Diabetes Mellitus and Congestive Heart Failure
Design a study guide that will assist you and your peers to translate relevant clinical guidelines and evidence-based research into evidence-based practice to promote health and prevent chronic health problems.
You must choose one of the conditions below:
Diabetes Mellitus
Congestive Heart Failure
Chronic Kidney Disease
COPD
Your study guide must include:
Definition, etiology
Occurrence/epidemiology
Clinical presentation
Diagnostic testing
Differential diagnosis
Non-pharmacological and pharmacological management and follow up
Study Guide: Translating Evidence into Practice for Diabetes Mellitus Management
I. Definition & Etiology
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Definition:
- Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by sustained high blood glucose (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both (American Diabetes Association [ADA], 2024). This impaired glucose regulation leads to disturbances in carbohydrate, fat, and protein metabolism.
- Type 1 Diabetes (T1DM): An autoimmune disease where the body's immune system attacks and destroys insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency. It typically presents in childhood or adolescence but can occur at any age.
- Type 2 Diabetes (T2DM): Characterized by insulin resistance (cells don't respond effectively to insulin) and/or a progressive decline in insulin secretion. It is often associated with obesity, sedentary lifestyle, and genetic predisposition. It accounts for the vast majority of diabetes cases globally and in Kenya.
- Gestational Diabetes Mellitus (GDM): Diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation. It increases the risk of T2DM later in life for both mother and child.
- Other specific types: Resulting from genetic defects, diseases of the exocrine pancreas (e.g., cystic fibrosis), drug- or chemical-induced (e.g., steroid use), or other endocrinopathies.
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Etiology:
- T1DM: A complex interplay of genetic susceptibility and environmental triggers (e.g., viral infections).
- T2DM: Multifactorial, including strong genetic predisposition, obesity (especially abdominal), physical inactivity, unhealthy dietary patterns (high sugar, processed foods), and advancing age. Insulin resistance often precedes the decline in beta-cell function.
- GDM: Hormonal changes during pregnancy lead to insulin resistance, unmasking a predisposition to glucose intolerance.
II. Occurrence/Epidemiology
- Global: According to the International Diabetes Federation (IDF), in 2023, approximately 537 million adults (20-79 years) worldwide were living with diabetes. This number is projected to rise significantly.
- Kenya: Diabetes is a major public health concern.
- Prevalence of T2DM in Kenya is increasing, particularly in urban settings. A national survey indicated that prevalence was almost twice as high in urban (3.4%) compared to rural (1.