemia and minimizing drug side effects on weight, but they downplay the likelihood that medication could increase cardiovascular risk. Knowing the best and safest approaches to treat high blood sugar in persons with type 2 diabetes is crucial because specific glucose-lowering medicines have not been proved to impact underlying cardiac prognosis. This article analyzes the most widely acknowledged consensus guidelines for hyperglycemia treatment in such patients.
Because this article 2 is centered on the patient situation, there are various elements to consider when selecting the optimal diabetic medication after assessing all probable diagnoses. Hyperlipidemia and cardiovascular event are some of the conditions that should be identified as risk factors for developing the treatment (Madhu et al., 2020). As a result, applying Article 2 enables physicians to prescribe the most appropriate therapy for each patient.
Madhu et al. (2020) examines fundamental ideas such as screening periodicity, diagnostic procedures for diabetes mellitus classification, as well as making essential recommendations. One of the key concepts we learn is that even though there are many diagnostics tests for diabetes mellitus, Madhu et al. (2020) article has majorly emphasized the hemoglobin A1C test. Other diabetic diagnostic tests include competitive insulin autoantibodies, zinc transporter 8 (ZnT8) autoantibodies as well as glutamic acid decarboxylase. These tests have specific functions; for example, c-peptide is essential for determining endogenous insulin production, and ZnT8 is essential in checking the prevalence of autoimmune-dysfunction diabetes
Gnesin et al. (2020) article discusses both therapeutic options for t2dm and the pathogenetic abnormalities that underpin the condition. The article also discusses lifestyle adjustments and metformin monotherapy. To support this, a study conducted in the United Kingdom compared the drug’s effectiveness to that of other treatments and discovered that it inhibits hepatic glucose production and impaired insulin secretion. Moreover, Gnesin et al. (2020) article discuss the characteristics of insulin glucose-lowering drugs, which will aid in the decision-making process for those with type 2 diabetes.
This subject of diabetes mellitus is not particularly contentious as a medical issue caused by a range of well-known risk factors. In terms of study quality, the two articles give sufficient evidence to support my clinical recommendations for resolving client-related difficulties and answer the same issue regarding the requirement of screening high-risk individuals on a regular basis as a control strategy. Diabetes type 2 is the most likely diagnosis based on the patient’s symptoms and the results of tests and an evaluation of their medical history (Madhu et al., 2020). Using this clinical method, I managed to figure out what this person’s problem was and develop a treatment plan.
Merit of Evidence
Both studies contain sufficient evidence to support their results for the identical condition. Madhu et al. (2020) article refer to reputable authorities, such as the United States Centre for Disease Control, which advocates for screening individuals aged 40 and above. Additionally, the American Diabetes Association (ADA) has case examples demonstrating the importance of expanding risk assessment (Davies et al., 2018).
To make therapeutic decisions, the American Diabetes Association (ADA) says people should look at clinical effectiveness, patient compliance, glucose level as well as a patient preference (Davies et al., 2018). These are just a few of the things the ADA says should be taken into account when making decisions about how to treat diabetes. As per the reviewed literature, screening is an important health practice that should be undertaken on those who are at a higher risk of developing diseases such as type 2 diabetes.
Current EBM guidelines
Evidence-based guidelines for type 2 diabetes management are already available and updated in order to enhance the quality of performance and standards. The guidelines clarify that pharmaceuticals should address many Type 2 diabetes shortcomings and take a patient-centered strategy that takes into account aspects other than blood sugar control and cardiovascular rehabilitative activities (Davies et al., 2018). Comorbidities, cost, tolerance, as well as glycemic efficacy all have an effect on the therapy alternatives available to a patient (American Diabetes Association, 2021). The Type 2 diabetes mellitus recommendations developed in the United States have placed a heavy emphasis on the dangers of hypoglycemia and the detrimental effects of pharmaceutical therapy, but little attention has been made to the possibility of specific medicines to affect heart attack risks (American Diabetes Association, 2021). The new guidelines for treating people with T2dm say that individuals on metformin medication should take them every day.
Impact Practice and What Should be done
The two articles suggest that earlier screenings and pharmaceutical therapies in patients with diabetes are the optimal long-term solution for diabetic patients. Whereby regular screening and administering of the medicine minimizes organ harm. With the intervention provided in the two published studies, I intend to modify my approach to managing diabetic patients in order to guarantee that they receive a broad variety of treatment alternatives. These include lifestyle changes, medication therapy, as well as screenings for patients aged 40 and above. Everyone in the family of patients who have diabetes should be involved in the test results and education that will be given. This way, everyone knows how the disease is progressing in their family, and they can help each other get better at managing their health.
The first step toward developing effective diagnosis and treatment is to recognize the importance of cultural awareness (Juanamasta et al., 2021). It transcends a limited interpretation of societal beliefs, attitudes, traditions, language groups, and other forms of thought and behavior. Clinicians must possess cultural humility in order to give effective medical training to their patients. This will aid in the development of a mutually beneficial and supportive relationship between patients and health care workers (Juanamasta et al., 2021). There are better results when both the patients with diabetes and the clinicians understand the culture. To successfully overcome cultural barriers in healthcare, clinicians must use proper communication skills with patients.
The spiritual convictions of patients with diabetes might profoundly affect their treatment. Many people with diabetes find it difficult to maintain a healthy diet, burn calories, or exercise just because of their spirituality (Choi & Hastings, 2018). There may be a link connecting religious beliefs, the capacity to cope with diabetes-related mental anguish, and healthy lifestyles that result in improved glycemic control for diabetes patients and their family members (Choi & Hastings, 2018).
Individuals’ social and economic status in society can be defined in a variety of ways, but it always boils down to how well they perform in comparison to their peers. Consequently, this can be based on their income or social status. These inequalities in socioeconomic status may deepen social class divisions. Diabetes and its effects disproportionately impact those from lower socioeconomic backgrounds (Choi & Hastings, 2018). Poor metabolic parameters, mental stress, and lack of access to prescribed preventative therapy are all factors that contribute to poor health outcomes for people with diabetes (Choi & Hastings, 2018). Many Americans at risk of chronic illness can now obtain better, more coordinated treatment at a reduced cost as a result of enhanced insurance coverage and new care plans (Choi & Hastings, 2018). People at risk for diseases like diabetes have not been able to get the help they need because health care reform has not been able to find socioeconomic concerns and put more emphasis on the risk factors of socioeconomic status.
We have described how to handle and regulate diabetes mellitus with the help of the two articles. Aside from raising awareness of the disease, the two articles have worked to educate the public on the need for self-care and following treatment standards. These publications have been beneficial in terms of diagnosis of diabetes and learning more about metformin therapy options and the distinctions between various techniques for controlling certain ailments.
American Diabetes Association. (2021). Standards of medical care in diabetes-2021 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 39(1), 14–43. https://doi.org/10.2337/cd21-as01
Choi, S. A., & Hastings, J. F. (2018). Religion, spirituality, coping, and resilience among African Americans with diabetes. Journal of Religion & Spirituality in Social Work: Social Thought, 38(1), 93–114. https://doi.org/10.1080/15426432.2018.1524735
Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing, P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018). Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 41(12), 2669–2701. https://doi.org/10.2337/dci18-0033
Gnesin, F., Thuesen, A. C. B., Kähler, L. K. A., Madsbad, S., & Hemmingsen, B. (2020). Metformin monotherapy for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 2020(6). https://doi.org/10.1002/14651858.CD012906.pub2
Juanamasta, I. G., Aungsuroch, Y., Gunawan, J., Suniyadewi, N. W., & Nopita Wati, N. M. (2021). Holistic care management of diabetes mellitus: An integrative review. International Journal of Preventive Medicine, 12, 69. https://doi.org/10.4103/ijpvm.IJPVM_402_20
Madhu, S., Chawla, R., Makkar, B., Ghosh, S., Saboo, B., & Kalra, S. (2020). RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020. Indian Journal of Endocrinology and Metabolism, 24(1), 1. https://doi.org/10.4103/ijem.ijem_225_20
Poudel, P., Griffiths, R., Wong, V. W., Arora, A., Flack, J. R., Khoo, C. L., & George, A. (2018). Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5485-7
Saraogi, G. K., Tholiya, S., Mishra, Y., Mishra, V., Albutti, A., Nayak, P., & Tambuwala, M. M. (2022). Formulation Development and Evaluation of Pravastatin-Loaded Nanogel for Hyperlipidemia Management. Gels, 8(2), 81. https://doi.org/10.3390/gels8020081
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