Healthcare Professional Consideration: Type 1 diabetes is divided into idiopathic and immune-mediated types. In idiopathic diabetes (referred to as type 1b diabetes) there is nearly complete insulin deficiency. There is no evidence of autoimmunity (Kalyani, 2017; Rebar et al., 2019). Healthcare professionals must be aware of the various types of diabetes to recognize them and to provide safe and appropriate care. Screening and patient education are critical elements of care. Clinical Practice Guidelines are constantly being updated and should be followed for effective care. The Centers for Medicare & Medicaid Services (CMS) sets reimbursement rates for Medicare providers and generally pays them according to approved guidelines. Latent autoimmune diabetes (LADA)
● The pancreas produces some insulin initially ● LADA is often misdiagnosed with type 2 diabetes because the patients are older at diagnosis and some insulin production is still evident. ● Initially, LADA is managed with diet, weight reduction as needed, exercise, and oral medications as needed. But insulin is eventually needed because the pancreas gradually loses its ability to produce insulin. Research is underway regarding LADA and the best way to manage treatment. Health care providers with expertise in all forms of diabetes should direct treatment initiatives (Castro, 2021). ● About 90% to 95% of people with diabetes have type 2 diabetes. ● Type 2 diabetes has a strong hereditary component. ● Its onset is typically slow and insidious ● Type 2 diabetes is significantly less common in children and young adults than in older adults. But the number of children with type 2 diabetes is increasing because of the prevalence of overweight children. ● Although some people with this type of diabetes may need insulin, they are still categorized as having type 2 diabetes.
Latent autoimmune diabetes in adults (LADA) is characterized by a slow progression of autoimmune reaction against the pancreas. Some experts recognize LADA as a form of type 1 diabetes, while others do not. LADA occurs because of an inadequate production of insulin. However, LADA does not require insulin administration for several months up to years after diagnosis is made (Castro, 2021). Following are characteristics of LADA (Castro, 2021): ● People are usually over the age of 30 when the disease is diagnosed.
TYPE 2 DIABETES: PATHOPHYSIOLOGY AND ETIOLOGY
Type 2 diabetes is an impairment of the way the glucose is regulated and used by the body. A chronic condition, type 2 diabetes can lead to disorders of the circulatory, nervous, and immune system (Mayo Clinic, 2021g). The following are general characteristics of type 2 diabetes (Mayo Clinic, 2021g Santos- Longhurst, 2020): ● The disease is caused by a combination of insulin resistance and insulin deficiency. Some people develop the disease predominantly because of insulin resistance, whereas others are affected predominantly by deficient insulin secretion but have little insulin resistance. Pathophysiology Under normal conditions, insulin molecules bind to body cell preceptors. Insulin activates cell portals to open allowing glucose to enter the cells where it is then converted to energy. Insulin decreases the amount of glucose in the blood. As the blood glucose level decreases, so does the amount of insulin secreted by the pancreas (Mayo Clinic, 2021g). Etiology Type 2 diabetes is mainly the result of two interrelated issues (Mayo Clinic, 2021g): ● Muscle, fat, and hepatic cells become insulin-resistant and are unable to function efficiently. ● The pancreas is not able to manufacture adequate amounts of insulin to appropriately manage blood glucose levels. Several environmental and lifestyle factors play a role in the development of type 2 diabetes. The aging process, alcohol consumption, smoking, lack of exercise, and obesity have all been found to be related to the development of diabetes (Mayo Clinic, 2021g). Obesity seems to have an impact on disease development. Obesity, especially visceral fat obesity, leads to a decrease in muscle mass and an increase in insulin resistance (Mayo Clinic, 2021g; Taylor, 2020b). Prediabetes is sometimes referred to as a “wake-up call” that the development of diabetes may be imminent. About 84 million Americans over the age of 20 have prediabetes, but 90% of these people do not know that they have it. (Dansinger, 2019b; Mayo Clinic, 2020d). Lifestyle modifications—including weight loss, implementing an exercise regimen, and following a healthy diet—are strongly recommended to prevent prediabetes from progressing to type 2 diabetes (Dansinger, 2019b; Mayo Clinic, 2020d). With a diagnosis of prediabetes, patients must be counseled regarding diet, exercise, and weight loss. Patients may also need antidiabetic agents (Mayo Clinic, 2020d).
In type 2 diabetes, the cells develop a resistance to insulin. This inhibits the ability of glucose to enter the cells. If glucose cannot enter the cells, the cells fail to receive enough energy. Blood glucose levels increase, and organs are damaged throughout the body (Mayo Clinic, 2021g).
Research has shown that a number of factors contribute to an increase in the amount of visceral fat in the body (Mayo Clinic, 2021g; Taylor, 2020b): ● Disorders of the nervous or endocrine systems that lead to an increase in cortisol and abnormalities in the secretion of sex hormones. ● Smoking ● Increased intake of alcohol ● Overeating, particularly an excessive intake of simple sugars ● Decreased energy consumption because of insufficient exercise
● Genetic influences ● The aging process
PREDIABETES
Healthcare Professional Consideration: Prediabetes is a significant risk factor for developing type 2 diabetes and cardiovascular disease (Dansinger, 2019b; Mayo Clinic, 2020d). Risk factors for the risk of developing prediabetes are the same as for type 2 diabetes, which will be discussed later in this education program.
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