The Nursing Management of Type 2 Diabetes Mellitus

The Nursing Management of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus – referred to throughout this paper as ‘Type 2 diabetes’ – is a
chronic condition involving the insufficient production of insulin (Robbins, Shaw and Lewis,
2007). It occurs due to the exhaustion of insulin-producing β-cells in the pancreas (Robbins,
Shaw and Lewis, 2007). Insulin is a hormone which has the effect of maintaining a stable Multidisciplinary Diabetes Care Essay
blood glucose level, within the range of approximately 3.9 to 6.7mMol/L (Robbins, Shaw and
Lewis, 2007). Type 2 diabetes causes hyperglycaemia, or excessive blood glucose (Robbins,
Shaw and Lewis, 2007; National Institute for Heath and Care Excellence [NICE], 2015a).
When it is poorly controlled, hyperglycaemia results in a variety of complications,
underpinned by micro- and macro-vascular disease (Goldstein and Muller-Wieland, 2007;
World Health Organisation [WHO], 2018).
Type 2 diabetes is common in the United Kingdom (UK); indeed, in 2017 there were nearly
3.7 million people diagnosed with Type 2 diabetes in the UK (Diabetes UK, 2017). Diabetes
UK (2017), the peak national body for diabetes in the UK, estimates that there are an
additional 1 million people in the UK who have undiagnosed Type 2 diabetes. Because of the
prevalence of Type 2 diabetes, nurses in every clinical setting are likely to care for patients
with this condition; it is therefore essential that nurses understand the correct nursing
management of Type 2 diabetes. This paper critically analyses the nursing management of
Type 2 diabetes.
The fundamental goal of Type 2 diabetes management is to achieve adequate glycaemic
control, measured by blood concentration of glycosylated haemoglobin (HbA1c).
Glycosylated haemoglobin is an objective indicator of long-term glycaemic control and,
subsequently, of the risk of a person’s Type 2 diabetes progressing, and their development
of diabetes-related complications (Zhang et al., 2012). Research suggests that although the
holistic, multidisciplinary management of a person with Type 2 diabetes is important, nurses
have a key role in Type 2 diabetes management, and particularly in relation to supporting a
person with Type 2 diabetes to achieve long-term glycaemic control (Richardson et al.,
2014). Multidisciplinary Diabetes Care Essay
There is a large volume of evidence about the effective nursing management of Type 2
diabetes. Indeed, the Royal College of Nursing (RCN) identify no fewer than eleven discrete
roles for nurses in relation to the nursing management of Type 2 diabetes. Ultimately,
however, the literature advises nurses to follow the recommendations in the most current
NICE guidelines (Nair, 2007). For this reason, the strategies discussed here are based on the
NICE (2015a) Type 2 Diabetes in Adults: Management guideline, the primary guideline for
practice in the UK.
Strategy #1 – Patient education: The NICE (2015a) guideline recommends that all patients
with Type 2 diabetes are offered structured, evidence-based and resource-effective education
to enable their self-management of the condition. This education must focus on dietary advice
(refer to Strategy #2 following), and also related lifestyle changes such as exercise for weight
control (Lawrence, Conrad and Moore, 2012). A recent systematic review and meta-analysis
concluded that nurse-led education for people with diabetes can improve glycaemic control to
a statistically-significant degree, and that this improvement is often sustained over time
(Tshiananga et al., 2011). However, currently there is a paucity of conclusive evidence about
the most effective design for patient education for Type 2 diabetes – including in terms of
frequency and timing, delivery strategies and content (Tshiananga et al., 2011) – and nurses
should therefore be guided by local policies and / or those of their healthcare organisation.
Strategy #2 – Dietary advice: Patient education, as outlined in Strategy #1 above, must focus
on dietary advice, as dietary intake is the fundamental factor in the development and
management of Type 2 diabetes (Ley et al., 2014). The NICE (2015a) guideline emphasises
the importance of providing ongoing, individualised dietary advice to people with Type 2
diabetes, particularly in relation to the intake of high fibre, low glycaemic index (GI)
carbohydrates. In addition to the types of foods people with Type 2 diabetes consume, nurses
should also provide advice about correct eating patterns to achieve glycaemic control:
specifically, consuming three balanced meals plus appropriate between-meal snacks each day