1. The World Health Organisation defines Diabetes as quot;... a chronic disease that occurs when the pancreas does not produce enough
insulin, or when the body cannot effectively use the insulin it producesquot; (World Health Organisation on-line 2008a). It goes on to
suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income
countries. The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete,
type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tollerance and impaired fasting
glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.
There are several types of Diabetes. Historically, Diabetes Mellitus tended to be classified by depending on insulin administration
or the lack of it. In more recent times, it is accepted the disease is more complex. Type 1 Diabetes refers to
Type 2 refers to where insulin is produce which
This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus. The
latter name has been challenged as the number of individuals under 16 is now significantly
Because the symptoms of Diabetes Mellitus type 2, individuals may be going undetected. On a global scale, this could include
In the United Kingdom, the quot;missing Millionquot; is the subject of some debate. This, until now, could have included Jack.
This could have many implication as individuals may not have any idea that, as they have no symptoms, that they are do not have
the disease and so do not feel that they need to alter any

2. Pre-diabetis, also referred to Metabolic Syndrome and formally called Glucose Intolerance in now the subject of much research.
Diabetes Insidus is a condition which is not related to insulin production and is
The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine
(polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in
that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus
causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the
hypothalamic thirst centres causing polydipsia. As the large ammounts of glucose can not enter cells as insulin is not fascilitating
this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness, and less
commonly genital itching, frequent Thrush infections and blurred vision
Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience. Smoking tabacco can result
in vascular compromiseation can compund the changes which are caused by Diabetes Mellitus

3. The aim of this assignment is to
allow you an opportunity to
examine public health and health
promotion concepts relevant to
adult nursing practice.
1. explain how the
particular health need has
been identified using
demographic and
epidemiological data to
support your discussion
2. apply health promotion
theory to explore
possible health
promoting activities
3. identify possible
evaluation methods to
demonstrate the
effectiveness of health
promotion interventions
This discussion will based upon a scenario involving Jack Ford,72, who
presents to his General Practioner with the symptoms of diabetes (see appedix
1). Jack has several demographicand lifestyle factors which will affect his
disease experience, some of which are changable and some which are not. A
Intro: Identify the scenario and
discussion of the types of diabetes will be followed by an investigation into
outline the particular aspects you
will be exploring (250 words) some of the demographic and epidemiological factors that are pertinent to
diabetes and Jack's situation. The focus of this discussion will be to explore how
the risk factor of obesity can impact upon the development of this disease and
how its reduction of weight can significantly improve the health and lifes tyle of
of an individual who finds themselves in this situation.
Three degrees of helath promotion have been identified. Primary health
promotion pertains to that which is undertaken to prevention of the
commencement of health consequense occuring. This is exemplified as health
eating campagnes in schools which can help to decrease the onset of diabetes ().
Secondary health promotional activity aims to prevent any adverse health
consequence from deteriating further. This would include teaching foot care
techniques to newly diagnosed diabetics. Tertiary health promotion is
concerned with
DESMOND (Diabetes Education and Self-Management for Ongoing and
Newly Diagnosed) is a national education program taylored for individuals with
Diabetes type 2. Being primarily pioloted by 15 English Primary Care Trusts
(PCTs) from 2004 and is now being tested via a 1000 subject randomised
control trial in selected English and Scotish PCTs.
Taking its lead from the National Institute for Health and Clinicle Excelence

4. guidance
Jack is affected by several National Service frameworks. These include those
for Elderly People,
Body Mass index (BMI), the calcuation of weight divided by height squared,
has been widely used as an indicator of obsesity, normal weight and under
weight. It is one of the factors that is included in several nutritional scores. It
can provide a basic analogue of whether any weight management activities need
to be implicated. However, it is limited in that it does not take into account any
risk factors. Moreover, there is now much research which brings into question
the validity of BMI. Waist measurement is now bieing mooted as a more
reliable predictor of risk with regard to weight.
The NMC (2008) call for Registrants to be non-judgemental in the Code for
asdfasfsadfs. However, much has been written about prejoritive attitudes of
Nurses and other health care professionals.
If
The NMC (2008) call for Registrants to be non-judgemental in the Code for
asdfasfsadfs. However, much has been written about prejoritive attitudes of
Nurses and other health care professionals

5. Diabetes Mellitus- 09:39
The incidence of diabetes is increasing in all age groups. .... Welcome to
DiabetesUK. Acknowledgements EMIS is grateful to Dr Hayley Willacy for
writing ...
www.patient.co.uk/showdoc/40000914/ - 57k - Cached - Similar pages - Note
this
Rising Incidence of Type 2 Diabetes in Children in the U.K....
Rising Incidence of Type 2 Diabetes in Children in the U.K.. Linda Haines,
MSC1, Kay Chong Wan, DPHIL1, Richard Lynn, MSC1, Timothy G. Barrett,
...
care.diabetesjournals.org/cgi/content/abstract/30/5/1097 - Similar pages - Note
this
[PDF]
Diabetes: State of the Nations 2006
File Format: PDF/Adobe Acrobat - View as HTML
areas of Diabetes UK: early identification of. diabetes, psychological and
emotional ...... Rising incidence of insulin-dependent diabetes in children ...
www.diabetes.org.uk/Documents/Reports/SOTN2006_full.pdf - Similar pages -
Note this
NLH - Diabetes - Incidence and prevalence of diabetes
10 Jun 2007 ... Numerous studies have shown that there is a rising incidence
of diabetes and it's complications in all age groups, both in the UK and ...
www.library.nhs.uk/diabetes/ViewResource.aspx?resID=261624 -67k -
Cached - Similar pages - Note this
[PDF]
NHS Diabetes
File Format: PDF/Adobe Acrobat - View as HTML
Incidence of new ischaemic heart disease in Type 2. 3.2% per annum.
Cardiovascular disease as cause of death. 55%. Number of people with
diabetes in UK...
nchod.uhce.ox.ac.uk/diabetes.pdf - Similar pages - Note this
ScienceDirect - The Lancet : The rising incidence of childhood ...

6. It goes onto discuss three other phenomena. Type 1 diabetes (formerly known as insulin-
dependent) in which the beta cells in the islets of langerhans cell in the pancreas fails to
produce the insulin which is essential for survival. The onset of this type of diabetes was more
prevelant in childhood or adolesence but this pattern is now changing.
Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's
maladaptive response to the action of insulin and accounts for approximately 90% of all
diabetes worldwide. The onset of this type of dabetes has also changed in that from being a
disease of adults, it is becoming more prevelent in children.
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) refer to levels of
blood glucose concentration above the normal range, but below those which are diagnostic for
diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes
and cardiovascular disease than those with normal glucose tolerance. The benefits of clinical
intervention in subjects with moderate glucose intolerance is a topic of much current interest.
Although not at a level that would constitute diabetes, individuals with Impaired glucose
tolerance (IGT) and impaired fasting glycaemia (IFG) demonstrate elevated blood glucose
levels which seems to place them at higher risk of developing both cardiovascular disease as
well as diabetes.

7. It must be noted that jack is a smoker. This could have an impact on his disease experience as nicotine has an
poor
fat and diet...
dietietic
locus of control
The World Health Organization (World Health Organisation on line (2008), defines diabetes as:
quot;Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or
by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which
in turn damage many of the body's systems, in particular the blood vessels and nerves.quot;
It goes onto describe four phenomena namely type one Diabetes mellitus where little or no insulin is produce, type two which
results from the body's maladaptive response to the action of insulin and Impaired Glucose Tollerence and Impaired Fasting
Glycaemia where elevated blood glucose levels which seem to place them at higher risk of developing both cardiovascular disease
as well as diabetes.

8. It is significant that the incidnece of diabetes type two is increasing.
There are seveveral significant dimension to this increase.
The overal global incidence has increased.
The disease in now presenting at a younger age.
This seems to be varying directly with the increase in obesity.
diabetetes fat relationship....
Randomised control tries have ini
Asseement of health needs
Randomised controlled trials have shown that (diabetes prevention research group, 2002 Lindström et al, 2003). The diabetes prevention
programme found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five
times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin (diabetes prevention resear
ch
group, 2002).
The Diabetes Prevention Research Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out
randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in

9. physical activity and improvements in diet. The former showed that found that weight loss of between 5% and 7% of total body
weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as
the use of the glucose lowering medication namely Metformin. The latter compared an intervention group against an interventions
group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older. More research may bring forth
some more answers, especially if it were longitudinal in nature.
Jack, as a man, is both less likely to visit his GP as well as be predisposed to health promotion.
From a global incidence, Wild et al (2004) have projected that dabetic incidence could more than double from its 2000 level of
171 million to that of 366 million by the year 2030. As the United kingdom as a whole,
c

10. This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of
diabetes (see appendix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of
which are changeable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some
of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will
be to explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can
significantly improve the health and lifestyle of of an individual who finds themselves in this situation.

11. Three degrees of health promotion have been identified. Primary health promotion pertains to that which is
undertaken to prevention of the commencement of health consequence occurring.This is exemplified as health
eating campagnes in schools which can help to decrease the onset of diabetes (). Secondary health promotional
activity aims to prevent any adverse health consequence from deteriorating further. This would include
teaching foot care techniques to newly diagnosed diabetics. Tertiary health promotion is concerned with
OBESITY

12. The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has
been written about pejorative attitudes of Nurses and other health care professionals
The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has
been written about prejoritive attitudes of Nurses and other health careprofessionals
There are several types of Diabetes. Historically, Diabetes Mellitus tended to be classified by depending on insulin administration
or the lack of it. In more recent times, it is accepted the disease is more complex. Type 1 Diabetes refers to

13. Type 2 refers to where insulin is produce which
This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus. The
latter name has been challenged as the number of individuals under 16 is now significantly
Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience. Smoking tobacco can result
in vascular compromisation can compound the changes which are caused by Diabetes Mellitus
The risk of the development of type 2 Diabetes is significantly greatened with increasing diabetes especially if
this is in the abdominal area (Chan et al 1994, Colditz et al 1995)
The Link between obesity and diabetes has its origins when Vague (1956)
who noted links a quot;masculinequot; or quot;androidquot; obesity phenotype and diabetes
Klien 2004 suggests that of the three types of abdomnial fat, visceral (intraperitoneal fat,) intraagdominal and
subcutaneous, it is the former that is most highly related with diabetes type 2.
The Link between obesity and diabetes has its origins when Vague (1956)
who noted links a quot;masculinequot; or quot;androidquot; obesity phenotype and diabetes
Klien 2004 suggests that of the three types of abdomnial fat, visceral (intraperitoneal fat,) intraagdominal and
subcutaneous, it is the former that is most highly related with diabetes type 2.

14. The Link between obesity and diabetes has its origins when Vague (1956)
who noted links a quot;masculinequot; or quot;androidquot; obesity phenotype and diabetes
Klien 2004 suggests that of the three types of abdomnial fat, visceral (intraperitoneal fat,) intraagdominal and
subcutaneous, it is the former that is most highly related with diabetes type 2.
References
World Health Organisation [on-line] (2008)a. Programes and Projects: Diabetes. http://www.who.int/diabetes/en/ visted 24th
April 2008
World Health Organisation [on-line] (2008)b. Diabetes Action On-line. http://www.who.int/diabetesactiononline/diabetes/en/

15. visited 5th May 2008
http://www.framinghamheartstudy.org/index.html
framingham http://www.framinghamheartstudy.org/index.html
Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes. Nusing Standard 21, 25, 37-44
Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes. Nusing Standard 21, 25, 37-44
Brown, I., Stide, C., Psarou, A., Brewins, L., Thompson, J. (2007) Management of obesity in primary care: nurse's practice, belief
and attitudes. Journal of Advanced Nursing 59 (4), 329-342
Marieb E. N. and Hoehn, K. (2007) Human Anatomy and Physiology: Pearson International Editional Edition. 7e. San Francisco:
Benjamin Cummings
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=128&sectionId=10
http://www.eatlas.idf.org/Diabetes_Atlas___Executive_Summary_download/#EN
http://www.eatlas.idf.org/Obesity_and_type_2_diabetes/
Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., et al. (2003). The Finnish Diabetes
Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12), 3230–3236
http://care.diabetesjournals.org/cgi/content/full/26/12/3230
Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 diabetes with lifestyle intervention or
metformin. New England Journal of Medicine, 346(6), 393–403.
http://content.nejm.org/cgi/content/full/346/6/393
Downie, R, Tannahill C Tannahill A (1996) health promotion: models and Values. Oxford Oxford medical publications
DAVIES MJ, HELLER S, SKINNER T C, CAMPBELL MJ, CAREY ME, CRADOCK S, DALLOSSO HM, DALY H,
DOHERTY Y, EATON S, FOX C, OLIVER L, RANTELL K, RAYMAN G, KHUNTI K on behalf of The DESMOND
Collaborative, 2008. Effectiveness of a structured group education programme on individuals newly diagnosed with Type 2
diabetes: a cluster randomised controlled trial of the DESMOND programme. BMJ published online 14 Feb 2008;
doi:10.1136/bmj.39474.922025.BE.
Després JP, Lemieux I, Prud'homme D (2001) Treatment of obesity: need to focus on high risk abdominally

16. obese patients. British Medical Journal. 322, 7288, 716-720
Joint Health Surveys Unit (2003) Health Survey for England 2002. The Stationery Office, Norwich.
Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1994) Obesity, fat distribution, and weight gain
as risk factors for clinical diabetes in men. Diabetes Care. 17, 9, 961-969.
Colditz GA, Willett WC, Rotnitzky A, Manson JE (1995) Weight gain as a risk factor for clinical diabetes
mellitus in women. Annals of Internal Medicine. 122, 7, 481-486.
Klein, S. (2004) The case of visceral fat: argurment for the defense. Journal of Clinical Invest gation 113(11):
i
1530-1532
Vague, J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes,
atherosclerosis, gout, and uric calculous disease. Am. J. Clin. Nutr. 1956. 4:20-34. In: Klein, S. (2004) The
case of visceral fat: argurment for the defense. Journal of Clinical Investigation 113(11): 1530-1532