Nursing Interventions to Manage and Prevent Type 2 Diabetes and Its Complications

Diabetes currently affects approximately 9% of the world’s population over 18 years of age and accounts for 1.5 million deaths, at a cost of $376 billion. This translates into 382 million individuals with the disease; and by 2030 the number is estimated to increase to  552 million. Persons living in low and middle income countries experience a disproportionate burden of diabetes and related complications often due to a lack of trained diabetes health care providers and resources. Africa currently has 12 million persons with diabetes and by 2030 the projected number will be 23 million, a 98% increase. The Middle East and North Africa have ~ 26 million persons with diabetes and will also experience an increase to 51 million by 2030, a 94% increase. Currently, China leads the world in number of persons with diabetes at 92 million followed by India at 51 million. These numbers illustrate the global burden diabetes however the extent of the problem is enormous when one considers diabetes complications particularly cardiovascular disease which is the leading cause of morbidity and premature mortality. Diabetes is the single leading cause of end stage renal disease (ESRD)in most countries. Further 171 million with people worldwide experience vision loss or impairment due to diabetes, and there are approximately 1 million lower limb amputations annually- one every 30 sends of which 85% are preventable. Given the complexity of self-management, often with few resources and supports, quality of life is less than optimal. It is reported that ~ 60% of persons living with diabetes suffer from depressive symptoms. Diabetes is a chronic disease that requires daily self-management of dietary intake, physical activity, and medications. Numerous studies have shown that effective cognitive behavioral self-management interventions can result in normal or near-normal glucose control which in turn may delay or slow the progression of micro and macro vascular complications, and improve quality of life. With the global increase in urbanization, obesity, and increased longevity, people are living longer with risk for diabetes or with diabetes thus greater efforts are needed to minimize the accompanying personal and economic burdens.