https://anglia.instructure.com/courses/34958/files/4102682?verifier=mBIsGn8t4408vrlMr1pGo877MQsbFVkgY6ieyXea&wrap=1
Introduction…………………………………………………………… Page 3
Case study………………………………………………………………Page 4
Pathophysiology…………………….…….……..…………………..… Page 4
Nursing Interventions………………………………..…………….…… Page 6
Health behaviours and health promotion……………………………… Page 9
Integrated care…………………………………………………………. Page 10
Conclusion and recommendations…………………………………….. Page 11
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Introduction :
The King’s Fund (2022) recognises long term conditions(LTCs) as chronic diseases with no available cure; symptom management is achieved through medication and other means.Approximately 26 million people in England alone have at least one LTC, whilst over 10 million have two or more(Pharmaceutical Services Negotiating Committee, 2022). In addition, roughly 70% of the National Health Service’s (NHS) budget is spent on LTCs (The King’s Fund, 2022). Type 2 Diabetes Mellitus (T2DM) is a prime example of an LTC- the International Diabetes Federation (2021) report an estimated 537 million adults living with T2DM worldwide, and an estimated over 4 million in the UK, with the number predicted to rise to 5.5 million by 2030 (Diabetes UK, 2019). 74% of all annual global deaths (41 million people) can be attributed to non-communicable diseases, with T2DM accounting for two million of those deaths (World Health Organization, 2022).T2DM remains a large financial burden on the NHS due to annual costs of £10 billion, a tenth of the total budget (NHS England, 2022). Being one of the most common chronic diseases in the UK (National Institute for health and CareExcellence, 2022c), T2DM remains a serious condition that requires close monitoring and can lead to multiplecomplications (NHS Inform, 2022).
This essay will elaborate on T2DM as an LTC, with a case study of Alan being the focus; his personal experience along with general patient experience of living with T2DM will be explored. This is in addition to how practice-based evidence was utilised to achieve best practice, supported by appropriate academic research. His holistic needs and difficulties faced will be analysed, also touching on legal and ethical details when caring for individuals with this condition.
It will discuss the pathophysiology of T2DM on a more molecular level and how it develops. Factors that increase likelihood of developing this condition and various nursing interventions used to manage the patient’s T2DM will be explored. With T2DM being partially attributed to environmental factors (Kolb and Martin, 2017), health behaviours influencing the onset of the condition is discussed,in addition to the nursing role in health promotion. Ways to potentially improve health promotion are also considered.Finally, the significance of integrated care when supporting individuals to manage their health needs, particularly in relation to physical and mental health wellbeing, is addressed.
Case study:
To retain confidentiality in line with the NMC Code, the patient will be referred to using the pseudonym ‘Alan’(Nursing and Midwifery Council, 2015). Consent was invariably gained from the patient during the delivery of care and prior to writing this essay.
Alan, a 56-year-old left lower leg amputee, was initially brought to A&E due to severe pain in his lower right leg. He was admitted to the endocrinology ward where he was assessed by the multidisciplinary team. Alan had a right below-knee amputation due to a gangrenous leg; prolongedhyperglycaemia had caused poor circulation in his lower right extremities resulting in tissue death (Diabetes.co.uk, 2019).Now a bilateral below knee leg amputee, Alan can mobilise confidently and independently with a wheelchair. He requires leg dressing change twice a week and wears a Juzo sock.
Alan was initially diagnosed 22 years ago by his General Practitioner (GP) following complaints of thirst, urinating frequently at night and general tiredness, all of which are well documented symptoms of T2DM (Bilous et al., 2021, p. 14). Alan lives a sedentary lifestyle at home and is overweightwith a BMI of 28 (National Health Service, 2019b). Being a heavy smoker, who consumed a normal non-diabetic diet at home, Alan has many risk factors that can potentially hasten the progression of his diabetes as T2DM is a progressive condition (National Health Service, 2019a). Smoking worsens diabetes as it contains elements of nicotine, known to increase blood sugar hence reducing glycaemic control (Wiginton, 2022).
Initially, his diabetes was controlled with a strict diet and exercise regimen, however he now requires insulin therapy.
Pathophysiology:
Type 2 diabetes mellitus (T2DM) is a long-term disease whereby the body becomes resistant the insulin, or produces too little insulin, resulting in hyperglycaemia (World Health Organization, 2022a). Insulin is a hormone secreted by beta cells in the pancreas (Diabetes.co.uk, 2022a), which causes the liver to store excess glucose in the form of glycogenthrough a process called glycogenesis (Jiang et al., 2020).Through this, a process called glucose homeostasis is maintained, where internal regulation of blood glucose is controlled by a negative feedback system (Lam et al., 2005).When the blood glucose is too high, the beta cells detect this, prompting them to secrete insulin (Katsumoto et al., 2022). Therefore, blood glucose levels decline to the normal ranges, maintaining glycaemic control.
Individuals like Alan who have T2DM are unable to produce enough insulin or are resistant to their own insulin and the excess glucose accumulates in their blood, hence why hyperglycaemia occurs (British Heart Foundation, 2021).
Frequent hyperglycaemia incurs many health problems, one of which is poor circulation. High blood glucose causes damage to the blood vessels, reducing the blood supply (Bodman and Varacallo, 2022). This therefore reduces blood flow all over the body and poor circulation arises, thus diabetics experience delayed wound healing as there is a lack of oxygen and nutrients being delivered to the wound tissue. Similarly, according to the World Health Organization (2022a), diabetic retinopathy occurs because of accumulated damage to the blood vessels in the retina. The retina is no longer able to send sufficient signals to the optic nerve, causing vision loss (National Eye Institute, 2022).
Diabetic neuropathy is another complication deriving from persistent hyperglycaemia; nerve damage occurs leading to numbness in upper and lower extremities such as legs and hands (Dansinger, 2021). This makes individuals more prone to wounds as they cannot feel when they are being hurt, which is how Alan originally wounded his leg before it became gangrenous. Attaining wounds becomes notably easier due to lack of sensation, and when paired with poor circulation the process of healing can become cyclical. This makes each wound more susceptible to infections, raising risk of amputation. Feldman et al. found that at least 50% of diabetics develop diabetic neuropathy over time, which is further supported by Sloan et al. who also found that up to 50% of diabetics experience neuropathy, 20% of which experience painful neuropathy. Alan’s newly amputated leg wound was consequently monitored closely to promote healing of the surgical wound.
Caused by a combination of environmental factors and genetic disposition (Mambiya et al., 2019), T2DM can initially becontrolled by a strict diet and exercise regimen. However, when this is no longer feasible insulin therapy is used. Injections of insulin throughout the day are given and are categorised by the time it takes to take effect- rapid-acting(known as a bolus insulin) and slower-acting (known as a basal insulin) (Diabetes UK, 2022c). Despite being classed as a long-term condition, diabetes remission is possible. Researchers found in a clinical trial that remission was a realistic target for type 2 diabetics diagnosed in under 6 years and 64% of early T2DM cases were reversible, with the strongest indicator being weight loss (Thom et al. 2020).However, it can be argued that the trial lacked population validity with just over 200 participants, making it unreasonable to generalise these findings to the wider type 2 diabetic population.
On the one hand, T2DM can be largely attributed to being conditioned by the environment around individuals- those from lower socioeconomic backgrounds are more likely to develop it than those of higher socioeconomic status. Alan is an example of this, as he described being raised in a lower socio-economic status and having completed the minimum education level. However, on the other hand the heritability risk is 40% with one affected parent, and 70% with two affected parents (Ali, 2013). This study focuses on monozygotic and dizygotic twins, creating a better understanding of the distinct role of the environment and genetics in T2DM. Prevalence of T2DM is higher in those of south Asian, African Caribbean and black African descent than of other ethnic background (Diabetes UK, 2022a).
Type 2 diabetes is associated with a lower life expectancy and decreased quality of life (National Institute for Health and Care Excellence, 2022c). All diabetic related healthcare costs in the UK are covered by the NHS (National Health Service, 2020), regardless of age unlike most prescriptions which are only free for individuals aged 60 and above. This cost the NHS an annual total of £958 million for diabetic prescription drugs in 2016 (NHS Business Services Authority, 2021).
Nursing interventions-
The nursing acronym ‘APIE’ was utilised to assess Alan’s condition, ensuring he received an individualised care plan(Glasper, 2020). Doing so ensured evidence-based practicethrough holistically identifying and acting on his care needs. This was achieved by assessing physical needs as a diabetic in addition to his spiritual, psychological, and social demands(National Health Service, 2018).
Assessment:
Upon admission Alan was routinely assessed using two methods; firstly, a conversation utilising motivational interviewing occurred. Research by Lundahl and Burke(2009) found that when it came to reducing negative health behaviours, motivational interviewing was 10% to 20% moreeffective than no treatment. Motivational interviewing is a collaborative process which helps the patient draw out their own motivation to facilitate goal-related behavioural change(Frost et al., 2018). Nevertheless, it has been found ineffective when utilised with patients such as Alan who was already motivated to change (Lanitis, 2022).
Following this Alan’s physiological state was assessed using various clinical assessment tools. T2DM is typically characterised by a persistent blood glucose reading above the normal of 7mmol/litre before meals (National Health Service, 2022); upon conducting the finger prick test, Alan had a capillary blood glucose reading of 12.4 before lunch time, prior to his lunch time dosage of insulin indicating hyperglycaemia.
The A-G model was applied as standard practice- airway, breathing, circulation, disabilities, exposure, further information, and goals (Cathala and Moorley, 2020). The National Institute for Health and Care Excellence (NICE)(2020) recognises the National Early Warning Score (NEWS2) as an effective method of detecting deterioratingpatients through measuring physiological parameters. His vital signs were taken, totalling a NEWS2 score of one due to a temperature of 38.1ºC.
Physical pain is subjective to each individual and is measured in various ways such as the Abbey Pain Scale in patients unable to verbalise (National Health Service, 2021). In this particular trust, the numeric 0-3 Pain Scale was used. Pain in the stump was identified as Alan’s biggest concern, scoring 2/3 (moderate pain). Further assessment of the pain occurred utilising the mnemonic SOCRATES (Ford, 2019), identifying the pain as sharp, shooting sensations worsening upon movement.
Planning and implementation:
Alan was very vocal in the decision-making process, expressing wishes to have a better diet and begin smoking cessation after being informed that these were critical factors contributing to his amputation. This idea is reinforced by astudy presented by Liu et al. (2018) which explored the relationship between smoking and diabetic foot amputation, with results suggesting smoking notably increased the risk of diabetic foot amputation. Other significant findings from this study include smoking cessation reduced the risk, and there was an insignificant difference between major and minor amputations and smoking. Extensive research has confirmed that tobacco consumption has adverse effects on health(Office for Health Improvement & Disparities, 2022) and smoking cessation is the single most impactful way to prevent development of disease (UK Health Security Agency, 2018).
1mg of paracetamol was prescribed as a regular medication, being an antipyretic and a form of analgesia (National Institute for Health and Care Excellence, 2022b) whilst morphine was prescribed as a stronger form of analgesic (PRN) to ease the pain (National Institute for Health and Care Excellence, 2022a). The TVN analysed the surgical wound and devised a care plan outlining specific products to use, changing the dressing every 3 days and covering the stump with a Juzo (compression) sock, which has been proven to prevent oedema and provide stump formation (Demir and Aydemir, 2020). A dietician referral was completed by the nurse; the dietician visited Alan and discussed his pre-admission eating habits, diet goals and advised him to follow a diabetic diet reducing highly processed sugary snack intaketo avoid spikes in blood glucose. He was also encouraged to increase physical activity to promote weight loss.
Nursing interventions relating to safety were completed such as the falls risk assessment, following research by Chihuri et al (2021) suggesting in the abstract that lower-limb loss individuals experience a higher annual rate of falls and injuries. However, there is a legal and ethical duty to ensure the patient consents to the use of bed rails; if the patient lacks capacity, decisions must be in accordance with the Mental Capacity Act 2005 (Mind, 2017).
Alan received his regular analgesia and was informed of PRN medication being available. Regular comfort rounds were carried out, ensuring Alan was regularly mobilising to prevent deconditioning. The wound care plan was followed and reviewed after two weeks. Alan was given a total of 3 Juzo socks to rotate usage, decreasing the risk of infection due to being in close proximity of the wound (McManus, 2021). Alan was served a diabetic diet during his stay and requested that his family not bring him an excess of chocolates and sugary treats which contain a high glycaemic index (Diabetes UK, 2022b). Resources regarding healthier lifestyle choices were given to him upon his request and he was encouraged to read through and ask questions.
Evaluation:
The surgery was effective as there was only post-operative pain which was managed by regular and PRN analgesia. SinceAlan was very vocal when he needed more pain relief his PRN medication was utilised as intended and was very effective. Following the regular dosage of paracetamol, Alan’s body temperature returned to the normal range at 36.7 degrees Celsius. The surgical wound was healing well with no signs of infection and minimal exudate, allowing Alan to be medically fit for discharge after four weeks. The appropriate discharge planning was put in place so that district nurses could redress the wound as Alan was desperate to return home after weeks in the hospital.
A key factor of his success was because Alan was very committed to changing for the better therefore was cooperative and involved with his care, which is fundamental to having Alan as a partner in care as opposed to having a ‘them and us’ dynamic (The King’s Fund, 2016). He actively participated in the provision of his care; his input was respected and acknowledged in every clinical decision.
Health behaviours and promotion-
With causation of T2DM significantly associated to environmental factors (Dendup et al., 2018), health promotion from a nursing standpoint is critical in educating individuals how their behaviours affect them long-term. Of the estimated 4.8 million individuals in the UK with diabetes, type 2 diabetes accounts for 90% of the diabetic population (Diabetes.co.uk, 2022b). This shows the significance of educating and promoting positive health behaviours, especially towards the pre-diabetic community. Implementing health promotion through public health initiatives that target negative health behaviours therefore targets and reduces premature deaths on a national basis due to T2DM.
Nurses can promote the prevention of type 2 diabetes through guiding patients to the NHS Diabetes Prevention Programme, targeting the risk factors of diabetes in those who are anticipating it to delay the onset of type 2 diabetes. In early stages of type 2 diabetes a change in both diet and exercise can be effective enough to control blood glucose without medication, and as mentioned in the pathophysiology it is possible for patients to go into remission. Alan reported that he was informed of the benefits of good diet and exercise but was unaware remission was possible, thus he lacked motivation to maintain a healthy lifestyle. This signifies there is a gap in patient education which needs to be filled. In spite of this, the NHS Long Term Plan is an initiative thought to have already prevented over 18,000 individuals from developing T2DM through educating individuals on how their own behavioural choices affect them over the course of several months (National Health Service, 2022). This is supported by a recent study by Raghupathi and Raghupathi (2020) who found adults with better education generally have longer lifespans and greater health. Alan was provided with an excess of contacts, leaflets, and resources on T2DM to improve his confidence in self-management.
Making Every Contact Count (MECC) is another method that nursing staff can implement on a more daily basis. This involves having the skills to encourage patients to take action and change their behaviour, through having meaningful conversations and directing them to other local services and organisations that may be of use to them (Public Health England, 2016). Lawrence et al. (2016) describes this model as a sustainable way to create significant changes in the public’s health due to being not very complex and straightforward to learn, making it accessible for all practitioners to partake in.
Integrated care-
Care of T2DM patients involves much more than the nurse. Podiatrists, specialist nurses such as the TVN, opticians, and diabetes nurse are some examples of practitioners involved in the process of co-ordinated care. Having an integrated approach has been shown to produce improved outcomes; integrated care ensures patients feel at ease with managing symptoms independently or with support. Despite this, reportedly only 64% of those living with LTCs feel supported,and only 55% of those with an LTC are confident self-managers (National Health Service, 2018). To add to this, only 5.4% of individuals with an LTC have a written care plan(National Health Service, 2015), indicating that there is a lack of patient support and clarity on how care should be provided. Care plans are integral to upkeeping consistency of care, especially amongst individuals like Alan who work with numerous members of the multidisciplinary team. It would be difficult to upkeep the same standard of care across different service providers without having a written record, which again suggests a gap in communication across practitioners.
The King’s Fund (2013) emphasises the importance of enabling the patient to become more self-supporting in their own homes as opposed to having an exclusively clinical focus on solving symptoms. However, many patients have reportedphysical challenges, such as with mobility. Being a bilateral amputee, Alan may take a while to adjust to his missing limbs and may experience phantom limb syndrome (Schone et al., 2022) whereby pain is perceived to originate from his amputated right leg. Although the exact cause is uncertain, over 79% of patients in a research study conducted by Hanyu-Deutmeyer et al. (2022) have also experienced this, which can cause issues with mobility. However, referral to other specialists such as physiotherapists can help increase mobility to promote independence.
Other challenges when dealing with T2DM include psychological difficulties. There are many individualsvulnerable to social isolation, such as individuals who feel stigma because of their T2DM (Liu et al., 2017) and most notably the elderly. Research from Pardhan et al. (2021) has found that isolation negatively impacts self-management of diabetes. Although Alan lives with his wife, he has reported feelings of shame deriving from members of extended family, causing him to self-isolate. This in turn has hindered his ability to self- manage in the past. Research shows that levels of mental disorders such as depression and anxiety are much higher in individuals why are socially isolated (Megans and Fisher, 2021). This poses a challenge as T2DM patients may feel embarrassed asking for help.
Despite this nurses and other healthcare practitioners areexpected to be compassionate towards individuals with T2DM, as well as competent in knowing how to approach situations where a vulnerable individual is involved, both of which are components of the 6C’s of nursing (Nursing Times, 2022).
Conclusion-
T2DM is a long-term condition affecting millions of individuals, with prevalence predicted to rise steadily over the years. This essay has highlighted the multiple complications that can develop as a result of unmonitored T2DM, as well as the pathophysiology behind the symptoms of this long-term condition. With Alan being the focus of the case study, it has shown that the patient should be kept at the centre of care and treated individually with personalised care plans, as all patients have different experiences of living with T2DM. This essay has shown the roles of nurses in promoting health as well as interventions taken when caring for Alan. Emphasis has also been placed on the role of nurses in integrated care and how this may be achieved, as well as challenges faced by patients when living with T2DM.
Due to the lack of confidence of self-management in many patients, services empowering and guiding patients to take control of their own treatment need to be more accessible.This would benefit patients like Alan, who wish to manage their condition independently but lack the knowledge to do so, therefore they access primary care like A&E as opposed to the GP. This would result in reduced strain on the A&E department as well as better mental and physical health for the patient. Further recommendations include an increase in support for mental health services for those with diabetes as well as ensuring continuity of care when being discharged home, since Alan alongside other patients have reported a large drop in quality of support and care post-discharge.
Reference List
Ali O. (2013). ‘Genetics of type 2 diabetes’. World journal of diabetes, 4(4), pp. 114–123. Available at:https://doi.org/10.4239/wjd.v4.i4.114
Bilous, R.W., Donnelly, R. and Idris, I. (2021) Handbook of diabetes. 5th ed. Hoboken, New Jersey: Wiley Blackwell.
Bodman, M. A., and Varacallo, M. (2022) Peripheral Diabetic Neuropathy. Florida: StatPearls Publishing.
British Heart Foundation (2021) Diabetes- causes, symptoms & treatments. Available at: https://www.bhf.org.uk/informationsupport/risk-factors/diabetes (Accessed: 28 December 2022).
Cathala, X., and Moorley, C. (2020) ‘Performing an A-G patient assessment: a step-by-step guide’, Nursing Times, 116 (1), pp. 53-55. Available at: https://www.nursingtimes.net/clinical-archive/assessment-skills/performing-an-a-g-patient-assessment-a-step-by-step-guide-06-01-2020/ (Accessed: 17 November 2022).
Chihuri, S.T., Youdan Jr, G.A., and Wong, C.K. (2021) ‘Quantifying the risk of falls and injuries for amputees beyond annual fall rates- A longitudinal cohort analysis based on person-step exposure over time’, National Library of Medicine, 24, article number 101626. Available at:10.1016/j.pmedr.2021.101626 (Accessed: 18 November 2022).
Dansinger (2021) Peripheral Neuropathy and Diabetes. Available at: https://www.webmd.com/diabetes/peripheral-neuropathy-risk-factors-symptoms (Accessed: 29 November 2022).
Demir, Y., & Aydemir, K. (2020) ‘Gülhane lower extremity amputee rehabilitation protocol: A nationwide, 123-year experience’. Turkish journal of physical medicine and rehabilitation, 66(4), pp. 373–382. Available at:https://doi.org/10.5606/tftrd.2020.7637
Dendup, T., Feng, X., Clingan, S., & Astell-Burt, T. (2018)’Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review’, International journal of environmental research and public health, 15(1), p. 78.Available at: https://doi.org/10.3390/ijerph15010078
Diabetes.co.uk (2022a) Beta cells. Available at: https://www.diabetes.co.uk/body/beta-cells.html (Accessed: 1 January 2023).
Diabetes.co.uk (2022b) Diabetes Prevalence. Available at: https://www.diabetes.co.uk/diabetes-prevalence.html(Accessed: 22 November 2022).
Diabetes.co.uk (2019) Gangrene. Available at: https://www.diabetes.co.uk/diabetes-complications/gangrene-and-diabetes.html (Accessed: 4 January 2023).
Diabetes UK (2022a) Ethnicity and Type 2 Diabetes. Diabetes UK. Available at: https://www.diabetes.org.uk/preventing-type-2-diabetes/diabetes-ethnicity (Accessed: November 28 2022).
Diabetes UK (2019) Number of people with diabetes reaches 4.7 million. Available at: https://www.diabetes.org.uk/about_us/news/new-stats-people-living-with-diabetes#:~:text=The%20new%20figures%20show%20that,number%20up%20to%204.7%20million. (Accessed: 3 January 2023).
Diabetes UK (2022b) Glycaemic index and diabetes. Diabetes UK. Available at: https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/carbohydrates-and-diabetes/glycaemic-index-and-diabetes (Accessed: 18 November 2022).
Diabetes UK (2022c) Types of Insulin. Available at: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin/types (Accessed: 29 December 2022).
Evans, M., & Fisher, E. B. (2022) ‘Social Isolation and Mental Health: The Role of Nondirective and Directive Social Support’. Community mental health journal, 58(1), pp. 20–40.Available at: https://doi.org/10.1007/s10597-021-00787-9
Feldman, E.L., Callaghan, B.C., Pop-Busui, R., Zochodne, D.W., Wright, D.E., Bennet, D.L., Bril, V., Russell, J.W., and Viswanathan, V. (2019) ‘Diabetic neuropathy’, NatureReviews Disease Primers, 5, p. 41. Available at:https://doi.org/10.1038/s41572-019-0092-1
Ford, C. (2019) ‘Adult pain assessment and management’, British Journal of Nursing, 28(7), pp. 421–423. Available at: https://doi.org/10.12968/bjon.2019.28.7.421.
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., Cheyne, H., Coles, E., andPollock, A. (2018) ‘Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews’. PloSone, 13(10), article number 0204890. Available at:https://doi.org/10.1371/journal.pone.0204890
Glasper, A. (2020) Strategies to ensure that all patients have a personalised nursing care plan. Available at: https://www.britishjournalofnursing.com/content/healthcare-policy/strategies-to-ensure-that-all-patients-have-a-personalised-nursing-care-plan/#:~:text=The%20primary%20four%20APIE%20steps,E%3A%20evaluation. (Accessed: 18 November 2022).
International Diabetes Federation (2021) About Diabetes. Available at: https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html (Accessed: 28 November 2022).
Jiang, S., Young, J.L., Wang, K., Qian, Y., and Cai, L. (2020) ‘Diabeticinduced alterations in hepatic glucose and lipid metabolism: The role of type 1 and type 2 diabetes mellitus (Review)’, Molecular Medicine Reports, 22, pp. 603-611.Available at: https://doi.org/10.3892/mmr.2020.11175
Katsumoto, K., Yennek, S., Chen, C., Silva, L.F.D., Traikov, S., Sever, D., Azad, A., Shan, J., Vainio, S., Ninov, N., Speier, S., and Grapin-Botton., A. (2022) ‘Wnt4 is heterogeneously activated in maturing β-cells to control calcium signaling, metabolism and function’. Nauret Communications 13, p. 6255. Available at: https://doi.org/10.1038/s41467-022-33841-5
Kolb, H., Martin, S. (2017) ‘Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes’, BMC Med, 15, p. 131. Available at: https://doi.org/10.1186/s12916-017-0901-x
Lanitis, A. (2022) Learn more about motivational interviewing. Available at: https://mindlercare.com/uk/motivational-interviewing/#:~:text=To%20conclude%20motivational%20interviewing%20is,are%20already%20motivated%20to%20change. (Accessed: 1 January 2023).
Lam, T.K.T., Gutierrez-Juarez, R., Pocai, A. and Rossetti, L. (2005) ‘Regulation of Blood Glucose by Hypothalamic Pyruvate Metabolism’, Science (American Association for the Advancement of Science), 309(5736), pp. 943–947. Available at: https://doi.org/10.1126/science.1112085
Lawrence, W., Black, C., Tinati, T., Cradock, S., Begum, R., Jarman, M., Pease, A., Margetts, B., Davies, J., Inskip, H., Cooper, C., Baird, J., & Barker, M. (2016) ‘’Making every contact count’: Evaluation of the impact of an intervention to train health and social care practitioners in skills to support health behaviour change’. Journal of health psychology, 21(2), pp. 138–151. Available at:https://doi.org/10.1177/1359105314523304
Liu, N. F., Brown, A. S., Folias, A. E., Younge, M. F., Guzman, S. J., Close, K. L., & Wood, R. (2017) ‘Stigma in People With Type 1 or Type 2 Diabetes’. Clinical diabetes : a publication of the American Diabetes Association, 35(1), pp. 27–34. Available at: https://doi.org/10.2337/cd16-0020
Lundahl, B., & Burke, B. L. (2009). ‘The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses’. Journal of clinical psychology, 65(11), pp. 1232–1245. Available at:https://doi.org/10.1002/jclp.20638
Mambiya, M., Shang, M., Wang, Y., Li, Q., Liu, S., Yang, L., Zhang, Q., Zhang, K., Liu, M., Nie, F., Zeng, F., and Liu, W. (2019) ‘The Play of Genes and Non-genetic Factors on Type 2 Diabetes’, Frontiers in public health, 7, pp. 1-6. Available at: https://doi.org/10.3389/fpubh.2019.00349
McManus, E. (2021) Wound Infection Diagnosis, Treatment and Prevention. Available at: https://idcare.com/blog/how-to-diagnose-treat-and-prevent-wound-infections/#:~:text=According%20to%20WoundSource%2C%20when%20the,damaged%20tissue%20and%20inhibiting%20healing. (Accessed: 2 January 2023).
Mind (2017) Mental Capacity Act 2005. Available at: https://www.mind.org.uk/information-support/legal-rights/mental-capacity-act-2005/overview/ (Accessed: 21 December 2022).
National Eye Institute (2022) Diabetic Retinopathy. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy#:~:text=Diabetic%20retinopathy%20is%20caused%20by,vessels%20all%20over%20the%20body. (Accessed:29 December 2022).
National Health Service (2015) Personalised care and support handbook: The journey to person-centred care. Available at: https://www.hey.nhs.uk/patient-leaflet/holistic-needs-assessment/ (Accessed: 29 November 2022).
National Health Service (2018), Making the case for the personalised approach. Available at: https://www.england.nhs.uk/blog/making-the-case-for-the-personalised-approach/ (Accessed: 23 December 2022).
National Health Service (2019a) Diabetes. Available at: https://www.nhs.uk/conditions/diabetes/ (Accessed: 6 January 2023).
National Health Service (2019b) Obesity. Available at: https://www.nhs.uk/conditions/obesity/ (Accessed: 29 December 2022).
National Health Service (2020) Understanding medicine Type 2 diabetes. Available at: https://www.nhs.uk/conditions/type-2-diabetes/understanding-medication/#:~:text=If%20you%20take%20diabetes%20medicine,known%20as%20a%20PF57%20form. (Accessed: 3 January 2023).
National Health Service (2021) Abbey Pain Assessment Tool.Available at: https://www.chesterfieldroyal.nhs.uk/news/royal-round/abbey-pain-assessment-tool (Accessed: 2 January 2023).
National Health Service (2022) NHS Prevention programme cuts chances of type 2 diabetes for thousands. Available at: https://www.england.nhs.uk/2022/03/nhs-prevention-programme-cuts-chances-of-type-2-diabetes-for-thousands/#:~:text=Evidence%20has%20shown%20that%20the,effective%20in%20the%20long%2Dterm. (Accessed: 22 December 2022).
National Institute for Health and Care Excellence (2020) National Early Warning Score system that alert to deteriorating adult patients in hospital. Available at: https://www.nice.org.uk/advice/mib205/chapter/The-technology (Accessed: 17 November 2022).
National Institute for Health and Care Excellence (2022a) Morphine. Available at: https://bnf.nice.org.uk/drugs/morphine/ (Accessed: 2 January 2023).
National Institute for Health and Care Excellence (2022b) Paracetamol. Available at: https://bnf.nice.org.uk/drugs/paracetamol/ (Accessed: 2 January 2023).
National Institute for Health and Care Excellence (2022c) Type 2 Diabetes. Available at: https://bnf.nice.org.uk/treatment-summaries/type-2-diabetes/(Accessed: 19 November 2022).
NHS Business Services Authority (2021) NHS report shows diabetes drugs prescribed increased by 8 million since 2015/16. Available at: https://media.nhsbsa.nhs.uk/news/diabetes-stats (Accessed: 3 January 2023).
NHS England (2022) NHS Prevention Programme cuts chances of Type 2 Diabetes for thousands. Available at: https://www.england.nhs.uk/2022/03/nhs-prevention-programme-cuts-chances-of-type-2-diabetes-for-thousands/(Accessed: 23 December 2022).
NHS Inform (2022) Hyperglycaemia (high blood sugar). Available at: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hyperglycaemia-high-blood-sugar (Accessed: 1 January 2023).
Nursing and Midwifery Council (2015) The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (Accessed: 18 November 2022).
Nursing Times (2022) What are Compassion in Practice and the 6C’s of Nursing?. Available at: https://www.nursingtimes.net/news/policies-and-guidance/what-are-compassion-in-practice-and-the-6cs-of-nursing-14-02-2022/ (Accessed: 2 January 2023).
Office for Health Improvement & Disparities (2022) Smoking and tobacco: applying All Our Health. Available at: https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health (Accessed: 6 January 2023).
Pharmaceutical Services Negotiating Committee (2022)Essential facts, stats and quotes relating to long-term conditions. Available at: https://psnc.org.uk/lpcs-and-local/locally-commissioned-services/essential-facts-stats-and-quotes/long-term-conditions/ (Accessed: 28 January 2022).
Public Health England (2016) Making Every Contact Count (MECC): Consensus statement. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/04/making-every-contact-count.pdf(Accessed: 4 January 2023).
Raghupathi, V., Raghupathi, W. (2020) ‘The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015’. Arch Public Health, 78, p. 20. Available at: https://doi.org/10.1186/s13690-020-00402-5
Santini, Z.I., Jose, P.E., Cornwell, E.Y., Koyanagi, A, Nielsen, L., Hinrichsen, C., Meilstruo, C., Madsen, K.R., and Koushede, V. (2020) ‘Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): A longitudinal mediation analysis,’ The Lancet Public Health, 5(1). Available at: https://doi.org/10.1016/s2468-2667(19)30230-0.
Schone, H.R., Baker, C., Katz, J., Nikolajsen, L., Limakatso, K., Flor, H., and Makin, T.R. (2022) ‘Making Sense of Phantom Limb pain,’ Journal of Neurology, Neurosurgery & Psychiatry, 93(8), pp. 833–843. Available at: https://doi.org/10.1136/jnnp-2021-328428.
Sloan, G., Shillo, P., Selvarajah, D., Wu, J., Wilkinson, I.D., Tracey, I., Anand, P., and Tesfaye, S. (2018) ‘A new look at painful diabetic neuropathy’, Diabetes Research and Clinical Practice,144, pp. 177-191. Available at: https://doi.org/10.1016/j.diabres.2018.08.020.
Stedman, M., Lunt, M., Davies, M., Livingston, M., Duff, C., Fryer, A., Anderson, S.G., Gadsby, R., Gibson, M.., Rayman, G., and Heald, A. (2020) ‘Cost of hospital treatment of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) compared to the non-diabetes population: a detailed economic evaluation’, BMJ Open, 10, article number 033231. Available at: https://doi.org/10.1136/bmjopen-2019-033231.
The King’s Fund (2016) Patients as partners: Building collaborative relationships among professionals, patients, carers and communities. Available at: https://www.kingsfund.org.uk/publications/patients-partners(Accessed: 5 January 2023).
The King’s Fund (2022) Long-term conditions and multi-morbidity. Available at: https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity (Accessed: 26 November 2022).
Thom, G., Messow, C.M., Leslie, W.S., Barnes, A.C., Brosnahan, N., McCombie, L., Al-Mrabeh, A., Zhyzhneuskaya, S., Welsh, P., Sattar, N., Taylor, R., and Lean, M.E.J. (2020) ‘Predictors of type 2 diabetes remission in the diabetes remission clinical trial (direct),’ Diabetic Medicine, 38(8). Available at: https://doi.org/10.1111/dme.14395.
UK Health Security Agency (2018) Health Matters: Stopping smoking- what works?. Available at: https://ukhsa.blog.gov.uk/2018/09/25/health-matters-stopping-smoking-what-works/ (Accessed: 3 January 2023).
Wiginton, K. (2022) Smoking and diabetes. Available at: https://www.webmd.com/diabetes/smoking-and-diabetes(Accessed: 4 January 2023).
World Health Organization (2022a) Diabetes. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes(Accessed: 11 December 2022).
World Health Organization (2022b) Noncommunicable diseases. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Key%20facts,74%25%20of%20all%20deaths%20globally. (Accessed: 5 January 2023).
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