Evidence-Based Practices to Guide Clinical Practice: Diabetes

Abstract

In contemporary times, the rate of Type 2 diabetes (T2D) among the older patient populace is nearing epidemic proportions. Characteristically, numerous studies have established that in most developed nations like the US, older patients will majorly comprise patients with T2D. In the United States, the increased incidence of T2D in the senior population is reflected both in males and females and across ethnic and racial groups. Nonetheless, particular groups are disproportionately impacted, and efficient strategies need to account for these vital disparities. In old age, T2D gets associated with traditional diabetes effects and complications comprising macro and microvascular condition and other comorbidities like urinary incontinence, cognitive impairment, high fall risk, and sarcopenia among others. A general state of protracted inflammation and deregulated immune system might underlie the growing risks, yet individuals’ understanding of immunometabolism during the aging process stays scanty. Thus acknowledging the gap is inadequate, and the goal remains to have strong evidence-based information, which would help to effectively distinguish diabetes patients and then intervene with effective evidence-based practice and strategies.

It has been observed that in the previous decade alone, the percentage of individuals in the United States aged over 65 has increased by 18% with projections that by 2030 one in every five Americans will be aged over 65 (Bradley & Hsueh, 2016). Research has similarly established that individuals within the population bracket aged over 85 years represent the fastest-growing segment of the American population. This segment represents 1.5% of the total population and is expected to account for 5% by 2050. The demographic shift represents a threat of attracting dramatic consequences to the economic and social structures of both the private and public sectors, placing unforeseen demands on the American healthcare system. Research in the health sector reveals that over 80% of the individuals aged over 65 experience manifold protracted ailments with T2D accounting for over 95% of their overall healthcare expenditures.

T2D incidence has increased over the preceding decades as the American population has become heavier and older. Obesity levels have doubled from the ’90s to 2010 (Aguilar-Valles, Inoue, Rummel, & Luheshi, 2015). This signifies a danger factor for T2D bearing in mind that it is the chief basis for both weakened beta (?)-cell role and insulin resistance (IR), which are principally fused in T2D’s progression (Bradley & Hsueh, 2016). Consequently, the rate of T2D in adults has characteristically risen and represents a primary cause of excess mortality and morbidity in the United States. From 1980 to 2014, the rate of diagnosed diabetes in the US populace increased by more than 120% for those aged between 65-73 years old (9.6% to 21.4%) and 75 years old (8.5% to 19.1%) (Bradley & Hsueh, 2016). In contrast, in 2011, the degree of established diabetes among individuals aged 65-74 increased 13 times from that of individuals younger than 46 years of age.

Essentially, the degree of established T2D is even increased in long-term care residents, with upwards of 1/3 impacted. It is projected that in the coming decades, individuals over 65 years will account for the mainstream of diabetic population in the US and most developed countries (Bradley & Hsueh, 2016; Gamble, Clarke, Myers, Agnew, & Hatch, 2015). The findings give rise to the need for a greater emphasis on individualized care, particularly in the obese populace, and highlight the necessity for fresh policies and treatment strategies in the management of T2D and obesity in the senior population. The senior population suffering from T2D faces distinct challenges as they similarly face the risk of functional decline, polypharmacy, falls, urinary incontinence, cognitive impairment among others. These have augmented the danger of comorbidities and deaths among the populace (Gamble et al., 2015). As such, it becomes imperative therefore to establish evidence-based practices to guide treatment and management of T2D among the older population. This guarantees the patients to uphold a meaningful value of life during the aging progression.

Definition of Old Age

This research study dwells more on the prevalence of T2D in the elderly population. As such, it becomes essential to define what constitutes the elderly. Essentially, there lacks a universally acknowledged age limit to describe the terms ‘old age’ or the ‘elderly’. Most developed nations stick to the chronologic age of either 60 or 65 as the definition of a senior person (Bradley & Hsueh, 2016). Nevertheless, this research will focus on the description of the elderly as people being over 65 years (except else emphasized).

Interrelationship among Theory, Research, and Evidence-Based Practice

Essentially, the relationship between theory, research, and evidence-based practice are interconnected, complex, and influenced by economic, political, and social order reservations represented in marketization, globalization, public scrutiny, policy interventions, and accountability. It is through this complexity that people are required to chart their path forward, reacting to daily challenges and getting logic out of their experience. The association between theory and research is characteristically implied through the discussion of their functions (Wilkinson, Treas, Barnett, & Smith, 2016). The primary impetus for the study is the search for a theory. Theory development banks on research, with the latter counting on theory. The relationship between evidence-based practice, research, and theory is dialectic, where the theory establishes what information is to be gathered, and research studies offer challenges to accepted theories, which are substantiated through evidence-based practice.

Essentially, research entails the approach employed to gather data needed for theory, while evidence-based practice offers the guidelines and framework for gathering such information. From an evidence-based perspective, the link between research and theory on T2D prevalence on the senior population may further be described by examining the research designs employed to advance numerous categories of theories that explain the prevalence (Bradley & Hsueh, 2016). From this standpoint, such concepts might be termed as either relational or descriptive. The evidence-based practices that create and test the type of theories are characteristically correlational, descriptive, and experimental. In the study, descriptive research gets used to test descriptive theories giving factual information regarding the prevalence of T2D in the senior American population.

Methods

In probing the aspect of T2D incidence among the American populace, the study examined the incidence of prediabetes, undiagnosed and diagnosed diabetes. The study employed Boyle et al.’s conventional 3-state dynamic model and lessened diabetes deaths. Nonetheless, few contemporary studies imply that the diagnosed diabetes prevalence trend could be declining (Bradley & Hsueh, 2016). It becomes challenging to establish whether the trend will persist owing to factors like the increasing aging population and ailing diabetes mortality and morbidity. Diabetes statistics were based on the data of CDC national diabetes statistics. The research sample was taken from various metropolitan areas, which revealed unique prevalence rates. Relying on the data, the prevalence of undiagnosed, diagnosed, and prediabetes for each state for 2012 was calculated.

Results

It is projected that by 2030 the total figure of individuals with T2D will rise by over 19 million, representing a 54% upsurge. Additionally, the expenditure for diabetes is expected to rise significantly by 2030 (Bradley & Hsueh, 2016). This is typically so within the marginal groups, predominantly the African Americans and Hispanic Americans. Data from Native Americans, Asian Americans, and seniors aged over 65 was also examined. The study observes that there exist broad disparities in incidence rates among states. Essentially, the process of examining past and prevailing data trends to reflect on their implications for the prospect results in numerous insights regarding the future course of diabetes if the United States stays on its present course. As such, the incidence of diabetes may be leveling off.

Pathogenesis of T2D in the Elderly

In the United States, there exist many prospective explanations for the rise in T2D prevalence with growing age. This comprises cultural and lifestyle factors, potential age-associated transformations in insulin action and removal, hormonal and inflammatory dysregulation, and genetic factors among others. Obesity gets described as the primary cause for insulin resistance and beta-cell function, which are instrumental in developing T2D (Aguilar-Valles et al, 2015). The increased incidence of T2D in the elderly is reflected across ethnic and racial groups in both women and men. Nonetheless, particular ethnic groups in the United States are disproportionately impacted giving the need for effective evidence-based strategies to combat the issue. Evidence points to an increased T2D prevalence among African Americans in the United States.

Ethnic differences are characteristically more pronounced in African American females, where diabetes impacts 38% of the females between the ages of 65-74. In these statistics, most females are perceived as obese, which represents a risk factor for T2D. Latino and Hispanic Americans are increasingly at high danger for T2D and associated metabolic abnormalities. The Hispanic population in the US is expected to increase, giving rise to the number of individuals ailing from T2D by 2050 (Bradley & Hsueh, 2016). Like with other groups in the United States, the incidence of T2D in Hispanics rises dramatically with growing age. Similarly, the Native Hawaiians and Asian Americans population, who are at risk of T2D, is fast-growing (Yehuda, Zinger, & Durso, 2014). Similarly, in the senior Asian population in the United States, it is imperative for practitioners to be acutely conscious of the duration of their T2D condition, which might be more protracted in the identified ethnic affiliation and create interventions efficiently.

In such populations, an efficient educational approach is vital given most groups to lack education in comparison to other groups. With people of African American, Latino, and Hispanic descent, culturally decent lifestyle intervention is likely to be efficient in order to lessen obesity (Goldberg & Dixit, 2015; Schneiderman, Llabre, Cowie, Barnhart, & Carnethon, 2014). Other studies have established that most patients from those ethnic affiliations are more likely to adhere to the recommendations of a healthcare expert than other ethnic groups.

Progressing de-acculturation, which supports the consumption of certain fresh diets from their native states and less western nourishments, similarly proves effective, predominantly with Mexicans-Americans (Bradley & Hsueh, 2016). It is also essential to implement a culturally sensitive community-founded combined lifestyle and pharmacologic intervention, particularly among African Americans. Lastly, it is imperative to conduct further studies on the effect of ethnicity on diabetic treatment therapeutics to facilitate management.

Implementation Strategies

The above-mentioned findings reveal the necessity for a more ethnic-conscious and evidence-based approach to diabetes management extending the lifetime. Owing to the prevalence among the different identified groups in the United States, the ethnicities need be targeted with efficient and implementable preventative strategies earlier in life to lessen diabetes and obesity risk and lessen diabetes-associated conditions in old age (Bradley & Hsueh, 2016). Early treatment of T2D in the course of the condition has a significant impact in averting lasting implications in old age.

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The credibility of the Source and the Research

The sources and research employed in the study are credible as they come from scholarly sources. The study has relied on qualitative and quantitative approaches to acquire facts and information regarding the prevalence of T2D in the elderly population in the United States. Additionally, through evidence-based analysis, appropriate implementation strategies are advanced making the study credible for the examination of the T2D prevalence in the United States.

Conclusion

In conclusion, the prevalence of the elderly population suffering and at risk of T2D in the United States continues to grow and is expected to increase by 2050, giving rise in comorbidities and mortalities among the elderly population. People of old age have been defined as those being over 65 years. Obesity gets linked to T2D with reduced beta-cell role and insulin resistance, which are principally assimilated to the T2D’s pathogenesis. Ethnic and cultural factors have similarly been associated with the increased incidence of T2D with senior population from Asian, Hispanic, African Americans, Natives, and Latino ethnic backgrounds impacted significantly. Women are characteristically more affected compared to men. Nonetheless, employing evidence-based strategies may alter the trend.