Diabetes is not just a disorder of carbohydrate metabolism, but also a cause of vascular complications observed in most patients (Forbes & Fotheringham, 2017). According to Haw et al (2021), about than 13% of people in the United States have diabetes mellitus which is associated with an increase in overweight and obesity. Peripheral vascular disease, heart disease, and stroke are conditions that mostly affect the elderly with diabetes (Li et al., 2020). Vascular disease among these patients is the area that has raised concerns due to its complexity and gaps in effective management strategies. This review focuses on associated factors, disparities, gaps in the treatment of vascular complications of diabetes, and the best strategies that can be used to prevent the disease.
Microvascular and macrovascular complications of diabetes increase with the elderly. Studies indicate that men are usually at risk of developing microvascular complications while women become more affected by macrovascular complications (Li et al., 2020). The difference is usually attributed to genetic and hormonal factors that increase the overall risk of vascular complications in women. Another factor that is observed to contribute to vascular complications is the level of education. Higher educational levels are observed to help in patient education which improves the overall management of the disease among populations (Haw et al., 2021). Those who adhere to treatment and seek medical care often have better outcomes compared to their counterparts. Other studies have evaluated the risk of vascular complications among the elderly living with their families, single, divorced, or widowed (Li et al., 2020). The elderly with enough support are observed to manage vascular complications and other associated conditions better than those who live alone.
Racial and ethnic minority populations have a higher burden of diabetes-related complications. In the US, diabetes mellitus disproportionately affects minority populations because of factors like income levels, education, and healthcare access (Haw et al., 2021). For example, American Indians, Hispanics, and non-Hispanic Blacks have the highest rates of diabetes. Likewise, the rate of vascular complications among these groups is high. Haw et al (2021) explain that non-Hispanic Blacks and Hispanic adults have higher rates of albuminuria, retinopathy, and poor glycemic control. Ineffective control of blood glucose levels can be among the reasons why these populations have higher risks for vascular complications. In other findings, minority groups still experience high rates of macrovascular complications like stroke and myocardial infarction (MI) despite their decline in recent years (Haw et al., 2021). While planning for the care of patients with vascular complications, it is important to consider minority groups because different approaches might be required during care delivery.
Effective management of microvascular and macrovascular complications requires treating a range of factors. There is no single strategy that has been identified to deal with vascular complications of diabetes across all populations. Most evidence has focused on managing nutritional intake, lifestyle and activity, blood pressure control, and control of blood glucose levels (Zimmerman, 2016). There is evidence that keeping blood glucose levels within the normal limits can aid in managing vascular complications. For the elderly, behavioral interventions like quitting smoking, alcohol intake, and taking low-dose aspirin can help to lower the risk of macrovascular complications (Forbes & Fotheringham, 2017). In recent studies, there is increasing evidence of using newer approaches to manage vascular complications. For example, the use of next-generation glucose-lowering therapies is a promising approach to address diabetes and its complications. Additionally, studies on therapies thought to improve mitochondria function and nutrient flux for energy production could produce more effective approaches to vascular complications management (Forbes & Fotheringham, 2017).
Gaps in Literature
The importance of early and intensive control of blood sugar levels in managing vascular complications is well-established in the literature. However, it is widely recognized that most patients do not achieve the required HbA1c targets leading to delayed prevention of complications. Another observed treatment gap is the lack of adequate statistics on the patients’ diabetes control including charts for monitoring HbA1c levels, weight, and cholesterol. These treatment gaps can be contributing factors to poor glycemic control and early initiation of intensive glycemic control. Despite supporting tight glycemic control as a strategy to address vascular complications, most studies failed to dictate the most probable approach between intensive insulin therapy and conventional therapy that can be used to achieve better results. There is a need for more research to clarify measures of achieving tight glycemic control and factors that hinder the achievement of desired glucose levels in patients.
Nursing Theory: Roger’s Theory of Unitary Human Beings
Martha Rodger’s theory of unitary human beings is observed to fit the ideas in my research. This theory emphasizes both the scientific nature of nursing as well as the humanitarian aspects that are key to nursing care delivery (Phillips, 2019). The theory provides nurses with a base to view nursing from a scientific point. For example, nurses must understand the anatomy and physiology of human tissues to save lives and reduce suffering. Rodgers identified nursing as an art and science directed toward the unitary human being and the use of science can lead to changes in the patient’s condition (Phillips, 2019). Additionally, maintenance and promotion of health, diseases, nursing diagnosis, and interventions encompass the scope of nursing practice.
My research involves determining the most appropriate approaches to manage vascular complications in elderly patients with diabetes. Basing the interventions on nursing research and evidence-based practice demonstrates the use of the scientific view of nursing described by Rodger. According to Phillips (2019), nurses must understand the human body and its processes to provide effective treatments and cure. The nursing process in Rodger’s theory is described by three steps; assessment, voluntary mutual pattering, and evaluation (Phillips, 2019). Managing vascular complications among the elderly can utilize these steps that emphasize the importance of sharing knowledge, and fostering partnership for effective disease management.
Forbes, J. M., & Fotheringham, A. K. (2017). Vascular complications in diabetes: Old messages, new thoughts. Diabetologia, 60(11), 2129–2138. https://doi.org/10.1007/s00125-017-4360-x
Haw, J. S., Shah, M., Turbow, S., Egeolu, M., & Umpierrez, G. (2021). Diabetes complications in racial and ethnic minority populations in the USA. Current Diabetes Reports, 21(1), 2. https://doi.org/10.1007/s11892-020-01369-x
Li, J., Chattopadhyay, K., Xu, M., Chen, Y., Hu, F., Chu, J., & Li, L. (2020). Prevalence and associated factors of vascular complications among inpatients with type 2 diabetes: A retrospective database study at a tertiary care department, Ningbo, China. PloS One, 15(6), e0235161. https://doi.org/10.1371/journal.pone.0235161
Phillips J. R. (2019). Unitariology and the changing frontiers of the science of unitary human beings. Nursing Science Quarterly, 32(3), 207–213. https://doi.org/10.1177/0894318419845404
Zimmerman, R. S. (2016). Diabetes mellitus: Management of microvascular and macrovascular complications. J Cleveland Clinic: Centers for Continuing Education. https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/diabetes-mellitus/
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