5SCZ0044 Principles of Diabetes for Professional Practice Answers

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Introduction to Principles of Diabetes for Professional Practice Assignment

This paper aims to discuss available non-pharmacological and pharmacological interventions aimed at supporting glycaemic control of T2D patients. First, it reviews lifestyle intervention as a potential way to avoid T2D in people with prediabetes. The course continues by assessing the pharmacotherapeutic management of patients with confirmed T2DM, with a focus on GLP-1 receptor agonists and SGLT2 inhibitors as second-line therapies after Metformin. The review provides the advantages and drawbacks of both approaches to address these factors that affect HbA1c, body weight, and cardiovascular outcomes while integrating academic insights similar to those used in Online Assignment Help in UK.

Answer 1

Danny has defined obesity, HbA1c of 46 mmol/mol, and smoking and, on that basis, he is at a high risk of developing T2D. Pre-diabetes with high glycaemic levels is brought about mostly by insulin resistance by which insulin’s ability to transport glucose into the various cells is compromised. This condition brings about hyperglycaemia which triggers other metabolic complications. Although pharmacologic interventions could be employed, a nonpharmacologic approach is central to translating reductions in HbA1c to T2D risk reduction. These are; nutrition, exercise, weight, tobacco, and stress control respectively.

Dietary Modifications

Maintaining a moderate caloric intake as well as consuming the right amount of nutrients can help prevent high blood sugar levels. A Mediterranean or low-carb diet has an impact on the improvement of the glycaemic levels of HbA1c. Some of the non-starchy vegetables and fruits, whole grains, and legumes should be consumed since slow down glucose absorption and increase insulin sensitivity(Albu et al., 2009). Comfortable portion control along with the decrease in intake of refined carbohydrates and sugary beverages reduces postprandial glucose levels. High-density fats like olive oil, nuts, and avocados should also be consumed as they will help to enhance the otherwise poor metabolic profile of Danny. Another technique for blood glucose level regulation and avoiding insulin resistance pertains to regular meal timing(Enkhmaa et al., 2015).

5SCZ0044 Principles of Diabetes for Professional Practice Answers

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Physical Activity

The process of stimulating muscles to take up glucose from the blood allows exercise to decrease blood glucose levels by improving insulin sensitivity. In the aerobic activity category including brisk walking. Cycling or swimming together with resistance training exercises have been observed to reduce HbA1c(Artinian et al., 2010). New guidelines call for 150 minutes of moderate-intensity aerobic activity per week plus two minimum sessions of muscle-strengthening activity. That could be something manageable starting with it like for Danny, it can be just simply walking during work breaks or using stairs. Going at a gradual pace regarding both intensity and duration will be more helpful for his metabolic health.

Weight Management

The choice of a diet depends on the goals and individual needs of patients with T2D: weight loss has been shown to have a potent effect on improving insulin sensitivity and lowering HbA1c. Studies have shown that even a loss of 5–10% of body weight can lead to important gains in glycaemic control and also in preventing the transition from pre-diabetes to T2D(Ajzen & Fishbein, 1980). Low energy intake in combination with the enhancement of dietary quality serves as the basis for the weight loss approach. It may be advisable for Danny to seek professional assistance in the form of a dietitian and come up with the most appropriate dieting program that will fit his lifestyle and choice.

Smoking Cessation

Tobacco smoke is an independent risk factor for the progression of insulin resistance and T2D. Nicotine also affects glycaemic control, of course, increasing blood glucose concentrations in the blood plasma. Hence, smoking cessation is a bulging intervention for Danny and hence, should be adopted as the framework for treating him(ASH, 2015). Data gathered indicates that smoking cessation enhances glycaemic outcomes and decreases cardiovascular complications in T2D. Putting into practice counselling regarding behaviours, the use of nicotine patches, gum, or any prescription drugs makes it easier to quit. Reducing weights resulting from smoking cessation by modifying analyses of foods and physical exercise is crucial in maintaining the desired glycaemic effects.

Reducing Stress and Improving Sleep

Stress and reduced sleep make cortisol levels high; high cortisol reduces the body’s insulin sensitivity thus resulting in worse glycaemic control. Stress-induced hyperglycaemia may also be managed by practicing stress-reduction techniques like mindfulness, meditation, or practicing yoga(Bibbins-Domingo et al., 2010). They also need to get proper night sleep of between 7-9 hours because sleep is very important in the management of glucose levels. Lack of sleep can be controlled by using a night clock, retiring to bed at a reasonable time, and avoiding the use of electronic gadgets before going to bed.

Behavioural and Social Support

Maintenance of the outlined behavioural changes entails the use of goal-setting, self-monitoring, and reinforcement policies. Third, employing Danny’s family in the health-related decisions may also improve compliance with interventions(Brown, 1990). The change in healthy habits on his side and from her side could lead to the improvement of the general well-being of the whole family, especially because the wife has type 2 diabetes.

Out of the above-mentioned interventions, I would consider dietary changes as the most important focus in the management of Danny. The consumption of a balanced, low-carb, or Mediterranean diet seeks to tackle his high HbA1c levels originating from poor glycaemic control and insulin resistance. Other methods have a profound influence on glucose management within a short period but do not require the person to make a permanent change to his/her diet to maintain the outcome as well as improve the metabolism and quality. Combined with the right meal time and portion size management, then the mentioned approach would help significantly to avoid further worsening of this condition in Danny and even help to avoid the development of type 2 diabetes(Albu et al., 2009).

In this process, patient involvement is essential, and their values, needs, preferences, and preferences and stages of change should shape this intervention. Consultations with healthcare providers and quite likely, with a dietitian, can help enable Danny to make and keep the goals realistic and follow them. Not only does such an individualized approach raise the likelihood of positive change but also enhances Danny’s confidence in making permanent positive changes to his lifestyle, thereby providing sustainable improvement to his health status(Enkhmaa et al., 2015).

Answer 2

The last recorded HbA1c of Danny is 58 mmol/mol, which is still below target despite he has been on metformin 1g in the morning and evening for six months. Because he remained obese (BMI 32.1 kg/m²) and a smoker, increasing the treatment of the diabetes is a logical step to avoid complications.

Mechanism of Action

GLP-1 receptor agonists interact with GLP-1, an incretin hormone that increases insulin secretion in a glucose-dependent manner and decreases glucagon release, delays gastric emptying, and causes satiety(Campbell, 2003). These actions have the effect of ameliorating postprandial glucose regulation together with lowered overall glycemia.

Benefits of the GLP-1 Receptor Agonists

• Glycaemic Control: Further, evidence has established GLP-1 receptor agonists to reduce HbA1c by 0.5 percent to 1.5 percent. This makes them very useful when used in combination with Metformin, in the attainment of better-quality glycaemic control.
• Weight Reduction: They are also known to lower body weight since they are prosecuting appetite and providing a sense of satiety. I concur with Danny on this merit since weight loss assists in moderating insulin resistance and decreases complications related to T2D. The effectiveness of these medications reveals that they lead on average, to a weight reduction of 2–5 kg.
• Cardiovascular Benefits: Liraglutide and semaglutide, some GLP-1 receptor agonists, show CV benefits in T2D patients with increased CV risk. This is especially true for Danny because he smokes and is clinically obese increasing his risk of cardiovascular disease.
• Low Risk of Hypoglycaemia: This is self-attested by customers in the fact that while using GLP-1 receptor agonists there is a lesser chance of developing hypoglycaemia unlike when using sulfonylureas or insulin(Cancer Research UK, 2021).
• Renal Protection: There appear to be some renal protective effects, which would have high benefits for Danny in long-term renal function, especially in diabetes.

Disadvantages of GLP-1 Receptor Agonists

• Gastrointestinal Side Effects: Adverse effects include gastrointestinal disturbances, especially in the early days of therapy, including nausea, vomiting, diarrhoea, and abdominal pain. These symptoms may cause Danny to deviate from the use of the medication. But in order to avoid such side effects, the dose titration process which involves the slow introduction of the new drug dosage into the system is helpful.
• Cost and Accessibility: Compared to other glucose-lowering agents in the market, products developed under GLP-1 receptor agonists are pricier(Catto, 2008). However, co-payment may be a hindrance especially if the healthcare coverage available for Danny does not allow for a consistent use of the treatment.
• Mode of Administration: Many of the GLP-1 receptor agonists are administered subcutaneously and this can be annoying or even a problem for Danny. However, oral semaglutide is on the market now and it may provide an even more acceptable solution.
• Risk of Pancreatitis and Gallbladder Disease: The incidence of pancreatitis and gallbladder disease are very rare but have been observed in a few cases using GLP-1 receptor agonists. Careful assessment for features of pancreatitis should be made during treatment, where severe abdominal pain is suggestive of the disease(Corrao et al., 2004).
• Potential for Thyroid Tumours: Some GLP-1 receptor agonists have been associated with an increased risk of, MTC in animal studies. However, its risk in humans is still unknown and the medication is forbidden to use for MTC personal or family history, multiple endocrine neoplasia syndrome type 2.

Answer 3

The second-line oral antidiabetic drug for Danny after metformin is either a sodium-glucose co-transporter 2 (SGLT2) inhibitor like empagliflozin, dapagliflozin, or canagliflozin. SGLT2 inhibitors operate through blunting glucose reabsorption insect proximal renal tubules with additional glucose excretion through urine. Not only does this unique mechanism lower HbA1c, but it has other extra advantages for health as well.

Advantages of SGLT2 Inhibitors

• Glycaemic Control: SGLT2 inhibitors also reduce HbA1c by about 0.5% to 1.0%. This makes them a worthy combination to Metformin for patients such as Danny whose HbA1c had not reduced to the required standard even after first-line treatment(Department of Health, 2016).
• Weight Reduction: SGLT2 inhibitors act through increasing urine glucose excretion, and while weight loss is moderate, it varies from 2-3kg. This could also help Danny to cut down his BMI even lower for he will be even healthier, thus lowering his possibility of getting the nasty complications related to diabetes.
• Cardiovascular Benefits: SGLT2’s empagliflozin and dapagliflozin have shown a lower risk experience of MACE, such as heart failure and cardiovascular mortality. Such privilege is pertinent for Danny most especially because he smokes and is also obese – factors that make him at risk for cardiovascular diseases(International Diabetes Federation, 2020).
• Renal Protective Effects: It has been demonstrated that SGLT2 inhibitors could provide benefits to renal function, meaning the progression of diabetic kidney disease, is one of the primary complications in T2D.
• Blood Pressure Reduction: SGLT2 inhibitors cause a mild diuretic effect with minor lowering of systolic and diastolic blood pressure. This benefit could be important in the lives of Danny despite the fact that at the current time, he has no diagnosed hypertension.
• Low Risk of Hypoglycaemia: Since SGLT2 inhibitors do not stimulate the release of insulin, they do not pose a high risk of hypoglycaemia, particularly when administered alone or with other drugs such as sulfonylureas and insulin(Foppa et al., 2002).

Disadvantages of SGLT2 Inhibitors

• Increased Risk of Genitourinary Infections: The presence of glucose in the urine promotes bacterial and fungal growth; thus, UTI and genital mycite infection rates rise. These side effects may pose a concern to Danny’s quality of life and may even contribute to noncompliance with the treatment.
• Dehydration and Hypotension: Some patients under SGLT2 inhibitors experienced volume depletion, particularly those of the elderly or dehydrated because of the diuretic effect of the drugs. This can lead to features of many symptoms including dizziness, hypotension, or even acute kidney injury in some instances(Gianinazzi et al., 2010).
• Risk of Diabetic Ketoacidosis (DKA): Despite being self-explanatory, there have been reported cases of euglycaemic DKA where patients were taking SGLT2 inhibitors. He had no idea that DKA has other symptoms than hyperglycaemia, like nausea, vomiting, or abdominal pain, which would require education.
• Cost: Similar to GLP-1 receptor agonists, SGLT2 inhibitors can be expensive for patients due to the high prices of these medications especially when they don’t have health insurance(Freeman & Loewe, 2000).
• Fracture Risk and Amputations: Rare side effects have been reported with SGLT2 inhibitors including increased risk of bone fractures and lower-limb amputation, especially with canagliflozin. Despite the uncertainty and risk, prevention is statesmanlike and crucial to educate patients(Grave et al., 2011).

Conclusion

T2D calls for changes in the living habits of the affected individuals and the use of suitable medications. Lifestyle changes that could include weight loss and smoking cessation are deemed to interrupt or even arrest disease progression. GLP-1 receptor agonists and SGLT2 inhibitors are pharmacological agents that provide good glycaemic control, effective weight loss, and cardiovascular outcomes. However, these are accompanied by several side effects that should be closely observed during medication. This indicates that there is a need to focus on the results and hence the need to employ patient patient-centred approach as a way of achieving the best outcomes as well as the prevention of the long-term effects of T2D.

References

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• Ajzen, I. and Fishbein, M. (1980) Understanding attitudes and predicting social behavior, Englewood Cliffs, N.J., Prentice-Hall. ASH (2015) Smoking and diabetes. http://ash.org.uk/files/documents/ASH_128.pdf
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• Corrao, G., Bagnardi, V., Zambon, A. and La Vecchia, C. (2004) A meta-analysis of alcohol consumption and the risk of 15 diseases. Preventive Medicine, 38(5), pp. 613-619. http://www.sciencedirect.com/science/article/pii/S0091743503003384
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• International Diabetes Federation (2020) Gestational diabetes https://www.idf.org/our-activities/careprevention/gdm