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Type 2 Diabetes (Complementary, Alternative & Integrative Medicine…

- - - - Patient is more likely to show up to appointment and continue with follow-up care with less wait time (20)
  - - - In 2010, 25% of PCPs in the U.S. were over 56
      - PCPs make an average of 55% less than other specialists
- - - - In 2015 almost 1 in 4 adults with T2D did not know they had it (10)
      - The faster it is diagnosed, the faster patients are able to regulate their glucose and avoid complications
    - - Education and awareness of prediabetes and diabetes can help prevent T2D which would drastically decrease cost associated with the disease and patients would be both healthier and at less risk for complications
    - - Over 80 million Americans are prediabetic (10) and most prediabetes can be "cured" with only diet and exercise but patients need to be aware of what food to limit
      - Addressing literary and numeracy skills could help patients understand condition and health behaviors associated with Type 2 diabetes (11)
        
        One way to help with this offering hands-on cooking classes for diabetics and using foods/dishes that are common to their culture
        
        This can lead to higher patient adherence to diet and lifestyle changes and overall better health
    - - Access to health care and high-quality treatments is limited for those with Type 2 Diabetes, especially since an estimated 16% of Type 2 diabetics are uninsured (4)
        
        Focusing on prescribing generic/non-name brand medications for patients with no insurance or high-deductibles
- - - - As social determinants begin to be studies more, they are continuously linked to increased T2D
      - Politics affect health care policy and the way that health care is administered
        
        These same politics further create social determinant divisions of economics and status that is linked to T2D
- - - - Diabetics have been shown to lack diabetes knowledge, self-efficacy and self-care behaviors. (11)
      - Poor glycemic control is associated with low health literacy and poor numeracy skills (11).
        
        All medications, whether they are insulin, oral hypoglycemics etc. are dosed with numbers and medical jargon that is difficult for patients with low educations levels to understand and can lead to harmful effects if medications are not taken correctly.
        
        Patients can feel frustrated and hopeless if they continue to have health issues and do not get better.
  - - - Medical costs cause hardships on families and studies have shown that older adults with T2D report difficulty paying bills and decreased medication usage due to costs (14)
      - Patients without health insurance can spend up to half of their paycheck on medications and insulin alone (15)
    - - All of these appointments require a lot of time and if patients work they have to request time-off
    - - Having a family or some sort of support system positively impacts diabetes outcomes and lowers stress which improves glycemic control (15), while not having a support system can drastically affect a patient's outcomes.
    - - Diabetics have to learn how to control what they eat, check glucose levels and keep record of them and know when and how much medication and/or insulin to take (12)
      - Patient has to have routine care with multiple providers (12)
        
        Routine care with PCP
        
        Endocrinologist if disease progresses
        
        Opthalmologist: diabetics are required to see them at least once a year
        
        Patient is often referred to a dietitian, diabetes educator, dentist and podiatrist, especially when the disease progresses
- - - - 82.2% of recently diagnosed T2D patients were uninsured
        
        Being uninsured was significantly (p<0.01) correlated with either micro/macro-vascular complications (1)
      - 69.9% of patients were unemployed so they had limited access to medications and treatments
- - - - Although prevention is important in maintaining patient health, information obtained from testing assesses risk and not a future diagnosis
        
        Miscommunication can lead to misunderstanding where patient may understand it to be a "diagnosis" and become worried and stressed
        
        Familial implications
        
        Questions about patient paternity or biological family may arise with genetic testing
        
        If given a positive result, patient can drastically improve their lifestyle, but will this will also likely change the immediate family's lifestyle
  - - - Due to limited access of medications, insulin, testing and physicians, these clinicians are limited in their ability to diagnose and manage patient's disease while adhering to standards of care
        
        Takes longer for patients to be diagnosed
        
        Complications due to unresolved hyperglycemia
- - - - Discovery made possible through better anatomical understanding of the pancreatic function and anatomy
      - Revolutionized therapy and prognosis
      - Brought controversies and disputes among scholars
      - Considered a "breakthrough"
        
        Before the discovery of insulin, some physicians suggested high-caloric diets to compensate for high urinary output
        
        Previously opium and dietary interventions were used to treat
- - - - Dinner or meal-centered interactions: it is hard to avoid these foods even when they are detrimental for diabetics
    - - Family is at the center of most activities
      - Highly social interactions
        
        Alcohol is a key component in social events
    - - Language varies among cultures and becomes a blend sometimes. There are also languages that do not have words for medical jargon. This makes it difficult to explain mechanisms of the disease.
- - - - Different computer and organizational systems can make it challenging for information to be shared
      - Important for providers to communicate changes and disease status for optimal patient safety
    - - Increased risk of dosing, omission and scheduling errors
      - "Fluctuating hospital formularies" often result in medication substitutions which can affect dosing and confuse patients
    - - Patient must safely:
        
        Monitor blood sugar
        
        Take medications as prescribed
        
        Recognize and treat hyperglycemia and hypoglycemia