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Diabetes: Aboriginal Groups Question: Discuss about the Diabetes for Aboriginal Groups.   Answer: Introduction Diabetes is the current world leader in the list of chronic diseases (Zimmet, Magliano, & Herman, et al., 2014,p. 56) and more specifically type 2 Diabetes has reached levels of an epidemic in Australia as well as around the globe. The diabetes prevalence is an issue of public health all over the world (Zimmet et al., 2014, p. 56; Shaw & Tanamas, 2012). The greatest burden of health is often allotted to the social groups that are disadvantaged and also to the  Indigenous communities (Zimmet et al., 201, p. 56). Aboriginal groups have an extremely high rate of diabetes incidences when compared to the rest of the Australian population. The rates are so high such that the current prevalence among these groups stands at three times that of non-Indigenous population (Australian Bureau of Statistics, 2014 a; Australian Bureau of Statistics, 2014 b). The adult females in Aboriginal groups have a likelihood of developing gestational diabetes which is double that of other women from non-Indigenous communities(Australian Institute of Health and Welfare, 2010). Additionally, the likelihood of an Aboriginal child to be diagnosed with type 2 diabetes is  eight times higher than that of a child from a non Indigenous community (Australian Institute of Health and Welfare, 2014). The mortality rates of diabetics who are from Indigenous communities is also very high when compared to non-Indigenous communities (Australian Bureau of Statistics, 2015). In this paper, a female patient (Alex) of Aboriginal ethnicity presents herself with various symptoms. The patient reports being fatigued, has a slight tingling sensation on her feet, is experiencing blurred vision, has been experiencing frequent episodes of thirst, and urinates more often than before. A diagnostic result reveals that Alex is diabetic with glucose present in her urine and high level of glucose recorded from her blood sample. The epidemiology, pathophysiology, symptomology, diagnostic procedures, and management and care of type 2 diabetes will be discussed.   Epidemiology Of Type2 Diabetes In 2014-2015 approximately 1 million adults in Australia (5%) had been diagnosed with  type 2 diabetes, as recorded from the ABS self-reported data. The breakdown of the prevalence is as follows: Similar males and females at 5% and 6%; threats were higher in males with regard to age specificity starting at 55 years and onward; the similarity was relative at 6% in inner regional, 5% in major cities, and 6% in remote and outer regions; the socio economic group that is lowest had prevalence of 8%, a figure that is close to double that of the higher socioeconomic group which stood at 3%. (AIHW, 2016).  The information that is available on self reported data, could be under-representing the prevalence  as many people do not report their status either because of inaccuracy of reporting by the persons participating in surveys or them  being unaware of their health status. According to the insulin-treated National Diabetes Register, approximately 18,000 people  in 2015 commenced their treatment which is equivalent to 76 persons for every 100,000 persons. Other information from the NDR include: the incidence rates in males was 1.5 times higher than females (83 against 56 for every 100,000 people respectively); nearly92% of persons on insulin treatment were 40 years and above with the rates increasing with age(those aged 75 to 79years being 255 persons for every 100,000-this was 10 times 30-34 year age group rate and double that of 50-54 years (AIHW, 2016). The greatest T2DM burden often falls on the groups that are disadvantaged socially as well as the Indigenous populace (Zimmet, Magliano, & Herman, 2014, p.56). Australians in the Aboriginal and Torres Strait Islander populace have diabetes prevalence that is disproportionately high(ABS, 2014a ABS, 2014b) with the Indigenous women having double the probability of developing gestational diabetes compared to their counterparts (AIHW, 2010). Evidence shows that Indigenous children have an eight times likelihood of developing type 2 diabetes compared to their counterparts (AIHW, 2014). The rates of mortality are equally high with Indigenous groups having a six times likelihood of dying from diabetes compared to their counterparts (ABS, 2015) he high diabetes prevalence rates are reflective of the different factors that are specific to the Indigenous groups and which need to be addressed for effective reduction of the disease burden (Diabetes Australia, 2013; AIHW, 2015). The measures taken require tailored management programs that are culturally appropriate  as well as a broader action that goes beyond the confines of healthcare services(O’Dea, Rowley, & Brown, 2007, p.494; Closing the Gap Clearinghouse, 2012).   Pathophysiology Insulin resistance and impaired insulin secretion  are the contributory factors in a more or less combined manner, to the pathophysiological development of the condition. Impaired Insulin Secretion Impaired insulin secretion is characterized by a reduced response of glucose which is observed prior to  the clinical onset of the condition. Impaired Glucose Tolerance (IGT) occurs when there is a reduction on the insulin secretion that responds to glucose in the early phase and a reduced amount of extra insulin secretion after consuming food which results in postprandial hyperglycemia (Kaku, 2010). Among the Hispanics and Westerners, an IGT oral glucose tolerance test (OGTT) is often indicative of high levels of insulin resistance. Among the Japanese, most patients will record decreased levels of insulin secretion in the early phase, this is despite an over-response being observed in persons that are obese or other factors. This decrease observed in the early phase is extremely important in the fundamental  pathophysiological change of the disease’ onset among all ethnic groups(Abdul-Ghani, Matsuda, & Jani et al., 2008) Typically secretion of impaired insulin is progressive, and involves lipotoxicity and toxicity. When left unattended, the two are known to be the causants of reduction in cell mass of the pancreas in animal experiments (Kaku, 2010). The pancreatic cells functionality impairment affects the blood glucose control in the long haul. Early stages of the disease manifests in patients  through postprandial blood glucose that is increased due to increased resistance of  insulin and decreased secretion in the early phase as well as deterioration of the pancreatic cell functionality which causes the subsequent blood glucose elevation (Kaku, 2010). Insulin Resistance Insulin resistance is characterized by the insufficient action exerted by insulin in proportion to the circulations of blood concentration. The insulin action impairment in major organs such as muscles and liver is a typical  T2DM pathophysiological feature. Development of insulin resistance and its expansion occurs prior to the onset of disease (Kaku, 2010). The insulin action molecular mechanism has shown the relationship between environmental and genetic factors (inflammatory mechanism , free fatty acids, and hyperglycaemia among others). Genetic factors that are known include gene polymorphism of insulin receptor substrate-1 and insulin receptor which affect thee insulin signals directly as well as thrifty genes polymorphisms such as the uncoupling protein gene (UCP) and _3 adrenergic receptor gene which are associated with promotion of insulin resistance and visceral obesity. Inflammatory mediators and Glucolipotoxicity also play a role in secretion of impaired insulin as well as insulin impairment signalling mechanisms (Kaku,2010).  Symptomology Of T2DM Increased or frequent urination: The elevated levels of glucose in the blood force fluids to babe penetrate through the cell. This results in the amount of fluid being sent into the patient’s kidneys increasing in response to the cellular malfunction. This is what causes Alex to urinate often times than she did before and puts her at risk of dehydration(LaFlamme, 2016) Thirst: As the patient’s tissues become dehydrated, she will feel a sense of thirst. The more times she urinates, the more times she will experience thirst episodes(LaFlamme, 2016). Fatigue: Alex will feel tired and worn out and this is because glucose forms a critical source of body energy. When the cells are unable to absorb glucose, the patient begins to feel exhausted and fatigued(LaFlamme, 2016). Blurred Vision: High levels of glucose will result in swelling of the eye lenses which causes blurred vision. By controlling her blood glucose, Alex will correct any vision problems(LaFlamme, 2016) Recurring sores and infections: The elevates levels of glucose impede the body’ normal heading mechanism and causes injures and cuts to stay longer without healing. This predisposes Alex to getting further infection(LaFlamme, 2016) When the high glucose levels are left uncontrolled, Alex will experience further complications such as foot problems, eye disease, high heart disease risk, nerve damage, kidney diseases, and eye diseases (LaFlamme, 2016)   Testing Of T2DM Blood Glucose Levels Blood glucose self-monitoring is beneficial in the management of diabetes. It allows for one to adapt to the necessary changes in lifestyle and also treatment choices including monitoring symptoms of hyper and hypoglycaemia. Testing is done using glucometers or testing strips. The glucose level that should be indicated in these tests are ideally: 3.5–5.5mmol/l prior to taking meals, and less than 8mmol/l, after two hours have elapsed form taking a meal(Diabetes UK, 2016). Alex’s healthcare team will assist her in choosing a suitable glucometer for her individual needs. The team will teach her how to do the test correctly as a poor technique can result in incorrect recordings and subsequent incorrect dosing of medication. If Alex has a visual impairment, it would mean that using the glucomenter would be difficult and in such an incidence an alternative test will be given to her (Diabetes UK, 2016)r. Lancets and finger-pricking devices: These devices are automatic and will result in a skin piercing that will cause a drop of blood to form and which is extracted for the test to be done. The finger piercing device inserts a lancet that is held by a spring mechanism. The depth of  the needle insertion is adjustable depending on how thick the skin is. The lancets come in various different gauges or sizes  and lancets. A lancet that has a higher gage will tend to be less painful. Lancets are used only one time and then disposed off, attempting to use them several times will be painful as they become blunt with every use(Diabetes UK, 2016). Urine Testing The test involves holding a test strip and allowing for a urine stream on it for a few seconds. The strip is then compared against a chart that is glued to the container. The colour change on the strip is measured against the standard after a specific time has elapsed. However, the results from urine test are less accurate and do not give the amount of blood glucose at the specific time the test is done as the urine that is being tested may have been produced by the body a number of hours prior to testing (Diabetes UK, 2016).   HbA1c This test determines the level of glucose over a 2-3 month period and measures cellular glucose amounts. The target level for diabetic patients should be less 48 mmol/mol. This level will reduce the incidence of developing heart disease, kidney disease, eye disease, and nerve damage. (Diabetes UK, 2016) Management And Care Of Diabetes Type 2 Initial management of T2DM can be achieved through lifestyle changes including regular exercise, healthy diet, an blood glucose monitoring. Eating well allow for Alex to manage her body weight while at the same time control her blood glucose levels. The aim of managing diabetes is to keep the levels of glucose at 4-6 mmol/L (fasting) which will prevent long and short term complications(Diabetes Australia, 2016). However, due to the progressive nature of the disease, insulin resistance increases with time and the pancreas becomes ineffective. To help the pancreas, tablets are administered to patients to control the glucose levels. Eventually, the patient is prescribed daily insulin shots as a result of the body producing insufficient insulin on its own. At times the patient can take tablets together with insulin shots. The medications are supposed to be taken in tandem with regular exercises as well as healthy eating (Diabetes Australia, 2016) Conclusion The prevalence of diabetes T2DM in Australia has reached epidemic levels and gaining an understanding of what causes diabetes is a critical first step to minimizing or completely eliminating the disease menace. Currently, the highest rates of T2DM reported cases are among the Indigenous communities. The epidemiology, pathophysiology, symptomology, diagnostic procedures, and management and care of type 2 diabetes has been discussed. However, the high prevalence rates among Indigenous groups are due to underlying causes which need to be determined and effectively and culturally addressed in order to minimize or completely eliminate the prevalence of T2DM among these groups   References AIHW (2016). How many Australians have diabetes? Retrieved on 16th April, 2017). Australian Bureau of Statistics (2014a) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. (ABS Catalogue no. 4727.0.55.006) Canberra: Australian Bureau of Statistics Australian Bureau of Statistics (2014b) Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012-13. (ABS Catalogue no 4727.0.55.003) Canberra: Australian Bureau of Statistics Australian Bureau of Statistics (2014b) Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012-13. (ABS Catalogue no 4727.0.55.003) Canberra: Australian Bureau of Statistics Available at: Australian Bureau of Statistics (2015) Causes of death, Australia, 2013. (ABS Catalogue no 3303.0) Canberra: Australian Bureau of Statistics Available at: Australian Institute of Health and Welfare (2010) Diabetes in pregnancy: its impact on Australian women and their babies. (AIHW Catalogue no CVD 52, diabetes series no. 14) Canberra: Australian Institute of Health and Welfare. Available at: . Australian Institute of Health and Welfare (2014) Type 2 diabetes in Australia’s children and young people: a working paper. (AIHW Catalogue no CVD 64, diabetes series no 21) Canberra: Australian Institute of Health and Welfare. Available at: Australian Institute of Health and Welfare (2015) Cardiovascular disease, diabetes and chronic kidney disease – Australian facts: Aboriginal and Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare Closing the Gap Clearinghouse (2012) Healthy lifestyle programs for physical activity and nutrition. (Closing the Gap Clearinghouse resource sheet no. 9) Canberra: Closing the Gap Clearinghouse Diabetes Australia (2013) Aboriginal and Torres Strait Islanders and diabetes action plan. Canberra: Diabetes Australia Diabetes Australia (2016). Managing Type 2 Diabetes. (Retrieved on 17th April, 2017). Diabetes UK (2016). Testing. (Retrieved in 16th April, 2017) Kaku, K (2010) Pathophysiology of Type 2 Diabetes and Its Treatment Policy. JMAJ 53(1): 41–46. La Flamme, M. (2016) Recognizing Type 2 Diabetes Symptoms (Retrieved on 17th April, 2017). O’Dea K, Rowley KG, Brown A (2007) Diabetes in Indigenous Australians: possible ways forward. Medical Journal of Australia;186(10):494-495 Shaw J, Tanamas S (2012). Diabetes: the silent pandemic and its impact on Australia.(Retrieved April 16, 2017). Zimmet PZ, Magliano DJ, Herman WH, Shaw JE, (2014) Diabetes: a 21st century challenge. The Lancet Diabetes & Endocrinology;2(1):56 – 64

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