Case Study

Case Study

[Name of the Writer]

[Name of the Institution]

Case Study

Introduction

The case study is about the person who faced a sudden health problem and got admission in the hospital. The patient was male and 55 years old. Mr A is short in height, and his BMI recorded was 16.6kg/m2 (overweight). The patient is white American maintaining his personal business that is a stationery shop. His resident is near his store; therefore, he has hired people to look after his store while he most of the time stay at home with his wife. The patient has two sons who are doing jobs in other cities.

The patient got fainted at his store from where he brought to the hospital. The patient had a headache since morning, and he was feeling tired and drowsy. His insulin level was really high, and blood pressure too which created health issues. The doctor diagnosed him with diabetes (type 2). Family history of the patient indicates a record of blood pressure issue and depression. The patient faced depression and took counseling from the psychologist ten years ago. However, he has recorded a sudden weight loss in the past few months without changing his diet routine.

Patient History

The patient does not use alcohol or any other drug substance. However, he uses lovastatin (one tablet) at night due to his overweight and high cholesterol level. The tablet is prescribed by the physician to reduce the chance of any cardiovascular disease and to maintain health with lifestyle and age changes. The patient is financially stable, so he does not face any issues regarding nutrition. He loves food which made him obese due to overeating habit. Patient lifestyle is not much healthy because he eats a lot and does not bother about exercise. Most of the time, he stays at home, which reduces physical activities even more. He also faces the blood pressure issue due to high cholesterol level and takes one tablet each day to control blood pressure. The patient did not diagnose with diabetes in the past.

Discussion

Symptoms

The patient was admitted to the emergency department. He was short of breath, and his blood pressure was low. He was found conscious and alert on examination, and the doctor noticed his sugar level, respiratory rate, cardiovascular testing, and other tests. In the evening, he was diagnosed with type 2 diabetes. The symptoms which indicated that patient has diabetes include; sudden weight loss, thirst and hunger feeling, vomiting, tiredness, shortness of breath, sweating, and frequent urination.

Risk Factors

The risk factors for type 2 diabetes include family history, race, age, inactivity, fat distribution, weight, prediabetes, and depressive symptoms. The race is the not the factor in Mr. A case as he is a white American and reports indicates that Latin, Asian-American, Hispanic, and American Indian have more chances of being diagnosed with type 2 diabetes than the white Americans ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IdeMdjVq","properties":{"formattedCitation":"(Association, 2017)","plainCitation":"(Association, 2017)","noteIndex":0},"citationItems":[{"id":1245,"uris":["http://zotero.org/users/local/mlRB1JqV/items/YBRLUBWP"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/YBRLUBWP"],"itemData":{"id":1245,"type":"article-journal","title":"2. Classification and Diagnosis of Diabetes","container-title":"Diabetes Care","page":"S11-S24","volume":"40","issue":"Supplement 1","source":"care.diabetesjournals.org","abstract":"Diabetes can be classified into the following general categories:\n\n1. Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency)\n\n2. Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance)\n\n3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation)\n\n4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation)\n\nThis section reviews most common forms of diabetes but is not comprehensive. For additional information, see the American Diabetes Association (ADA) position statement “Diagnosis and Classification of Diabetes Mellitus” (1).\n\nType 1 diabetes and type 2 diabetes are heterogeneous diseases in which clinical presentation and disease progression may vary considerably. Classification is important for determining therapy, but some individuals cannot be clearly classified as having type 1 or type 2 diabetes at the time of diagnosis. The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both cohorts. Occasionally, patients with type 2 diabetes may present with diabetic ketoacidosis (DKA), particularly ethnic minorities (2). Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia, and approximately one-third present with DKA (3). The onset of type 1 diabetes may be more variable in adults, and they may not present with the classic symptoms seen in children. Although difficulties in distinguishing diabetes type may occur in all age-groups at onset, the true diagnosis becomes more …","DOI":"10.2337/dc17-S005","ISSN":"0149-5992, 1935-5548","note":"PMID: 27979889","language":"en","author":[{"family":"Association","given":"American Diabetes"}],"issued":{"date-parts":[["2017",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Association, 2017). In addition, the patient had several health issues in the past, but he was not diagnosed with diabetes which shows that prediabetes factor is not involved. The third factor that is family history does not directly show diabetes in the family, but the depressive disorder can be the element. Numbers of people who face the issue of depression often diagnosed with diabetes in later age and patient history indicates that he had depression. People who acquire more fats in the abdomen have more chances of type 2 diabetes ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"x70SUpNy","properties":{"formattedCitation":"(Souza et al., 2015)","plainCitation":"(Souza et al., 2015)","noteIndex":0},"citationItems":[{"id":1246,"uris":["http://zotero.org/users/local/mlRB1JqV/items/3D27SFJT"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/3D27SFJT"],"itemData":{"id":1246,"type":"article-journal","title":"Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies","container-title":"BMJ","page":"h3978","volume":"351","source":"www.bmj.com","abstract":"Objective To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes.\nDesign Systematic review and meta-analysis.\nData sources Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to 1 May 2015, supplemented by bibliographies of retrieved articles and previous reviews.\nEligibility criteria for selecting studies Observational studies reporting associations of saturated fat and/or trans unsaturated fat (total, industrially manufactured, or from ruminant animals) with all cause mortality, CHD/CVD mortality, total CHD, ischemic stroke, or type 2 diabetes.\nData extraction and synthesis Two reviewers independently extracted data and assessed study risks of bias. Multivariable relative risks were pooled. Heterogeneity was assessed and quantified. Potential publication bias was assessed and subgroup analyses were undertaken. The GRADE approach was used to evaluate quality of evidence and certainty of conclusions.\nResults For saturated fat, three to 12 prospective cohort studies for each association were pooled (five to 17 comparisons with 90 501-339 090 participants). Saturated fat intake was not associated with all cause mortality (relative risk 0.99, 95% confidence interval 0.91 to 1.09), CVD mortality (0.97, 0.84 to 1.12), total CHD (1.06, 0.95 to 1.17), ischemic stroke (1.02, 0.90 to 1.15), or type 2 diabetes (0.95, 0.88 to 1.03). There was no convincing lack of association between saturated fat and CHD mortality (1.15, 0.97 to 1.36; P=0.10). For trans fats, one to six prospective cohort studies for each association were pooled (two to seven comparisons with 12 942-230 135 participants). Total trans fat intake was associated with all cause mortality (1.34, 1.16 to 1.56), CHD mortality (1.28, 1.09 to 1.50), and total CHD (1.21, 1.10 to 1.33) but not ischemic stroke (1.07, 0.88 to 1.28) or type 2 diabetes (1.10, 0.95 to 1.27). Industrial, but not ruminant, trans fats were associated with CHD mortality (1.18 (1.04 to 1.33) v 1.01 (0.71 to 1.43)) and CHD (1.42 (1.05 to 1.92) v 0.93 (0.73 to 1.18)). Ruminant trans-palmitoleic acid was inversely associated with type 2 diabetes (0.58, 0.46 to 0.74). The certainty of associations between saturated fat and all outcomes was “very low.” The certainty of associations of trans fat with CHD outcomes was “moderate” and “very low” to “low” for other associations.\nConclusions Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats.","DOI":"10.1136/bmj.h3978","ISSN":"1756-1833","note":"PMID: 26268692","title-short":"Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes","journalAbbreviation":"BMJ","language":"en","author":[{"family":"Souza","given":"Russell J.","dropping-particle":"de"},{"family":"Mente","given":"Andrew"},{"family":"Maroleanu","given":"Adriana"},{"family":"Cozma","given":"Adrian I."},{"family":"Ha","given":"Vanessa"},{"family":"Kishibe","given":"Teruko"},{"family":"Uleryk","given":"Elizabeth"},{"family":"Budylowski","given":"Patrick"},{"family":"Schünemann","given":"Holger"},{"family":"Beyene","given":"Joseph"},{"family":"Anand","given":"Sonia S."}],"issued":{"date-parts":[["2015",8,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Souza et al., 2015). In this case, the patient is obese who overeat and have more fats in the abdomen. He cannot control his eating habits, and with age, this overeating is causing health issue. Another factor behind his problem is inactivity. People who are less active and do not control their weight and glucose level makes their cells sensitive to insulin. The patient also avoids any physical activity and do not maintain his weight and cholesterol level. In addition, he does not prefer healthy food like fruits and vegetable; instead, he intakes more of meat, junk, and desert as a meal.

Causes

Diet is one of the main cause behind type 2 diabetes. It is important to intake balanced diet and avoid excessive use of food containing sodium and nitrites. Red meat and processed red meat are rich in sodium and nitrates that increase the chances of type 2 diabetes. In addition, food that has a high level of carbohydrates like potato and rice must avoid controlling the sugar blood level. In the case of the patient, he prefers junk food like a beef burger, hotdog, bacon, potato chips, and deli meats that are his favorite. Intake of this food with proper amount and timing are healthy, but excessive use of these food items become the cause of type 2 diabetes for the patient ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hP9aV0fj","properties":{"formattedCitation":"(Schwingshackl et al., 2017)","plainCitation":"(Schwingshackl et al., 2017)","noteIndex":0},"citationItems":[{"id":1244,"uris":["http://zotero.org/users/local/mlRB1JqV/items/MHWUCCPW"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/MHWUCCPW"],"itemData":{"id":1244,"type":"article-journal","title":"Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies","container-title":"European Journal of Epidemiology","page":"363-375","volume":"32","issue":"5","source":"Springer Link","abstract":"The aim of this systematic review and meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups and risk of type 2 diabetes (T2D). We conducted a systematic search in PubMed, Embase, Medline (Ovid), Cochrane Central, and Google Scholar for prospective studies investigating the association between whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSB) on risk of T2D. Summary relative risks were estimated using a random effects model by contrasting categories, and for linear and non-linear dose–response relationships. Six out of the 12 food-groups showed a significant relation with risk of T2D, three of them a decrease of risk with increasing consumption (whole grains, fruits, and dairy), and three an increase of risk with increasing consumption (red meat, processed meat, and SSB) in the linear dose–response meta-analysis. There was evidence of a non-linear relationship between fruits, vegetables, processed meat, whole grains, and SSB and T2D risk. Optimal consumption of risk-decreasing foods resulted in a 42% reduction, and consumption of risk-increasing foods was associated with a threefold T2D risk, compared to non-consumption. The meta-evidence was graded “low” for legumes and nuts; “moderate” for refined grains, vegetables, fruit, eggs, dairy, and fish; and “high” for processed meat, red meat, whole grains, and SSB. Among the investigated food groups, selecting specific optimal intakes can lead to a considerable change in risk of T2D.","DOI":"10.1007/s10654-017-0246-y","ISSN":"1573-7284","title-short":"Food groups and risk of type 2 diabetes mellitus","journalAbbreviation":"Eur J Epidemiol","language":"en","author":[{"family":"Schwingshackl","given":"Lukas"},{"family":"Hoffmann","given":"Georg"},{"family":"Lampousi","given":"Anna-Maria"},{"family":"Knüppel","given":"Sven"},{"family":"Iqbal","given":"Khalid"},{"family":"Schwedhelm","given":"Carolina"},{"family":"Bechthold","given":"Angela"},{"family":"Schlesinger","given":"Sabrina"},{"family":"Boeing","given":"Heiner"}],"issued":{"date-parts":[["2017",5,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Schwingshackl et al., 2017). Genetics is another aspect which is difficult to find out in Mr. A case because the patient's parents were not diagnosed with diabetes, but the depressive disorder can increase the chances of diabetes. Therefore, it can be observed that poor lifestyle, including lack of exercise, unhealthy meal choice, and obesity are the causes of the patient’s current health issue.

Treatments

Proper treatment is required to control the health issue of the patient because diabetes in long run can lead to various other health issues like cardiovascular disease, nerve damage, depression, eye damage, kidney issue, and poor skin conditions. The physician can use an appropriate treatment like Metformin, insulin, Meglitinides, GLP-1 receptor agonists, and Sulfonylureas ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IIFy7KEk","properties":{"formattedCitation":"(Kalra, Verma, & Singh, 2017)","plainCitation":"(Kalra, Verma, & Singh, 2017)","noteIndex":0},"citationItems":[{"id":1248,"uris":["http://zotero.org/users/local/mlRB1JqV/items/I9CN8YYU"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/I9CN8YYU"],"itemData":{"id":1248,"type":"article-journal","title":"Management of diabetes distress.","container-title":"JPMA. The Journal of the Pakistan Medical Association","page":"1625-1627","volume":"67","issue":"10","source":"europepmc.org","abstract":"Abstract: This article discusses a comprehensive approach to the management of diabetes distress. It mentions the screening and diagnosis of diabetes...","ISSN":"0030-9982","note":"PMID: 28955090","journalAbbreviation":"J Pak Med Assoc","language":"eng","author":[{"family":"Kalra","given":"S."},{"family":"Verma","given":"K."},{"family":"Singh","given":"YP Balhara"}],"issued":{"date-parts":[["2017",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kalra, Verma, & Singh, 2017). In addition, it is necessary to control the lifestyle of the patient and help him to adopt a healthy lifestyle with proper nutrition. It is important because there is no cure for this issue, but by losing weight and adopting a healthy diet plan can maintain blood sugar level. Four pillar approach is most suitable for the patient because he is not aware of the disease consequences and how to control it. It consists of four steps to cope with the issue. First, proper guidance is provided to the patient regarding his health condition and consequences of disease, which help the patient to decide about his treatment. Second, the patient gets skills and training to control his health condition, that means health advisor teach patients about self-care. Third, patient get to know about various devices and tools like insulin injection or device that calculate insulin level in blood. Forth, the support network is arranged for the patient, so he can get involved with every health change and acquire useful information about the disease and its precautions ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9KhN4jFu","properties":{"formattedCitation":"(Chiasson et al., 2002)","plainCitation":"(Chiasson et al., 2002)","noteIndex":0},"citationItems":[{"id":1243,"uris":["http://zotero.org/users/local/mlRB1JqV/items/XHRSILCF"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/XHRSILCF"],"itemData":{"id":1243,"type":"article-journal","title":"Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial","container-title":"The Lancet","page":"2072-2077","volume":"359","issue":"9323","source":"ScienceDirect","abstract":"Summary\nBackground\nThe worldwide increase in type 2 diabetes mellitus is becoming a major health concern. We aimed to assess the effect of acarbose in preventing or delaying conversion of impaired glucose tolerance to type 2 diabetes.\nMethods\nIn a multicentre, placebo-controlled randomised trial, we randomly allocated patients with impaired glucose tolerance to 100 mg acarbose or placebo three times daily. The primary endpoint was development of diabetes on the basis of a yearly oral glucose tolerance test (OGTT). Analyses were by intention to treat.\nFindings\nWe randomly allocated 714 patients with impaired glucose tolerance to acarbose and 715 to placebo. We excluded 61 (4%) patients because they did not have impaired glucose tolerance or had no postrandomisation data. 211 (31%) of 682 patients in the acarbose group and 130 (19%) of 686 on placebo discontinued treatment early. 221 (32%) patients randomised to acarbose and 285 (42%) randomised to placebo developed diabetes (relative hazard 0·75 [95% CI 0·63–0·90]; p=0·0015). Furthermore, acarbose significantly increased reversion of impaired glucose tolerance to normal glucose tolerance (p<0·0001). At the end of the study, treatment with placebo for 3 months was associated with an increase in conversion of impaired glucose tolerance to diabetes. The most frequent side-effects to acarbose treatment were flatulence and diarrhoea.\nInterpretation\nAcarbose could be used, either as an alternative or in addition to changes in lifestyle, to delay development of type 2 diabetes in patients with impaired glucose tolerance.","DOI":"10.1016/S0140-6736(02)08905-5","ISSN":"0140-6736","title-short":"Acarbose for prevention of type 2 diabetes mellitus","journalAbbreviation":"The Lancet","author":[{"family":"Chiasson","given":"Jean-Louis"},{"family":"Josse","given":"Robert G"},{"family":"Gomis","given":"Ramon"},{"family":"Hanefeld","given":"Markolf"},{"family":"Karasik","given":"Avraham"},{"family":"Laakso","given":"Markku"}],"issued":{"date-parts":[["2002",6,15]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Chiasson et al., 2002).

Conclusion

With the help of an interview from Mr. A and analysis of peer-reviewed articles, I have learned that type 2 diabetes is linked to the lifestyle and genetic factor of the person. People have diabetes syndromes in their genes are at high risk of being diagnosed with the issue. In addition, poor diet choice, overeating, overweight, and obesity can cause diabetes. The physicians can use an appropriate treatment like Metformin, insulin, Meglitinides, GLP-1 receptor agonists, and Sulfonylureas. Moreover, it is important to give proper guidance to the patient and for that four-pillar approach is efficient. The patient should improve his lifestyle, especially diet choice to maintain the blood sugar level; otherwise, it can lead to other issues like kidney problem, heart disease, depression, and nerve damage. Diabetes cannot be cured, but it can be controlled through self-care.

References:

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Association, A. D. (2017). 2. Classification and Diagnosis of Diabetes. Diabetes Care, 40(Supplement 1), S11–S24. https://doi.org/10.2337/dc17-S005

Chiasson, J.-L., Josse, R. G., Gomis, R., Hanefeld, M., Karasik, A., & Laakso, M. (2002). Acarbose for prevention of type 2 diabetes mellitus: The STOP-NIDDM randomised trial. The Lancet, 359(9323), 2072–2077. https://doi.org/10.1016/S0140-6736(02)08905-5

Kalra, S., Verma, K., & Singh, Y. B. (2017). Management of diabetes distress. JPMA. The Journal of the Pakistan Medical Association, 67(10), 1625–1627.

Schwingshackl, L., Hoffmann, G., Lampousi, A.-M., Knüppel, S., Iqbal, K., Schwedhelm, C., … Boeing, H. (2017). Food groups and risk of type 2 diabetes mellitus: A systematic review and meta-analysis of prospective studies. European Journal of Epidemiology, 32(5), 363–375. https://doi.org/10.1007/s10654-017-0246-y

Souza, R. J. de, Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., … Anand, S. S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies. BMJ, 351, h3978. https://doi.org/10.1136/bmj.h3978