Research Proposal on "Type II Diabetes Prevention in the Adult Population"

Research Proposal 15 pages (4350 words) Sources: 15

[EXCERPT] . . . .

Type II Diabetes Prevention

While modern lifestyles and medical care have certainly improved the longevity of humans in the developed world, and contributed to a greater quality of life scenario, those same lifestyles have engendered a number of issues that contribute to disease. Lack of proper diet, fast food, high fat and carbohydrate diets without adequate fruits and vegetables, lack of exercise, smoking and alcohol contribute to an epidemic of obesity which, in turn, contributes to a serious metabolic disorder called Diabetes Mellitus Type 2. While not managed by insulin injections, it is nevertheless quite serious and has a number of progressing symptoms that, if not treated properly, can result in cardiovascular, renal and neurological problems, as well as amputation, ocular issues, and even cognitive dysfunction.

We review the issue from a medical and sociological standpoint, and propose a tri-part research study that combines a specific dietary regime, exercise protocol, and regular counseling and coaching look at the efficacy of a multi-tiered approach to type-2 diabetes control. This will allow not only lifestyle modification, but personal training in habit management so that the most effective interventions become part of the individual's daily life as opposed to a medical protocol.

Type II Diabetes, also known as diabetes mellitus, is also called non-insulin-dependent diabetes or adult onset diabetes. It is a medical disorder that, due to a number of factors codependent with the modern world, is characterized by higher than normal blood glucose levels that play havoc with insulin deficiency and resistance. There is no cure, per se, for the disease, although if managed through exercise and diet it usually diminishes. However, if untreated, Type II Diabetes may become quite serious and require the medication of symptoms in order to the patient to maintain a productive life (American Diabetes Association, 2009).

In the United States alone, scholars estimate over 25 million people (about 8% of the population), who have clinically diagnosed diabetes, but only 18 million of them actually diagnosed, 90 of the undiagnosed being type II. Since the actual prevalence of type II diabetes doubled between 1990 and 2005, the Center for Disease Control has labeled it as an epidemic. Since it traditionally occurs in adults, and because of the unique similarities in individuals who contract type II diabetes, the disease itself is considered to be related to rising obesity rates, lifestyle issues, and the general lack of exercise most Americans receive (Boseman & Victor, 2004).

One of the more serious aspects of type II diabetes is the new prevalence of onset during later teen years, most likely completely due to rising obesity patterns in children. Symptoms for both children and adults range from chronic fatigue, general weakness and malaise to excessive thirst, blurred vision, lethargy, and more serious internal dysfunction. There also appears to be a strong connection in type II diabetes to a genetic predisposition -- which is ironically a similar predisposition to hypertension, cholesterol issues and obesity. Clearly, the epidemic proportions of the disease have increased due to a rapidly aging population, high-fat diets, and a far less active lifestyle (Boseman and Victor).

A recent article in Nature brings the problem full force -- the global consequences of obesity and diabetes as a true social, cultural, and economic problem. One does not always think of disease as having such a hydra-like, multidimensional effect upon society, but the authors of this study see a clear relationship between the consumption of certain foods and type II diabetes, "Over the last decade, profound change in the quality, quantity, and source of food consumed in many developing countries, combined with a decrease is levels of physical activity & #8230; have led to an increase in the prevalence of diabetes and its complications" (Yach, 2006), 62).

Globally, obesity and being overweight are to diabetes what tobacco is to lunch cancer. Over 60% of type II diabetes cases can be directly attributed to weight gain -- an alarming trend when one examines the exponential growth of cases even in the last decade. For instance, as a percent of the population, there has been a dramatic 40 per cent increase in adult obesity since 2002. This figure is triple in lower middle income families, and low income households. The country with the largest percentage of obese citizens is, of course, the United States, but the countries with the largest percentile growth since 2002 are Brazil and Mexico, almost doubling in their obesity rates (Yach).

Extrapolating the data, the authors, "using modest assumptions about future growth, the number of people with diabetes will increase from 175 million in 2000 to 353 million in 2030, with the biggest increases expected in India (25 million to 59 million) and China 914 million to 25 million" (Yach, 63). The issue is more than just a clinical or medical issue; the larger consequences of illness, especially to the global economy, are staggering. Not to mention that the expectation of a health model in the 21st century does not include increased expenditures and suffering that type-2 diabetes may cause.

Physical inactivity and unhealthy diets lead to more disease, days away from work, and burdens on the social systems of countries

Risk factors rise for cardiac disease, or an inability to remain part of the labor force as long as a healthy person

Greater siphoning of resources away from necessary programs and into control of an epidemic caused by behavior patterns

Problem- The cost burden of diabetes is staggering and it is expected to increase. Demographically, diabetes is moving from an adult disease to a pandemic across the entire age spectrum without regard to ethnicity or demographic/psychographic modifiers. While there is no single effective approach to the disease; we suggest a multistage approach in which a combination of counseling, dietary modification, and exercise to be an appropriate response to the issue. Each intervention alone (counseling, diet, or exercise) may be somewhat appropriate, but the combination will prove to be the most efficacious. Previous research shows that exercise for the management of type-2 diabetes, combined with nutritional strategies, when used with culturally appropriate education and training have the best chances for long-term success (See: Zanuso, 2010; Thomas & Elliott, 2009; Hawthorne, 2008),

Population (target)

Adults with Type-II diabetes (ages 21-59)

Intervention

Combination of ongoing and aggressive counseling, dietary education and change, and exercise

Comparator Intervention

Medication and self-management

Outcomes

Improvement of condition, weaning of artificial interventions

Timeframe

Part I of study, 90 days; potential to increase and amplify once initial data is analyzed

Clinical Causation -- Diabetes mellitus type II, formerly called non-insulin dependent diabetes or adult onset diabetes is a metabolic disorder that is medically characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. It is initially managed by increasing exercise and dietary modification, but if the condition is unresponsive, medications may be needed (Kumar, 2005, 1194-5). Typically, there is little tendency toward ketoacidosis, but often nonketonic hyperglycemia. Longer-term complications from high blood sugar can increase risks of heart attacks, strokes, amuptation, diabetic reinopathy, and kidney failure. In extreme cases, circulation of limbs is affected; as is loss of hearing, eyesight and cognitive ability (Valentine, Biermann, & Toohey, 2008). Classic and typical symptoms are polyuria (increased urination), polydipsia (increased thirst), polyhagia (increased hunger), as well as fatigue and some weight loss. In the elderly, reduced glucose tolerances have been shown to have negative effects on memory, cognitive funtions and even atrophy in certain parts of the brain (Smith & Roberts, 2011, 193-4).

Insulin resistance means that cells do not respond appropriately when there is free insulin in the blood system. Essentially, they body is reacting to an improper balance of sugars and insulin. Because obesity is often present, research suggests that even thought the mechanisms controling glucose and insulin are unclear, the adopose tissue likely plays a crucial role in the lack of proper uptake of sugards. Two new emergent ideas show that there is an issue of ectopic fat storage (fatty deposits in the muscles, liver, and pancreas) and secretion of various chemicals into the endocrine system because of excessive adipose (Medscape News, 2004).

There are three major causitive factors for Type-2 diabetes, typically a combination of genetic and lifestyle factors:

Lifestyle -- Individuals with normal weight and high levels of physical activity have over an 80 per cent less chance of contracting diabetes. Obesity contributes to almost 60 per cent of cases, along with increased consumption of saturated fats and trans fatty acids, alchohol, and cigarette smoking. The increased rate of childhood obesity from the 1960s onward is believed to have led to far more type-2 diabetes in adults (Rosenbloom & Silverstein, 2003). Additionally, environmental toxins have been shown to recent increases in type-2 diabetes; likely due to pollutants including some ingredients in plastics (Lang, Galloway, & Scarlett, 2008). In individuals that move to different environments and who adopt different lifestyles, even if genetically predisposed to diabetes rarely manifest the disease unless they move to environments with increased liklihood of overeating and sedentary lifestyles… READ MORE

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