When screening patients in a clinic the nurse would associate which population with belonging to a higher risk group for developing type 2 diabetes?

Education

Self-management skills are an essential part of diabetes care and with the help and support of nursing staff the condition can be managed to help people stay healthy and prevent complications. Diabetes UK provide resources for health care professionals to increase the provision and uptake of diabetes self-management education.

Three of the main diabetes education courses available to people with the condition in the UK are:

• DAFNE is a working collaborative of 75 diabetes services from NHS Trusts and Health Boards across the UK and Ireland. It is a structured education programme in intensive insulin therapy for adults with type 1 diabetes providing them with the necessary skills to estimate the carbohydrate content of their meal and to inject the correct dose of insulin.

• DESMOND is a group of self-management education modules, toolkits and care pathways for people with, or at risk of, type 2 diabetes. The programme offers training and quality assurance for health care professionals and lay educators to deliver any of the modules to people in their local communities.

• X-PERT Diabetes Programme is for people with diabetes and aims to increase the knowledge, skills and understanding of the condition in order that they can make lifestyle choices to manage their blood glucose levels effectively.

Type 2 Diabetes and Me is an online step-by step guide for people with type 2 diabetes that provides information about the condition and the options and support available to them.

The RCN has developed Diabetes essentials, a CPD online learning resource covering the core concepts of diabetes, diagnosis and current treatments and the role of the nursing team in treating people with diabetes. 

Prevention

Making lifestyle changes can often help people with type 2 diabetes and those with an elevated risk of diabetes. A poor diet leading to weight gain, a lack of physical activity as well as high cholesterol and high blood pressure are risk factors for diabetes combined with smoking and excessive alcohol consumption. Maintaining a balanced diet, losing weight, undertaking regular physical exercise, limiting alcohol consumption and giving up smoking are all ways to reduce the risk of developing type 2 diabetes.

Type 1 diabetes cannot be prevented, but people with type 1 diabetes can take steps to prevent or delay the development of complications by keeping their blood glucose level at the target level. They should also regularly meet with a health care professional to check for any signs of complications so they can receive treatment as early as possible.

Exercise can contribute to weight loss, increase insulin sensitivity and help to reduce high cholesterol and blood pressure. Diet is also an important factor in preventing diabetes. Excessive consumption of saturated fats, simple carbohydrates (such as found in white bread), sugar and salt can all contribute to the development of diabetes.

The following foods can provide the basis of balanced diet to prevent and manage diabetes:

• Fruit and vegetables are naturally low in fat and calories and a good source of vitamins, minerals and fibre.
• Wholegrains are a good source of fibre which aids digestion.
• Lean meats and fish are high in protein as are beans, pulses, soya and tofu.

The role of the nursing team in diabetes care

Diabetes Specialist Nurses (DSNs) are crucial in providing good patient care and promoting self-care management. DSNs work wholly in diabetes care and may be employed in a variety of care settings. A DSN is often the first point of contact for people, referring them to other specialist services. A joint position statement on how DSNs can improve patient outcomes and deliver cost effective care, produced by Diabetes UK, the RCN and Training, Research and Education for Nurses on Diabetes (TREND-UK) is available here. Competencies relating to diabetes nursing, dietetics and podiatry can be found here. DSN’s will also provide training, education and support to non-specialist health care professionals including GP's, nurses in primary, secondary and community settings and care homes.

All nursing staff have an important role and clear responsibilities when treating people with diabetes. Nursing teams from across the nursing spectrum including occupational health nurses, nurses working in public health and school nurses are likely to come into contact with people who have diabetes or are having tests to diagnose diabetes. Practice nurses have a particularly vital role as they are often the people who carry out the annual diabetes and foot check. Practice nurses in particular play a clinical role in screening, maintaining and supporting people with diabetes.

The roles and responsibilities of the nursing team relating to diabetes care include:

• Prevention advice, using behaviour change and health coaching techniques (See: Making Every Contact Count & Support Behaviour Change)
• Screening, prevention and early detection of type 2 diabetes
• Promoting self-care
• An awareness of how mental health issues can affect people with diabetes
• Assessing and meeting the patient’s nutritional needs
• Urine monitoring
• Blood glucose monitoring
• Oral therapies
• Injectable therapies
• Identifying and treating hypoglycaemia
• Identifying and treating hyperglycaemia

Further information on the roles and responsibilities of nurses can be found at Diabetes essentials.

What populations are now at the greatest risk for type 2 diabetes?

Which disorder would the nurse suspect in a patient with type 2 diabetes mellitus who experiences an eye hemorrhage and vision changes?

Who is at risk of developing type 2 diabetes?

Which distinguishing characteristic would the nurse associate with type 1 diabetes mellitus?