Page 158 - Encyclopedia of Nursing Research

DiABETES RESEARCh n 125

diagnosed with type 2 diabetes in the past Medicine (2009a) recently identified national
decade, particularly because of childhood priorities for comparative effectiveness
obesity, inadequate nutrition, and sedentary research to aid in the translation of best prac- D
lifestyles. Similar to the higher rates of obe- tices for preventing, treating, monitoring and
sity that are seen in African Americans and delivering care. Best practices result from the
hispanics (ogden, Carroll, Curtin, Lamb, most informed decisions of clinicians, con-
& Flegal, 2010), the incidence of type 2 dia- sumers of care, and policy makers generated
betes is also greater in these populations by well-designed investigations that explore
than in non-hispanic Whites (Mayer-Davis, alternative therapeutic approaches. The
2008). Epidemiological trends show that one conundrum facing nurse researchers is how
in three youth in the 2000 U.S. birth cohort best to participate in transdisciplinary teams
will develop diabetes during their lifetime to develop and to evaluate interventions
(narayan, Boyle, Thompson, Sorensen, & that promote effective, individualized self-
Williamson, 2003). management for optimal glycemic control in
Projections of the numbers of individu- persons with diabetes and to also implement
als who will be diagnosed with diabetes screening procedures for early detection and
indicate steady growth to epic proportions in prevention in those most at risk for develop-
elders older than of 65 years and in African ing diabetes.
and native Americans and hispanics (Boyle Tighter glycemic control is shown to
et al., 2001; Engelgau et al., 2004). in 2007, the decrease the progression of microvascular
estimate for the prevalence in adults of pre- diabetes complications in persons with type
diabetes, a condition where fasting blood 1 and type 2 diabetes (Diabetes Control and
glucose levels are higher than normal (i.e., Complications Trial [DCCT] Research Group,
100–125 mg/dl) but not yet at the level to 1993); United Kingdom Prospective Diabetes
be deemed diabetes (i.e., >126 mg/dl), was Study [UKPDS] Group, 1998). Longitudinal
57 million (niDDK, 2008). Diabetes-related follow-up of individuals enrolled in the
complications such as heart disease, stroke, DCCT, called the Epidemiology of Diabetes
kidney disease, blindness, and premature interventions and Complications (EDiC) trial
death are all more common in African and (nathan et al., 2005) and the UKPDS studies,
native Americans or hispanics versus non- demonstrated that intensive glucose control
hispanic White adults (niDDK, 2010). in early in the course of the disease decreased
2007, the total estimated cost of diabetes the incidence of myocardial infarctions and
was US$174 billion, including US$116 bil- cardiovascular mortality (Brown, Reynolds,
lion in excess medical expenditures and & Bruemmer, 2010). in contrast, the Action
US$58 billion in reduced national productiv- to Control Cardiovascular Risk in Diabetes
ity (American Diabetes Association [ADA], (ACCoRD) trial (Gerstein et al., 2008), the
2008). Given these sobering statistics, there Action in Diabetes and Vascular Disease:
is strong evidence that the United States Preterax and Diamicron Modified Release
will face ongoing public health challenges to Controlled Evaluation (ADVAnCE) trial
address the potential burgeoning onslaught (Patel et al., 2008), and the Veterans Affairs
of individuals who face declining health sta- Diabetes Trial (VADT; Duckworth et al.,
tus, quality of life (QoL), and lost productiv- 2009) results suggested that intensive glyce-
ity related to an earlier onset of diabetes. mic control to near normoglycemia (e.g., A1C,
With the continual onslaught of persons 6%–6.5%) in older adults with type 2 diabe-
afflicted with diabetes, research funding tes had either no effect on cardiovascular
for newer pharmaceutical agents, technolo- outcomes or potentially detrimental effects
gies, monitoring devices, and clinical trials because of severe hypoglycemia (Brown
is needed more than ever. The institute of et al., 2010).