According to the World Health Organisation WHO 2018 diabetes was the sixth

According to the World Health Organisation (WHO, 2018), diabetes was the sixth highest cause of global death in 2016. In that year 1.6 million deaths was estimated to arise from diabetes complications and other diseases as a result of high blood glucose. Diabetes is metabolic disorder that arises as a result of body inability to make use of glucose due to insulin deficiency or insulin resistance. The body then result to break down fat and protein as alternative sources of energy (Dunning, 2014). Type 2 diabetes (T2D) in United Kingdom is selected as a focus of this assignment. It will also explore how physiology and socio-Economics affect T2D and how T2D affects both factors. Healthier You: National Health Services (NHS) Diabetes Prevention Programme (NHS England 2015) will be analysed and evaluated. And lastly, the roles of Adult, child and learning disability nurse in relation to T2D will be discussed.In T2D the body still produces insulin but due to the body’s ineffective use of insulin, the blood glucose becomes high (Diabetes.UK, 2017). T2D is glycaemia glucose (HbA1c) ≥48mmol or blood glucose of ≥6.5% (National Institute of Health and Care Excellence NICE, 2015). The disease was known to exist usually in adults of 25 years and over for black and minority ethnicity (BME) and forty years and above in white community. However it has begun to occur in adolescent and younger children (WHO, 2016). In 2017 almost 3.7 million people were diagnosed with diabetes in the UK, 90% of this figure was type 2 (Diabetes UK 2017). The growing overweight, obesity and sedimentary life style are the primary predisposing factors in the increase risk of T2D (Public Health England PHE, 2018). According to WHO, any person with BMI over 30 is considered obese. BMI is determined by diving the weight of a person in kilogram multiply by squared height in metres. In addition to BMI is the measuring of the waist circumference and the Waist to hip ratio (WHR) to determine visceral obesity (McGuire & Marx 2014). An increase in visceral fat mass and liver fat deposit in the abdominal region, particularly, liver, pancreas and intestine is the root of T2D (McGuire & Marx 2014). The visceral adipose tissue activates and secret hormones called retinol-binding protein 4 (RBP4), which increases insulin resistance.People with T2D are twice at risk of developing cardiovascular disease, which affect their blood vessel and heart (NHS, 2015). Fluctuation in blood glucose levels –hyperglycaemia, especially in the presence of high blood pressure and high cholesterol, thickens the walls of blood vessels and restrict blood flow. This lead to an increased risk of having angina, heart attack or stroke (Waugh & Grant, 2018). Moreover, T2D can cause some other long term health problems. These include diabetic neuropathy – Lower limb amputation, poorly healing wounds, erectile dysfunction, retinopathy and nephropathy result into additional disability and premature mortality (Krentz et al, 2012). It is essential to maintain blood glucose levels as close to normal as possible and to have a healthy lifestyle, to reduce these risks (NHS England, 2015). Socio-economic factors are the factors that relate to the society where people live and the economic ability of individuals. The factors, which include employment, education, income, social network etc., influence one another. The level of ones education determines employment, employment dictate income and social network. ———————————————–Marmot Review, (2010) shows the impact of socio-economics and environment on health, well being and length of life. Socio-economics is closely linked to heightened risk of T2D. Individuals from the lower income suffer more from T2B due to deprivation of healthy food and dependence on ultra-processed, energy-dense, nutrient-poor foods (PHE, 2018). The Heath and Safety Executive (HSE 2017) divides household into quintile based on household income, number of adult and dependent children. The lowest quintile of household income had the highest mean BMI and prevalence of T2D is 60% (PHE, 2018). The difference is more evident among women where obesity rate in lowest quintile is more than double than that of the highest quintile. To prepare healthy food, perishable fruits and vegetables are necessary. As a result, healthy foods items have a price premium. On the average, there are more fast food outlets in deprived areas than affluent residential areas. (PHE, 2017) Moreover, deprived families do not take consultancy from professional nutritionist, which sometimes make it harder to put together a proper meal plan (Goff & Dyson, 2016). Also, deprived families generally have less time to prepare and shop for healthy foods. This is because, such people have limited income and as such they are constrained by their meagre finance and consequently, limit their options of patronising and cultivating healthy food lifestyles. This is the reason that more fast food outlets are seen more in deprived areas.T2D is a serious health issues in the United Kingdom (Diabetes.Co.UK, 2018). Complications related to the diseases account for a considerable amount of the direct health costs approximately 10% of the total health resource expenditure (Hex et al 2012). NHS spent approximately £8.8 billion direct cost related to the complications of T2D and £13 billion on indirect cost of T2D in 2012. It is projected to become £35.6 billion by 2035/36. Moreover, T2D affects wider prospect of individuals. It affects peoples’ self esteem and mental health (Hex et al 2012).One of the health policies that the UK government has implemented to prevent illness and promote quality of life for adults at high risk of T2D is HEALTHY YOU (NHS England 2015).The Healthier You: NHS Diabetes Prevention Programme (NHS DPP) as the name implies is a diabetes prevention programme. It is a joint commitment from NHS England, Public Health England and Diabetes UK that was launched in 2015. The aim of the programme is to identify early those at high risk of T2D and refer them to behavioural intervention in order to delay or prevent the onset of T2D (NHS England 2015). The programme targets individuals that are eighteen years and above with non-diabetic hyperglycaemia and refers them to evidence based behaviour change programme. The normal blood glucose level is HbA1c less than 42mmol or less 6.0%, those with non-diabetic hyperglycaemia are having HbA1c of 42 to 47mmol/l or 6.0 to 6.4% and are identified as qualified candidates. They are mainly referred to the programme from primary care and NHS Health Checks (NHS England 2015).The programme hopes to minimise the incidence of T2D, reduce the incidence of complications associated with T2D such as cardiovascular disease, stroke, kidney, foot and eye problems and also, reduce health inequalities associated with incidence of T2D, over the longer term (NHS England 2015). The programme adopts series of predominantly group-based strategies that is delivered in person over a minimum period of 9 months. There are minimum of thirteen classes, lasting between 1 and 2 hours, and at least, 16 hours of contact time. Each session gears towards educating on healthy eating and lifestyle that help to maintain normal glycaemia, weight reduction through increased physical activity and decrease in sedentary behaviour. They are underpinned by behavioural theory and involve the use of behavioural techniques (NHS England 2015).Barron et al (2017) evaluation of the Healthier You programme shows that it is reaching its targeted audience of individuals at high risk of developing T2D. Also the rate of attendance reveals that the programme accommodated individuals from different type of ethnicity and those from the most deprived quintile Barron et al (2017). In addition, 49% referred individuals attended first session of the programme however; it does not reveal the numbers of those that completed all the sessions. The evaluation also shows that the number of referrals and percentage uptake are in excess of the prior model value Barron et al (2017).This section of the assignment focuses on the roles of adult, child and learning disability nurses in promoting health and preventing illness in type 2 diabetes. According to the NMC, 2018, code of conduct Nurse should promote health and well being of their patients and prevent illness. Diabetes is a chronic condition that needs a lot of self-management. The nurses have an essential role to play in providing information, educating patients, and support to self-manage where appropriate (NICE, 2015). Also, promoting patient autonomy is crucial in areas such as diet, exercise, blood glucose monitoring for those on insulin, and drug therapy (Philip A. 2017). This can be done by ensuring patient centred care is followed to determine the patient’s needs, and preferences, and by recognising the challenges, and barriers, such as anxiety, and depression, that the patient may face (Malanda, et al. 2016). This allows appropriate interventions to be implemented, and high quality care provided.Diabetes inpatient nurses should work with catering staff to ensure diet and meal quantities are appropriate for individual with diabetes (Diabetic uk)“Adult nurses work with patients over 18. They can work in hospitals or in community settings such as people’s homes, health centres or nursing homes. Once qualified, they can take extra courses to specialise in areas such as cancer care, women’s health, accident and emergency, critical care, practice nursing, health visiting or school nursing.” (RCN

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