Therapeutic Approach to Diabetes Mellitus Type 2 in People
with Progressive Weight Gain: A Unique Case Study (Ucs)
Marta Fernández Batalla1*, José María Santamaría García2, Jorge Luis Gómez González3, Enrique Monsalvo
San Macario4, Blanca Gonzalo de Diego5 and Sara Herrero Jaén5
1Specialist in Nursing of Family and Community, Madrilenian Service of Health, Spain
2PhD Sciences of the Computation, Alcala University, Spain
4Specialist in Nursing of Family and Community, Madrilenian Service of Health, Spain
5Master in Management and Application of Knowledge of Nursing Self-Care, Alcala University, Spain
Received: July 21, 2017; Published: August 01, 2017
Corresponding author: Marta Fernández Batalla, Specialist in Nursing of Family and Community, Management of Primary care, Madrilenian Service of
Health, Madrid, Spain
Diabetes Mellitus (DM) is an important public health problem
of our time [1]. According to European Health Survey in Spain,
diabetes is 6.8% of the diagnosed chronic disease in people over
the age of 15 in 2014 [2]. There are studies that claim that most
chronic diseases, such as diabetes mellitus, are related to unhealthy
lifestyles [3]. These lifestyles produce obesity in the people,
associated causative factor of type 2 DM which in turn relates to
an increased cardiovascular risk [3-4]. Diabetes Mellitus type 2 is a
chronic and complex disease, which required continuous care. For
that reason diabetes brings about 75.000 million euros of health
expenditure in Europe [5], which means high levels of sanitary and
economics costs.
Nowadays, resources and efforts of health actions are not
focused on healthy lifestyle, as Lalonde mentioned [6]. This way,
in the clinical stage of the disease, the main goal is to control signs
and symptoms through overmedication, approaching therapeutic
control to a single vital parameter [7]. This can develop a “palliative
circle” with negative effects for health status of people. Therefore
the purpose of this study is to represent the “palliative circle” of
unhealthy eating habits in people with diabetes mellitus type 2
with increasing insulin treatment.
This unique case study (UCS) primary health care was carried
out in a rural primary health care (PHC) area of Madrid (Spain).
A literature review was carried out on the therapeutic approach
to diabetes mellitus and results associated with therapy in
people with diabetes. The single case was monitored from the
nutrition change through the following variable measures: weight,
measurement of blood glucose and control – insulin (Lantus®).
Information was collected by extracting knowledge from texts,
formalized through formal representation techniques and data
analysis of four computerized clinical histories. Consequently,
it was carried out a modeling of decision algorithms in order to
determine the different consequences to potential alternatives in a
given case for the acquisition of capabilities for the organization of
non-pharmacological therapeutic indications in coordination of the
pharmacological ones. The inputs of the algorithm were in relation
with the context and the potential evolution of the person’s state of
the case.
After the exhaustive study, records of planning cares
were shown according to the computer program, keeping the
confidentiality from the beginning. In addition, according to current
regulations, the diagnoses of each individual in the family have been
documented due to the computer system does not allow grouped
diagnoses, either family or community, such as “Ineffective family
health management”. This one involves the diagnoses detected
in each one of the members of the family. The research outcomes
show the evolution of the unique case. The clinical weight data decreased 10% and Body Mass Index (BMI) decreased 7%. Blood
glucose measurement was stabilized in 90 – 110 mg/dl and daily
units of Lantus® decreased from 41 to 16 IU. Glycated hemoglobin
(HbA1c) was in the range <7% after three months.
Finally, it was carried out a flow chart representing the
“palliative circle” of medication performed by a group of family and
community care experts in relation with the signs of inadequate
care giving. The diagram takes part of the element of unhealthy
habits to care problems that are manifested with alterations of
parameters debuting in a chronic process labeling. Usually these
signs are treated with medication, decreasing the intensity of the
alteration of the parameter and maintaining the unhealthy habits
which leads to the imbalance of the parameters. This process is a
continuing cycle.
European Commission focuses on regular population – based
measurement of risk factors related to chronic diseases, including
sedentary lifestyle and unhealthy eating [8]. Both risk factors
closely related to Diabetes Mellitus type 2 [9]. Other international
studies link weight management as a fundamental area in people
with diabetes for metabolic control because weight loss improves
HbA1c [8]. Spanish model is developing explanatory models of
how weight loss in diabetes contributes to decrease mortality and
morbidity.
The flow diagram shows the elements and relations that
take action in the “palliative circle” across the range of different
situations, improving process comprehension. The circle masks
rather uncertain outcome of health status of people and covering
up the situation. For this reason it is necessary to know it and
guiding the strategies towards positive heath situations. It should be pointed out that the professional must be attentive and actively
to break the causal chain of therapy focused on the control of a
single vital parameter. This fact, it can control the sign or symptom
but it has negative consequences on the health level in the longer
term because of it is based on “palliative” therapeutic strategies of
a sign. Likewise, that same “pallium” covers up uncertain outcome
of health status of people.
ISSN: 2574 -1241
