Acute Complications of Diabetes Mellitus

Introduction/Problem Statement

The incidence of diabetes mellitus proves that it has become a global problem. According to Guariguata et al. (2013), type 2 diabetes spreads fast, since more than three hundred eighty thousand million people are diagnosed with the ailment annually. The figure represents a proportion of eight percent. Guariguata et al. (2013) observed that diabetes mellitus is characterized by a phase known as asymptomatic stage, which occurs between the onset of clinical diagnosis and diabetes hyperglycemia. The outset of the condition is subtle and normally takes many years before a clinical diagnosis is made. The asymptomatic stage lasts between 4 and 7 years. Thus, almost from 30 to 50 percent of the patients remain undiagnosed (Kastelan, Zjacić-Rotkvić & Kastelan, 2007). Moreover, lack of resources and unawareness from the side of people partly contribute to the problem. Given such situation, diabetes mellitus is sometimes diagnosed when it has already developed dire complications. According to Kastelan et al.(2007), early detection, as well as the identification of risk factors, would be critical in the process of the disease treatment to avoid blindness, renal disease, and diabetic ulcers.

Despite the threat posed by the acute chronic diabetes complications in regard to such effects as unfitness at work, disabilities, and premature deaths, they remain inadequately addressed. In addition, the above statistics demonstrate that the incidence of the problem continues growing. In this regard, it is necessary to perform an evaluation of diabetic complications among hospitalized patients to gain deeper knowledge on the issue.

Purpose

The purpose of the proposed study is to assess the occurrence of chronic diabetic complications and their risk factors among patients suffering from diabetes mellitus. From the previous section, it is evident that a considerable percentage of the population is affected by diabetes. Given the severity of the acute complications, knowledge on the risk factors of acute complications of diabetes mellitus would be useful in addressing the problem. The information gained from the study would add value to the literature on the topic. Self-report and medical staff surveys of patients of acute diabetes complications will form the unit of analysis in the proposed study.

Research Question/Hypothesis

For the purpose of the proposed study, the following questions will be addressed:

1. Based on the Watson’s theory, absence of exercises is a risk factor leading to the emergence of diabetes mellitus and its complications;
2. The development of complications occurs due to poor administration of diabetes drugs, such as insulin;
3. Diabetes complications are likely to develop as a result of delayed diagnosis.

As a part of the proposed study, the investigation will include the following research hypothesis:

1. The more patients are exposed to diabetes, the more acute diabetes complications they will develop.

Definition of Terms

Risk factors – these are the factors that predispose individuals to a given problem or health condition (Azura, Adibah  & Juwita, 2012).

Acute complications – the term refers to complex or deep problems arising from a given condition (Ahmed, Reid & Khardori, 2008).

Diabetes mellitus – this is type 2 diabetes that results in an imbalance of body substances (Cold Spring Harbor Laboratory, 2014).

Theoretical Framework

The Watson’s theory on diabetes forms the theoretical base of the study. The theory explored is based on the hypothesis advanced by Watson in his statement that diabetes mellitus and other conditions, such as cardiovascular complications and cancers, result from the failure to generate enough biological oxidants known as reactive oxygen species {ROS} (Cold Spring Harbor Laboratory, 2014). In his theoretical frame, Watson’s theory also advances a different view on controlling diabetes. According to the theory, type 2 diabetes results from excess intracellular oxidation, which leads to inflammation (Cold Spring Harbor Laboratory, 2014). In turn, the inflammation leads to the destruction of the pancreatic tissue cells. Thus, the pancreas fails to function properly leading to sugar imbalance in the body.

Based on the reduction of oxidation, body cells are unlikely to survive, if they are unable to produce oxidants and antioxidants. Through exercising, the body produces a big volume of oxidants (also known as ROS). Such oxygen elements are critical as they pair with hydrogen peroxide within the endoplasmic reticulum to forge chemical bonds necessary for the stability of proteins when they fold (Cold Spring Harbor Laboratory, 2014). In the absence of adequate oxidation in the endoplasm reticulum, proteins come out unfolded, thus cannot function. The outcome is inflammation that harms the pancreas, at the stage that precedes type 2 diabetes.

From the above theory, it is discerned that given factors or states predispose individuals to diabetes. At the same time, it is held that the treatment regime and adherence to such arrangement influence the emergence of acute complications for patients suffering from diabetes mellitus. In brief, certain factors play a role towards the emergence of acute complications for diabetes patients.

Literature Review

Diabetes mellitus is a condition that has strong effects on patients. Nevertheless, it is important to note that some individuals appear resistant to the diabetic complications, as well as to the disease in general. According to Ahmed, et al. (2008), additional health concerns exacerbate the effects of diabetes. Such problems as inadequate exercising, high blood pressure, high cholesterol levels, smoking, and obesity predispose sufferers of diabetes to complications.

Chronic increase in the level of blood sugar precipitates the destruction of blood vessels. Agarwal, Sengar, Jain, & Khare (2011) explain that when the endothelial cells that line blood vessels draw more sugar, damage may occur. Insulin plays a role in controlling the level of sugar in blood as in its absence more glucose mixes with blood. Consequently, it poses a serious threat considering the fact that with the excess concentration of glucose in the blood, the formation of glycoproteins advances beyond the normal level, leading to the thickening and weakening of the basement membrane. As a result, damage to the arteries and small blood vessels is among the severe effects of diabetes mellitus.

Existing research has posed questions to the theory on hyperglycemia as the main contributor to diabetic complications. Given that 40% of the victims of the condition, who manage their sugar levels carefully, develop the neuropathy, many questions remain unanswered (Raman, Gupta, Krishna, Kulothungan, & Sharma, 2012). According to Raman et al. (2012), diabetes serum and neuropathy are toxic to the nerve system regardless of the blood sugar level. However, recent studies of Azura et al. (2012) indicate that the continuity in autoimmune disease that undermines the pancreas’ beta cells might also provoke retinopathy, as well as nephropathy. According to Azura et al. (2012), retinopathy is better treatable using drugs that suppress the abnormal immune responses rather than those controlling blood sugar. For Khazai et al. (2012), the familial grouping of the type or degree of diabetic complications has shown that genetics plays a major role in the emergence of such complications as nephropathy and retinopathy.

Acute Metabolic Complications

Acute metabolic complications arising from diabetes range from hyperosmolar non-ketotic coma (HNC), diabetic ketoacidosis (DKA), and hypoglycemia to lactic acidosis (LA). HNC and DKA emerge as a result of the deficiency of insulin (Khazai et al., 2006). On the other hand, hypoglycemia emerges as a result of diabetes problems treatment. Thus, insulin or oral agents are responsible for the condition. However, the problem is common among patients who receive treatment using insulin (Khazai et al., 2006). Regarding the case of LA, such factors as cardiovascular diseases, which arise due to the excess of lactic acid and hypoxia, are considered.

The rate of DKA differs based on such factors as sex and age. Based on previous studies, the incidence rate stands between 5 and 8 in every 1 000 cases (Khazai et al., 2006). The condition is more pronounced among children. In addition, the problem manifests itself more in women than men. The author also suggests that the condition is an early manifestation of diabetes among certain victims. Further, Khazai et al. (2006) observed that risk factors for the acute problems include co-morbidity, acute illness, infections or injuries, medications, and compliance errors to treatment. Errors in the administration of insulin or oral dosages are known to lead to hypoglycemia. They include timing, particularly the delaying regarding taking insulin, delays in meals, renal insufficiency, adrenal inadequacy or pituitary insufficiency. Towards the management of the diabetes problem, prevention of the above eventualities is considered critical. To improve the effectiveness of treatment, it is essential to recognize the precipitating factors and appropriate dosage, self-care, and awareness necessary to decrease the emergence or occurrence of the complications.

Risk Factors

According to Guariguata et al. (2013), diabetes mellitus is a complex disease with its long asymptomatic stage that exposes patients to long-lasting hyperglycemia before clinical diagnosis. The lag between the onset and diagnosis is a precursor for the development of chronic complications. Azura et al. (2012) indicated that the onset of diabetes mellitus in other cases occurs earlier than the 4-7 period that is commonly assumed to be the duration before diagnosis.

Cross-sectional studies on the issue have contributed to the understanding of the topic. A number of studies have found interesting results. For instance, Raman et al. (2012) in their assessment of 248 diagnosed diabetes mellitus patients found a prevalence rate of 30%.  According to Raman et al. (2012), variability in prevalence is attributable to the differences in the ages and the diagnostic criteria used.

Other studies such as the one by Del Canizo Gomez et al. (2011) found that advanced age was a crucial factor for suffering the disease, since individuals at an advanced age were at risk. In particular, the study identified a connection between triglycerides and microvascular complications. Based on the research, aging and triglyceride are autonomous risk factors for the emergency of neuropathy. Despite the finding, the underlying mechanism to explain the advancement of neuropathy in connection with the rise in triglycerides remains unclear. However, the problem might be connected with the effect of treatment on the metabolism of lipids in motor and sensory neurons (Del Canizo Gomez et al., 2011).

Sex is also an important factor in the emergency of acute complications for diabetes mellitus patients. A study conducted by Guariguata et al. (2013) found a positive connection between male and the emergency of type 2 diabetes complications. According to the researchers, the renoprotective substance in estrogens might be responsible for the decreased incidence of nephropathy in women. In addition, lipid precipitated renal injury might occur through the stimulation of transforming growth factor-beta, which precedes the production of a harmful product that attacks glomerular and glomeruli glycocalyx (Azura et al. 2012).

Methodology

In order to perform a study of such nature, establishing a soundly outlined procedure is critical. The proposed study intends to take a survey approach through a cross-sectional design to collect data for the research. Other aspects, such as instruments to be used and data analysis methods, are discussed subsequently.

Research Design

The proposed study will rely on a cross-sectional research design. Through a cross-sectional approach, data collection will take place at different times with the intention of reviewing any changes in the subjects under study (Weathington, Cunningham & Pittenger, 2010). All study subjects will undergo an extensive examination to establish the presence of complications, such as neuropathy, nephropathy, and retinopathy. In other words, the observation of medical records of the patients is expected to demonstrate the risk factors of the disease, as well as the occurrence of acute complications.

The subjects for participation in the study will be chosen based on the purposive sampling method. Under the approach, the researcher selects respondents based on their possession of appropriate characteristics for a study. In the present case, the hospital staff of the selected medical facility will help the researcher to identify diabetes patients for the study.

The theoretical model that underpins the study is drawn from the Watson’s hypothesis that imbalances in the body either resulting from excess or inadequate substances contribute to the emergency of diabetes. Subsequently, the condition deteriorates leading to acute complications. Understanding of such imbalances is central to comprehending the risk factors that precede the development of chronic complications among victims of diabetes.

Sampling

In selecting the sample, reference is made to the purposive sampling approach. It is also noted that the population of the study is comprised of patients suffering from diabetes mellitus in the selected hospital facility. As mentioned in the previous section, the adoption of the purposive sampling method is preferable in instances where a researcher is interested in the given population chosen from the larger society and possessing distinct characteristics (Weathington et al., 2010). Considering the flexibility of the sampling technique, the researcher has the mandate to identify and select the right subjects for the study. In order to succeed, the researcher will contact the hospital staff, and seek guidance on the identification of the diabetic patients, who are capable of participating in the study. In the process of applying the technique, it is extremely important to be cautious to eliminate chances of bias. For instance, the sampling deals with such differences as age, sex, and other characteristics. To enhance representativeness, the researcher intends to use a proportionate method to select participants. For instance, in case when 60 men and 40 women take part in the research, the selected sample will have 60% men and 40% women.

Instrumentation

In order to collect data for the study, the researcher intends to rely on two instruments of data collection. In particular, questionnaires and interview lists will be used. The employment of two data collection instruments is preferred in order to corroborate the data that is generated.

Questionnaires. Questionnaires are data collection instruments that comprise of prompts or statements deemed applicable to the topic under review. In practice, questionnaires contain standardized statements that are expected to carry the same meaning to all respondents. In the current case, questionnaires will be mailed to hospital staff for filling in. The instrument will be important to the study because it will provide data that is standardized and easy to analyze.

Interview Lists. The interview list comprises of items that are intended to assess the risk factors that patients of diabetic mellitus portray. In practice, such lists contain statements that help an interviewer to receive necessary information from the respondents. Two following lists will be prepared for the given study: one for the patients, and the other for the staff of the medical facility. Data from the interviews will be transcribed and analyzed based on the theme of the study. The instrument is preferred as it is useful for collecting in-depth information.

Data Collection and Analysis Procedures

In this type of studies, consent must be obtained, since human participants are involved. The essence of seeking consent is in ensuring that human rights are observed, or the interests of subjects are not compromised. Since one medical facility will be involved, it is necessary to contact with the hospital staff members to obtain the detailed information on the patients. Upon gathering the contact information, it is also important to communicate with the relatives of the patients to receive their consent for performing the research. For this purpose, email communication will be used to persuade the family members of the participants to fill in and return the forms.

The reliance on the observation method will be given prevalence. The main source of information will be the records of the patients. Interviewing of patients and medical staff will also be considered. The choice of two data collection methods is expected to reinforce the reliability of the data.

The analysis will focus on the risk factors and occurrences of diabetic complications of retinopathy, peripheral and autonomic neuropathy, diabetic nephropathy, coronary artery disease (CAD), and diabetic foot syndrome. Among the risk factors to be considered are the following: BMI, lipid profile, diabetic control, hypertension, alcohol consumption, smoking, and family history of cardiovascular conditions and cases of diabetes. To ease the data analysis, SPSS program will be applied.

Protection of Human Rights

As previously observed, the proposed study entails data collection from human participants. One of the initial steps to ensure that their rights are protected is to brief them about the proposed study, its ramifications, and how they can be affected if they participate. Upon their understanding of the details, they will be required to sign consent forms, indicating their understanding and agreement to take part in the study. Given the sensitivity of the data, the researcher also guarantees to secure the provided information, and ensure that it is only used for the purpose of the study topic understanding. However, copies of the study will be sent via email to the participants for their personal use.

Discussion

The proposed study has a number of implications. To begin with, the outcome of the study is expected to influence the understanding of acute complications in diabetes mellitus and its responses. Regarding the additional value, it is evident that the proposed study will clarify issues pertaining to risk factors connected with the occurrence of acute diabetes complications. Thus, it will contain valuable information for the future researches as it contributes to the literature, which is a primary input in the research process. It is also anticipated that the findings might influence the practice of handling or managing victims of diabetes with the view of lowering their exposure to the risk of developing complications. Moreover, it is critical to attain both internal and external validity to make the study reliable. To ensure internal validity, the researcher intends to assess each independent variable at a specific time, which is useful for eliminating any form of bias. External validity relates to how generalizable findings are. To guarantee such validity, sample selection must be representative of the population.