Evidence based project on diabetes

Introduction

Diabetes is a variety of metabolic disorders that result from defects in insulin action, insulin secretion or both that is characterized by a chronic hyperglycemic condition. Type 1  diabetes comes from an autoimmune reaction to proteins present in islet cells of the pan crease while type 2 diabetes result from various environmental factors and genetic factors that impact on insulin secretion and resistance. The paper reviews information on diabetes with an emphasis on types of diabetes, types of tests pathophysiology and an evidence-based project that impacts on the diagnostic criteria in clinical practice.

Pathophysiology of diabetes

Pathophysiology of type 1 diabetes

According to Ozougwo et al, the autoimmune of destruction of beta cells of the pancreases results to a deficiency in insulin secreted which leads to metabolic derangements of type 1diabetes. In addition, there is excessive secretion of glucagon in patients with diabetes type 1. This results in elevated glucagon levels that result to metabolism defects from insulin deficiency. In addition, there are various biochemical mechanisms that lead to tissue impairment that affect the response to insulin. Insulin deficiency leads to elevated levels of free fatty acids and uncontrolled lipolysis in plasma that suppresses peripheral tissues’ glucose metabolism. Glucose utilization is impaired, and the action also causes insulin deficiency reduces the expression of necessary genes such as GLUT 4 class of glucose transporters and glucokinase in the liver to respond normally to insulin. (Ozougwo et al, 2013)

Pathophysiology of type 2 diabetes

Patients with type 2 diabetes have detectable levels of circulating insulin, unlike type 1 diabetes patients. On the basis of oral glucose tolerance, elements of type 2diabetes can be sub-divided into diabetes mellitus, diabetes with minimal fasting hyperglycemia, chemical diabetes and those with normal glucose tolerance. Most patients with type 2diabetes have both insulin resistance and insulin deficiency. (Ozougwo et al, 2013)

Types of diabetes

Type 1 diabetes

It results from the destruction of beta cells of the pancreases by the body’s immune system. Type 1 diabetes occurs when small levels of or no insulin is released from the body resulting from immune system attack of the beta cells. The production of little or no insulin causes glucose build up in the blood that could otherwise be used as energy. It is commonly first diagnosed in children and young adults.

Type 2 diabetes

It is the most prevalent type of diabetes characterized by insulin resistance. This type of diabetes in linked to excess weight, family history, physical inactivity, gestational diabetes and certain ethnicities. The factors result in the loss of the capability of the pancreases to release adequate insulin in response to meals causing the blood sugar levels to rise.

Gestation diabetes

Gestation diabetes develops only during pregnancies. The hormones produced during pregnancies increase the levels of insulin necessary in controlling blood glucose levels. Gestation diabetes goes away shortly after the pregnancy; however, women, who continue to have high glucose levels after pregnancy, may be diagnosed as having type 2 diabetes.

Different types of tests

Oral glucose tests

The oral glucose method is a test used to diagnose diabetes by checking blood sugar glucose levels before and after taking a sweetened drink containing 75 grams of glucose. The physician analyzes the results by checking the processing of glucose by the subject’s body.

Random (casual) glucose tests

The random test is carried on during ordinary hours of the day when there are severe diabetes symptoms. A level of or exceeding 11.1 mmol/L indicates diabetes.

HbA1C test

The test is carried out on blood to reflect the average person’s glucose level over the past period of three months. It is more convenient than other glucose tests owing to the fact that it does not require fasting and can be carried out at any time of the day. It is commonly used together with home blood sugar monitoring.

Fasting plasma glucose test

The fasting plasma glucose test is carried out to detect diabetes and pre-diabetes. The person is required to fast for at least eight hours before taking the test.  It has been used as the frequent test for diagnoses of diabetes due to its convenience and inexpensiveness. (Walter Siegenthaler, 2007)

HbA1c in adults without known diabetes and Impact of the new diagnostic criteria in clinical practice

The experiment was aimed at investigating the differences in the frequency of diabetes and dysglycaemia using HbA1c and fasting plasma glucose criteria. The research methods applied were the analytical cross-sectional study using a random sample of 2144 individuals from the primary care setting in Spain between the ages of 18-80 years without known diabetes. Diabetes was reflected by fasting plasma glucose ≥ 7.0 mmol/l or HbA1c≥ 48 mmol/mol (≥ 6.5%) while Dysglycaemia as fasting plasma glucose 5.6-6.9 mmol/l or HbA1c 39-46 mmol/mol (5.7-6.4%). According to the results, the percentage of persons who were normoglycemic was considerably higher using fasting plasma glucose as compared to when using HbA1c (83.5 vs. 65%) (P < 0.0001)  HbA1c detects more cases of diabetes (3 vs. 1.7%) (P < 0.0001) and dysglycaemia (32 vs. 14.8%) (P < 0.0001) compared with fasting plasma glucose. From the experiment, using HbA1c for the diagnosis of diabetes and pre-diabetes could increase the target population for therapeutic and preventive measures. (Lopez et al, 2011)

References

Bernal-Lopez, M. R., Lopez-Carmona, D., Tinahones, Santamaría-Fernandez, S., F. J., Mancera- Gomez-Huelgas, R. Romero, J., and Peña-Jimenez, D., (2011). HbA1c in adults with diabetes. Impact  in clinical practice. Diabetic Medicine, 28(11), 1319-1322.

Ozougwo, j. C, Belonwu, C.D, Obimba, K.C,  and Unakalamba, C.B( 2013) Journal of Physiology and pathophysiology volume 4(4) pp 46-57 September 2013.

Walter Siegenthaler (2007) From Symptom to Diagnosis Thieme: Differential Diagnosis in Internal Medicine.

Carolyn Morgan is the author of this paper. A senior editor at MeldaResearch.Com in custom research paper services. If you need a similar paper you can place your order from urgent essay writing service.