Type 2 Diabetes Mellitus

      Diabetes mellitus (DM) is a common chronic disease that brings burden on health care systems worldwide and the ninth major cause of death (Marie et al., 2018, Zheng et al., 2018). DM

is a clinically and genetically heterogeneous group of disorders characterized by abnormally high blood glucose levels as a result of either insulin deficiency or cellular resistance to the action

of insulin (Arcangelo et al., 2016). Type 2 diabetes mellitus (T2DM) is the most prevalent form of DM accounting to 90% to 95% of the DM cases. In T2DM, there is insulin resistance and

inappropriate insulin secretion.  Family history of DM, obesity (205 over desired body weight), Race/ethnicity (African Americans, Hispanic Americans, Native Americans, Asian Americans,

Pacific Islanders have increased risk), age older than 45 years-old, previously identified as having impaired fasting glucose, hypertension, high-density lipoprotein (HDL) cholesterol level

greater than 35 mg/dl or triglyceride level greater than 250 mg/dl, history of gestational DM, and sedentary lifestyle are the major risk factors for T2DM (Rosenthal & Burchum, 2018).

                                                                                      Drug for T2DM

                 The Association for the Study of Diabetes (ADA) and the European Association for the study of Diabetes recommended a four-step approach in managing hyperglycemia for

T2DM. Metformin is the first drug of choice for T2DM after diagnosis (Rosenthal & Burchum, 2018). Biguanides (metformin) are oral antidiabetic drugs. However, are not considered

hypoglycemic agents because their primary pharmacologic action does not increase insulin secretion (Arcangelo et al., 2016). Metformin is started immediately along with lifestyle and diet

changes. Metformin when used as monotherapy does not caused hypoglycemia and do not promote hyperinsulinemia or weight gain. Metformin reduces low-density lipoprotein (LDL) and

raised HDL. Common side effects are lactic acidosis, gastrointestinal reactions (nausea, upset stomach and diarrhea). Patients’ needs to take metformin before meals in the morning and

evening. The dosage is started low (500 or 850 mg daily or twice daily for the IR tablets) and can be increased weekly as needed to the maximum (2,550 mg per day). Metformin should be

carefully titrated in elderly and contraindicated in children, alcoholics, presence of kidney and hepatic dysfunction (Rosenthal & Burchum, 2018). 

       Short-term impact of uncontrolled DM

        Maintaining a healthy body weight by engaging in regular physical activity, consuming a healthy diet and medication adherence is important for reducing the risks of chronic

uncontrolled DM (hospitalizations due to diabetic ketoacidosis and coma) ( Zheng et al., 2018).

           Long-term impact of uncontrolled DM

     Insulin dysfunction affects many body systems causing hypertension, coronary heart disease, and other complications like neuropathies, retinmopathies, amputation that may affect social

life and quality of life ( Zheng et al., 2018). Advanced practice registered nurses have a vital role in focusing on preventative healthcare maintenance to promote quality of life and prevent

uncontrolled DM impacts.

                                                                                              References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2016). Pharmacotherapeutics for advanced practice (4th ed.). Lippincott Williams And Wilkins.

Marie, M. H., Andersen, H. U., Thorsteinsson, B., & Pedersen- Bjergaard, U. (2018). Hypoglycemic exposure and risk of asymptomatic hypoglycemia in type 1 diabetes assessed by

    continuous glucose monitoring. The Journal of Clinical  Endocrinology and Metabolism, 103(6), 2329-2335. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.  1210/jc.2018-00142

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Speed Pharmacology. (2017). Drugs for Diabetes (Made Easy) [Video]. https://www.youtube.com/watch?v=LWDQyaKVols&t=79s

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews.Endocrinology, 14(2), 88-98.

     doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1038/nrendo.2017.151