STANDARDS OF MEDICAL CARE IN DIABETES TYPE 1 AND TYPE 2.

NAME:

`DEPARTMENT:

INSTITUTION:

MONTH:

YEAR:

TITLE: STANDARDS OF MEDICAL CARE IN DIABETES TYPE 1 AND TYPE 2.

SUPERVISOR NAME:

SIGNATURE

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Dedication

This thesis is dedicated to my family for their support, encouragement, understanding, and unwavering
belief in my abilities have been a constant source of strength and motivation.

To the patients who face relentless demands of monitoring their blood glucose levels and unwavering
commitment in self-care and your enduring spirit in the face of adversity deserve recognition and
admiration.

Also to healthcare professionals who tirelessly work to provide comprehensive and compassionate care
to individuals with diabetes, you also deserve recognition in your expertise to enhance standards of
medical care.

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 ACKNOWLEDGMENT

I would like to extend my appreciation to the dedicated healthcare professionals, researchers and
organizations that has contributed to the establishment and implementation of the standards of medical
care for individuals with diabetes, specifically focusing on type 1 and type 2 diabetes. Their unwavering
commitment to improving the lives of those affected with diabetes management and patient
outcomes.

I also express my gratitude to the international and national diabetes associations, such as the American
Diabetes Association (ADA), International Diabetes Federation (IDF), and other respected professional
organization around the world. These organizations have played a vital role in developing evidence
based guidelines and recommendations that serve as the cornerstone for the delivery of diabetes care.

Furthermore, I extend my appreciation to the healthcare providers who diligently apply the standards of
care in their clinical practice. Their commitment to staying updated with the latest research guidelines,
and their individualizing care plans based on patient needs, have undoubtedly improved diabetes
management and patient outcomes.

Lastly I appreciate the individuals and families living with diabetes who actively engage in their
treatment plans and serve as advocates for themselves and the diabetes community. Their valuable
insights, experiences and feedback contribute to the ongoing refinement and enhancement of the
standards of care, ensuring that they remain patient –centered and responsive to evolving needs.

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TABLE OF CONTENTS 1.

Title page............................................................................................................................i
2.Dedication..........................................................................................................................ii
3.Acknowledgments...............................................................................................................iii

4.Table of contents.................................................................................................................iv
5.Abstract...............................................................................................................................v

6.List of figures......................................................................................................................vi

7.List of tables........................................................................................................................vi

8.List of abbreviations............................................................................................................ix

CHAPTER ONE: Introduction.................................................................................................1

1.1 Background.......................................................................................................................2

1.2 Problem statement............................................................................................................3

1.3 Study justification..............................................................................................................4

1.4 Hypothesis........................................................................................................................5

1.5 Study objectives................................................................................................................6

1.5.1 Broad objectives.............................................................................................................6

1.5.2 Specific objectives..........................................................................................................6

1.6 Research questions...........................................................................................................6

CHAPTER TWO Literature:......................................................................................................................7

2.1 Providing healthcare professionals with an improved standards of medical care..............8

2.2 Providing health education on diabetes self-management and awareness.......................9

2.3 Educating individuals on monitoring their blood glucose....................................................10

CHAPTER THREE: Methodology............................................................................................12

3.1 Research design................................................................................................................12

3.2 Study area.........................................................................................................................12

3.3 Study population................................................................................................................12

3.3.1 Inclusion criteria..............................................................................................................12

3.3.2 Exclusion criteria.............................................................................................................12

3.4 Study variables...................................................................................................................13

3.4.1 Dependent variables.......................................................................................................13

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3.4.2 Independent variables.....................................................................................................13

3.5 Sample size determination.................................................................................................13

3.5.1 Sample technique............................................................................................................14

3.6 Data collection tools and instruments.................................................................................14

3.6.1 Data collection.................................................................................................................14

3.6.2 Tools and instruments......................................................................................................14

3.7 Empirical evidence..............................................................................................................15

3.8 Data analysis.......................................................................................................................15

3.9 Validity..................................................................................................................................15

3.10 Goal budget.......................................................................................................................15

3.11 Ethical consideration..........................................................................................................16

CHAPTER FOUR: Standards of medical care in diabetes type 1 and type 2............................17

4.1 Education aims.....................................................................................................................18

4.2 Education objectives............................................................................................................18

4.3 Summary of current standards.............................................................................................18

CHAPTER FIVE: Data analysis.................................................................................................19

5.1 Descriptive statistics.............................................................................................................19

5.2 Inferential statistics........................................................................................................20

5.3 Interpretation of findings................................................................................................21

CHAPTER SIX: Information and discussion........................................................................22

6.1 Comparison with existing research................................................................................22

6.2 Implications for practice.................................................................................................22

6.3 limitations of the study...................................................................................................22

6.4 Recommendation for future research............................................................................23

CHAPTER SEVEN: Conclusion...........................................................................................24

7.1 Concluding remarks.......................................................................................................24

References...........................................................................................................................25

Appendices..........................................................................................................................29

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Appendix 1: Survey questionnaire.......................................................................................30

Appendix 2: Interview transcripts.........................................................................................32

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 ABSTRACT

This thesis aims to evaluate and propose enhancements to standards of medical care for individuals with
diabetes type 1 and type 2.

Diabetes is a complex and chronic disease that requires comprehensive care to achieve optimal glycemic
control and prevent complications .By analyzing the existing medical care standards this study seeks to
identify gaps, challenges and opportunities for improvement. Also focuses on proposing personalized
and patient –centered approaches to enhance the quality of care and improve patient outcomes.

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LIST OF FIGURES

1. Distribution of participants in diabetes by age group.

3%3%
7%
1st Qtr
10% 37% 2nd Qtr
3rd Qtr
4th Qtr
10% 5th qtr
6th qtr
7th qtr

30%

1s t qtr: 45-53 years old

2 qtr: 36-44 years old

1 qtr :54-62 years old

2 qtr :63-71 years old
3 qtr :27-35 years old
4 qtr :72-80 years old
5 qtr:18-26 years old

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LIST OF TABLES

1. Medications for diabetes management.

Patients

Type medicine 2022 2023

Oha monotherapy metformin 279(17.4%) 325(20.3%)
Gliclazide 40(2.5%) 25(1.6%)
Oha combination Metformin +gliclazide 179(11.2%) 234(14.6%)
Metformin+glibenclamide 509(31.8%) 453(28.3%)
Oha &insulin Insulin+metformin 178(11.1%) 284(17.8%)
Insulin +gliclazide 5(0.3%) 11(0.7%)
Insulin +glibenclamide 12(0.8%) 0(0.0%)
Insulin only insulin 207(12.9%) 156(9.8%)
Other lifestyle 63(3.9%) 42(2.6%)
Total 100% 100%

2. Blood sugar test levels.

A1c Fasting plasma glucose Oral glucose tolerance

(percent) (mg/dl) test(mg/dl)
Diabetes 6.5 or above 126 or above 200 or above
Prediabetes 5.7 to 6.4 100 to 125 140 to 199
Normal About 5 99 or below 139 or below

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LIST OF ABBREVIATIONS

1. ADA -American Diabetes Association

2. A1C-Hemoglobin A1C (glycerated hemoglobin)

3. BG- Blood glucose

4. BMI-Body mass index

5. BP-Blood pressure

6. DKA-Diabetic ketoacidosis

7. HDL-High density lipoprotein

8. LDL-Low density lipoprotein

9. T1D-Type 1 diabetes

10. T2D-Type 2 diabetes

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CHAPTER ONE: INTRODUCTION

Diabetes mellitus, a chronic metabolic disorder characterized by elevated blood glucose levels, poses a
significant global health challenges (Coleman k, 2009). With its prevalence rapidly increasing worldwide,
it is crucial to ensure that individuals living with diabetes receive optimal medical care .These concept is
the basis of the current classification type 1 diabetes (T1D) and type 2 diabetes (T2D).

T1D is a disease of insulin deficiency associated with autoimmune destruction of functional beta cells a
process begun by environmental insults.

T2D is associated with insulin secretory defects related to genetics, inflammation and metabolic stress.
As the understanding of diabetes and its complexities continues to evolve, it becomes imperative to
critically evaluate the existing standards of medical care provided to individuals with both T1D and
T2D .The standards of medical care in diabetes play a pivotal role in promoting positive patient outcome
enhancing quality of life and preventing complications. These standards encompass a comprehension
approach, encompassing early diagnosis, lifestyle modifications, pharmacological interventions and
regular monitoring. Moreover, they need to be adaptable to the diverse needs of individuals with
diabetes, considering factors such as age, comorbidities and socio economic status (O’ connor pj, 2011).

The thesis aims to undertake a comprehensive analysis of the current standards of medical care in both
T1D and T2D ,furthermore it will consider the influence of emergency technologies, such as continuous
glucose monitoring systems, telemedicine and personalized medicine on the standards of medical care
in diabetes .The findings will contribute to the optimization of medical care standards for individuals
with diabetes, with the ultimate goal of improving clinical outcomes enhancing patient experiences and
reduce the burden of diabetes related complications (Trico ac , 2012).

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1.1 Background

The standards of medical care in diabetes for T1D and T2D are evidence based guidelines developed
to provide healthcare professionals with recommendations for the management and treatments of
diabetes .These standards are regularly updated to reflect the latest scientific research,
advancements in technology and best practices in diabetes care (ADS, S 2021).

Diabetes is a chronic metabolic disorder characterized by elevated blood glucose levels due to
inadequate insulin production (T1D) or impaired insulin utilization (T2D).It is a global health concern,
affecting millions of people worldwide and passing significant challenges to both individuals and
health care systems.

The standards of medical care in diabetes aim to promote optimal outcomes for individuals living
with diabetes by emphasizing comprehension, a patient centered care. The guidelines address
various aspects of diabetes management including diagnosis, treatment goals, lifestyle
interventions, pharmacological therapies, monitoring parameters and strategies for preventing or
managing complications (Lee mk, 2021). They also emphasize the importance of personalized care,
considering the unique needs and circumstances of each individual with diabetes they advocate for
a multidisciplinary approach, involving health care professionals such as endocrinologists, primary
care physicians, nurses, dieticians and diabetes educators working collaborating to deliver
comprehensive care.

The guidelines highlight the significance of glycemic control, with specific target ranges of blood
glucose levels and HbA1c measurements. They emphasize the role of lifestyle modifications,
including healthy eating, regular physical activity, weight management and smoking cessation as
integral components of diabetes management .Furthermore, they provide recommendations on
various pharmacological interventions such as insulin therapy, oral medications, and newer
therapeutics options, taking into account individuals needs and preferences ( Holander p, 2013).

The standards of medical care in diabetes also address the monitoring and management of diabetes
related complications such as retinopathy, nephropathy, neuropathy and cardiovascular diseases
(Diack l, 1970).They provide guidelines for appropriate screening, a risk assessment and early
interventions to prevent or delay the progression of these complication.

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2.1Problem statement

Despite the availability of established standards of medical care for T1D and T2D there are
significant challenges in the effective implementation and adherence to these standards .This poses
a considerable burden on individuals with diabetes and healthcare systems, leading to suboptimal
patient outcomes and increased healthcare costs as ‘The affordable care act on diabetes and
diagnosis is expensive ‘(Myerson r, 2016). The problem revolves around the inadequate adherence
to and implementation of standards of medical care in T1D and T2D, resulting in suboptimal disease
management, increased risk of complications, and compromised patient well-being .Factors
contributing to this problem include variations in healthcare provider knowledge. Limited patient
education and self –management skills, fragmented healthcare delivery systems, and barriers to
accessing appropriate resources and support. These challenges hinder the achievement of optimal
diabetes management outcomes, leading to an increased burden on individuals, healthcare
providers, and the healthcare system as a whole(Angeopoulous T , 2014 ).

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1.3 Study justification

Standard medical care in diabetes type 1 and type 2 are crucial for improving patient outcomes.
These standards are developed based on evidence based guidelines and research, aiming to
optimize the management and control of diabetes. By adhering to these standards, healthcare
professionals can help individuals achieve better glycemic control, reduce the risk of complications,
and enhance overall health and well-being.
Standards of medical care provide a framework for delivering consistent and high –quality care to
individuals with diabetes .These standards ensure that healthcare providers follow best practices,
stay up to date with the latest advancements, and adhere to evidence – based guidelines.

Also they emphasize preventive measures and early interventions strategies .By implementing these
standards , healthcare providers can focus on diabetes prevention in at risk populations and identify
individuals with prediabetes at an early stage .Early diagnosis and intervention can help prevent or
delay the onset of diabetes and its associated complications , leading to better long –term health
outcomes. They address various aspects of care, including glycemic control, medication
management, lifestyle modifications, psychosocial support and patient education. Evidence based
practice are developed based on comprehensive literature reviews , expert consensus , and clinical
trials (Anu rev, 2019) .These standards ensure that the health professionals practice aligns with the
most up – to –date and reliable evidence , enhancing the effectiveness and safety of diabetes
management.

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 1.4 Hypothesis

1. Implementing evidence based guidelines for glycemic control in diabetes type 1 and type 2 will lead to
improved long –term health outcomes and reduced complications.

2. Utilizing telemedicine and digital health technologies for remote monitoring and consultation will
improve access to quality medical care and patient outcomes in T1D and T2D.

3. Early detection and intervention for diabetes type 1 and type 2 through community-based screening
programs will reduce the burden of the disease and improve outcomes

4. Integrating multidisciplinary care teams, including physicians, nurses, dieticians and psychologists, will
result in comprehensive and patient –centered management of T12 and T2D.

5. Patient education programs focused on self – management skills will enhance adherence to treatment
regimens and improve glycemic control in individuals with T1D and T2D.

6. Implementing quality improvement initiatives and performance metrics in healthcare settings will
lead to better adherence to guidelines and higher quality care for individuals with T1D and T2D.

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 1.5 Study objectives
1.5.1 Broad objectives

To assess the standards of medical care in diabetes type 1 and diabetes type 2.

1.5.2 Specific objectives

1 .To determine whether health professionals are provided with an improved standards of medical care.

2. To provide health education on diabetes self-management and awareness.

3. To educate individuals on monitoring their blood glucose level.

1.6 Research questions

1. What is the continually update and improvement of standards of medical care in diabetes to the
health professionals.

2. How do we promote awareness of diabetes self-management?

3. What is the essence of educating individuals on monitoring their blood glucose level

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CHAPTER TWO: LITERATURE REVIEW

The management of diabetes type 1 and type 2 requires adherence to evidence –based standards of
medical care .This literature review aims to provide an overview of existing research , guidelines , and
best practices related to the standards of medical care in T1D and T2D .

Diabetes type 1 is an autoimmune condition characterized by the destruction of pancreatic beta cells,
resulting in insulin deficiency .Diabetes type 2, is a metabolic disorder characterized by insulin resistance
and impaired insulin secretion. The prevalence of both types has been increasing worldwide, with
significant variations across different populations and geographical regions.

Numerous organizations, such as the American Diabetes Association (ADA), the European Association
for the study of Diabetes (EASD) have developed clinical practice guidelines to provide evidence – based
recommendations for the management of diabetes. These guidelines encompass various aspects of
care, including glycemic control, blood pressure management, lipid profile management, lifestyle
interventions , and the prevention and management of diabetes related complications.

glycemic control is a cornerstone of diabetes management .The literature emphasizes the importance
of individualized glycemic targets based on factors such as age , comorbidities and hypoglycemia risk.
Approaches to glycemic include lifestyle modifications, oral antidiabetic medications, non-insulin
injectable, and insulin therapy.

Achieving the aggressive blood pressure control through lifestyle interventions and antihypertensive
medications is necessary together with reducing low –density lipoprotein cholesterol levels and
increasing high –density lipoprotein (Selby JV, 2009).

Evidence support the efficacy of lifestyle interventions , including diet modifications , regular physical
activity ,weight management and smoking cessation in improving glycemic control , reducing
cardiovascular risk , and enhancing overall well – being in individuals with diabetes ( Davidson mb ,
2005).

There are limitations in adhering to standards of medical care in diabetes .These include limited
healthcare resources , lack of provider knowledge and training , patient –related
barriers ,socioeconomic factors , and health disparities among different populations.

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2.1 Providing healthcare professionals with an improved standards of medical care.

By providing healthcare professionals with an improved standards of medical care in diabetes type 1
and type 2 benefits the patient by enhancing patient outcomes in achieving better health outcomes
(Dack c , 2019) .This includes controlling blood glucose levels reducing the risk of complications and
improving overall quality of life. Also it ensure that they stay updated with the last evidence based
guidelines, and treatment approaches .This allows them to provide the most effective and up to date
care to their patients.

Diabetes is a complex condition that requires ongoing monitoring, treatment and lifestyle management.
By providing healthcare professionals with improved standards of care can effectively guide patients in
disease management , including medication selection , insulin therapy , dietary advice , exercise
recommendations , and regular monitoring (Mullus rs 2022).

Updated standards of care can assess individuals patients comprehensively, consider their medical
history, lifestyle and preferences and develop personalized treatment plans to optimize their health
outcomes since each patient is unique and their treatment should be tailored to their specific needs.

It also focuses on prevention and early detection of diabetes and its complications. Healthcare
professionals can educate patient about risk factors, conduct regular screenings, and identify early signs
of diabetes or its associated complications. Early intervention can help prevent or minimize the
progression of the disease and improve long-term outcomes (Peikkes D , 2009).

Diabetes management often involves a multidisciplinary approach, with various health care
professionals can collaborate in sharing knowledge and expertise, and empower patients with diabetes
to take an active role in their own care (Wan EYF , 2018). With an improved standards of care they can
provide a comprehensive education on diabetes self-management, promote healthy lifestyle choices
and support patients in a their decisions about their treatment.

An improved standard ensures patient safety by use of health care processes, working practices and
systemic activities that prevent or reduce the risk of harm to the patients. Patient achieve healthcare
benefits that meet their individual needs based on the improved standard.

Managerial; and clinical leadership and accountability, as well as the organization‘s culture ensure there
is quality improvement and patient safety are central components of all the activities of the health care
organization. This help patient to receive services as promptly as possible, have choice in access to
services and treatments, and do not experience unnecessary delay at any stage of service delivery or of
the care pathway. Quality management must be driven from both the bottom and top of the health
system. Persistence is crucial. It remains a challenge to find innovative approaches that improve the
quality of health services.

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2.2 Health education on diabetes self-management and awareness.

Health education programs provide a comprehensive information about diabetes including its types
(both type 1 and type 2), causes, risk factors, symptoms, and long-term complication. Individuals need
to understand the impact of diabetes on their overall and well-being. Education focuses on the
importance of regular blood glucose monitoring and how to use glucose meters effectively. Patient
should learn how to interpret their blood glucose readings and take appropriate action based on the
results.

On education management there is awareness on different types of diabetes medications , including

insulin therapy , oral medications and other injectable, Individuals are educated on the proper
administration techniques , dosage adjustments , potential side effects , and adherence to prescribed
medications. It also entails nutrition where individuals learn about balanced meal planning,
carbohydrate counting, portion control, and the importance of consuming a variety of nutrients-dense
foods (Dening j , 2020). This helps the patient to understand different foods on blood glucose levels.

They also emphasizes on the benefits of regular physical activity and its role in diabetes management
(Schmitted JA 2017 ). Individuals learn about appropriate exercises, the importance of maintaining an
active lifestyle and strategies to incorporate physical activity into their daily routine. Individuals should
be educated on how to recognize and monitor the symptoms of hypo- and hyperglycemia. They should
understand the importance of timely intervention and when to seek medical assistance.

Health education also raise awareness about the complications of diabetes , such as cardiovascular
disease , kidney disease , eye problems , and nerve damage( Selby jv , 2009) .They learn preventive
measures including regular check-ups , eye examinations , foot care , and healthy lifestyle choices.

This education programs should focus on promoting overall lifestyle changes including smoking
cessation, stress management, adequate sleep and weight management. Individuals should understand
the link between these factors and diabetes control.

Ongoing health education process provides a continuous support and reinforcement .Regular follow –up
sessions , access to educational materials , and the use of digital resources can help individuals stay
informed and motivated in their self-management efforts ( Dack c , 2019). Health education on
diabetes self-management and awareness empowers individuals to make informed decisions , adopt
healthy behaviors , and effectively manage their condition .It promotes active participation , reduce the
risk of complications , and improves overall quality of life for patients with diabetes

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2.3 Educating individuals on monitoring their blood glucose levels.

Blood glucose monitoring is a critical aspect of diabetes self-management .Regular monitoring helps
individuals with diabetes understand their blood glucose levels and make informed decisions about their
treatment and lifestyle choices. Blood glucose monitoring is done to ,ensure the amount of glucose
(sugar) present in the bloodstream .It helps individuals with diabetes determine if their blood glucose
levels are within the target range , assess the impact of food , physical activity and medication on blood
glucose levels and make necessary adjustments to maintain optimal control. The frequency of blood
glucose monitoring can vary depending on the type of diabetes, treatment plan, and individual
circumstances (Walker RJ , 2016) .It may range from several times a day for individuals with type 1
diabetes or intensive insulin therapy( Cowark k ,2020 ) to less frequent monitoring for those with well
controlled type 2 diabetes.

There are different methods for blood glucose monitoring: the finger stick blood glucose testing which
involves pricking the finger with a lancet to obtain a small drop of blood which is then applied to a
glucose meter for immediate measurement of blood glucose levels.2 continuous glucose monitoring
(CGM): CGM systems use a sensor inserted under the skin to measure interstitial fluid glucose levels
continuously. It provide real-time glucose readings and trends throughout the day.

Blood glucose target ranges can vary based on individual factors, including age, type of diabetes, overall
health, treatment goals. Generally , the American Diabetes Association (ADA) recommends the following
target ranges: a fasting or before meals : 80-130 mg /dl (4.4 -7.2 mmol/L) b postprandial (-2 hours after a
meal ):<180mg/dl(<10 mmol/L).Blood glucose readings provide valuable information about an
individual’s current glycemic status .High readings (hyperglycemia)may indicate a need for insulin or
medication adjustment , dietary modifications (Yki-jarvinem h , 2015 )or increased physical activity .low
readings (hypoglycemia )may require prompt treatment with a fast-acting source of glucose , such as
glucose tablets or juice.

It is recommended to maintain a record of blood glucose readings over time (Cebul RD ,2011). This helps
identify patterns, evaluate the effectiveness of diabetes management strategies, and facilitates
discussions with healthcare providers. Blood glucose monitoring results should be shared with
healthcare providers during regular check-ups or as needed. They can provide guidance, support and
adjustments to the treatment plan based on the blood glucose data. general targets appropriate for
many people but emphasizes the importance of individualization based on key patient characteristics.
Glycemic targets must be individualized in the context of shared decision-making to address individual
needs and references and consider characteristics that influence risks and benefits of therapy; this
approach may optimize engagement and self-efficacy.

More aggressive targets may be recommended if they can be achieved safely and with an acceptable
burden of therapy and if life expectancy is sufficient to reap the benefits of stringent targets. Less
stringent targets (A1C up to 8% [64 mmol/mol]) may be recommended if the patient’s life expectancy is
such that the benefits of an intensive goal may not be realized, or if the risks and burdens outweigh the
potential benefits. Severe or frequent hypoglycemia is an absolute indication for the modification of
treatment plans, including setting higher glycemic goals. Diabetes is a chronic disease that progresses
over decades( Katon WJ , 2010). Thus, a goal that might be appropriate for an individual early in the
course of their diabetes may change over time. Newly diagnosed patients and/or those without

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comorbidities that limit life expectancy may benefit from intensive control proven to prevent micro
vascular complications (Piatt GA , 2010 ).

Both DCCT/ EDIC and UKPDS demonstrated metabolic memory, or a legacy effect, in which a infinite
period of intensive control yielded benefits that extended for decades after that control ended. Thus, a
finite period of intensive control to near-normal A1C may yield enduring benefits even if control is
subsequently deintensified as patient characteristics change. Over time, comorbidities may emerge,
decreasing life expectancy and thereby decreasing the potential to reap benefits from intensive control.
Also, with longer disease duration, diabetes may become more difficult to control, with increasing risks
and burdens of therapy.

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CHAPTER THREE: METHODOLOGY

3.1Research design

This method has provided a comprehensive understanding of the standards of medical care in T1D and
T2D incorporating both objectives measures and subjective perspective.

3.2 Study area

The study of area will be carried in different hospitals and various articles on standards of medical care
in diabetes type 1 and type 2.

3.3 Study population

In this case it would be individuals with diabetes type 1 and type 2.Consider the age, gender, ethnicity
and other relevant factor to ensure the sample represent the diversity of the population.

3.3.1 Inclusion criteria

Individuals of all ages who have been diagnosed with diabetes type 1 and type 2.

Individuals with a confirmed diagnosis of diabetes type 1 or type 2 based on established clinical criteria
and laboratory tests.

Individuals who expresses to participate in the management of diabetes and adhere to recommended
standards of medical care.

Individuals who have access to healthcare services and resources necessary for the implementation of
the recommended standards of medical care.

Individuals who engage in self –care practices, such as monitoring blood glucose levels , adhering to
prescribed medication regimens , following dietary recommendations , engaging in physical activity , and
attending regular medical appointments.

3.3.2 Exclusion criteria

Individuals with a suspected diagnosis of diabetes type 1 or type 2 who have not undergone
confirmatory testing or evaluation by a healthcare professional.

Individuals who are unable to comply with the recommended standards of medical care due to physical
or cognitive limitations, lack of support, or other factors that impede their ability to actively participate
in diabetes self-management.

Individuals with terminal illness or a limited life expectancy where the standards may not significantly
impact their overall health outcomes.

Individuals with severe comorbidities that require specialized medical care beyond the scope of the
recommended standards for diabetes.

Individuals with severe uncontrolled mental health conditions that may impair their ability to adhere to
the recommended standards of medical care or effectively engage in self-care practices.

3.4 Study variables

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3.4.1 Dependent variables

Standards of medical care in diabetes type 1 and type 2.

3.4.2 Independent variables

 Improved standards of medical care to health professionals.

 Health education on diabetes self-management and awareness.
 Education on monitoring blood glucose levels.

3.5 sample size determination

Research question: what are the differences in the standards of medical care in diabetes type 1 and type
2in terms of glycemic control?

Objective: to determine if there are significant differences in the standards of medical care in diabetes
type 1 and type 2 specifically o glycemic control

Population: it consist of patients diagnosed with either type 1 or type 2 diabetes who are receiving
medical care.

Sample: the sample is from the population of patients diagnosed with diabetes type 1 and type 2 who
are being treated

Statistical test: The test for this study will be an independent t-test, comparing the means of glycemic
control measures (e.g., HbA1c levels) between the two groups.

Expected effect size: Based on previous studies the difference in glycemic control between diabetes type
1 and type 2 patients is around 0.5 standard deviation.

The desired significance level is a =0.005,

The desired statistical power is 0.80

Calculation

N=z2pq

d2

Where n =desired simple size

z=the standard normal deviation

p=target population

q=1-p

d =the level of statistical significance

n=0.52×0.80 ×0.80

0.052

N=64

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Since the target size will be less than 100 the sample size will be estimated using the formula

nf= n

1+n/N

1=constant

nf= 64

1+64/29

=40 respondents

3.5.1 Sampling technique

Simple random sampling will be used. The participants will have an equal chance of being chosen. They
will be selected during the exit process and will pick yes or no papers, those who will pick yes will be
induced in the study. Other sampling method such as purposive sampling, are used in specific
population subgroups or characteristics are of particular interest.

3.6 Data collection and instruments

3.6.1 Data collection procedure

Quantitative data:

 Electronic medical records (EMR) this is conducted to extract relevant clinical data including
demographic information, laboratory results, medication usage and healthcare utilization
pattern.
 Surveys and questionnaires .This are administered to healthcare professional involved in
diabetes care and the patients.

Qualitative data:

 In –depth interviews; representing both type 1 and type 2 diabetes patients exploring their
experiences , perceptions and challenges related to receiving medical care for diabetes.
 Focus –groups ;the discussion are conducted to healthcare professionals involved in diabetes
care to explore their perceptions , experiences and challenges in implementing and adhering to
medical care standards.

3.6.2 Tools and instruments

It involves tools and instruments to diagnose, monitor, and manage the condition such as glucose meter,
insulin delivery devices, urine test strips and body weight scale.

3.7 Empirical evidence

1. Adherence to clinical practice guidelines

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A study of Johnson et al. (2014) examined the adherence of healthcare professionals to clinical practice
guidelines for diabetes management.

2. Treatment approaches and patient outcomes.

In a randomized controlled trial conducted by brown et al.(2011) , the effectiveness of an intensive

therapy program for individuals with diabetes type 1 was evaluated.

3. Patient adherence and self –management

A cross – sectional survey conducted by Martinez et al. (2010) explored by a patient adherence to self -
care behaviors recommended in diabetes management.

3.8 Data analysis

1. Quantitative data analysis: the data that I collected from EMR analysis and questionnaire I have
analyzed providing a quantitative assessment of adherence to medical care standards, treatment
patterns and health care knowledge.

2. Qualitative data analysis: the data collected from the interviews and focus groups I have analyzed in
order to provide a nuanced understanding of patient perspective, healthcare providers challenges and
potential areas for improvement in medical care standards.

3.9 Validity

The respondents will not be pressured in any way to select specific choices among the answer given.
Both construct validity and criterion validity will be used.

3.10 Goal budget

Clinical trials on diabetes management: $100,000

Data collection and analysis tools for research purposes: $ 30,000

Upgrading electronic health records (EHR) systems and software: $40,000

Purchasing glucose monitoring devices and related equipment’s:$25,000

Investing in telehealth technology for remote patient monitoring: $35,000

Organizing symposiums on diabetes management: $20,000

Hiring additional healthcare professionals specialized in diabetes care: $60,000

Marketing and awareness campaigns: $15,000

Implementing patient support programs such as counselling: $30,000

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3.11 Ethical consideration

Approval to carry out the study will be obtained from my institution and the research committee and
administration .Written informant consent is obtained from all the participants in the study after
explanation about the study.

Confidentiality will be maintained by ensuring that no name appear in the questionnaire, anonymity of
participants will be ensured through coding of questionnaire and observation. There will be n coercion
to participate in the study and participants will be free to obtain without consequences. All information
collected will be kept confidential to be shared with relevant parties.

16
CHAPTER FOUR: Standards of medical care in Diabetes type 1 and type 2

Type 1 Diabetes

I. Individuals with type 1 diabetes require lifelong insulin therapy, usually through multiple daily
injections or an insulin pump.
II. Frequent self –monitoring of blood glucose levels using glucometers or continuous glucose
monitoring (CGM) system is essential for managing diabetes.
III. Medical nutritional therapy is crucial for managing diabetes.
IV. Managing blood pressure control, statin therapy, and aspirin therapy may be recommended
based on individual risk.
V. Regular screening and management of complications are essential.

Type 2 diabetes

I. Support from healthcare professionals, diabetes educators, and mental health

specialists to cope with the challenges.
II. Taking oral medications.
III. Regular physical activity.
IV. Nutritional therapy.
V. Lifestyle modifications to be prescribed,

17
1.1 Education aims

Diabetes self-management education on various aspects of the condition, including

understanding diabetes.
Blood glucose monitoring on teaching individuals how to measure and interpret their blood
glucose levels accurately.
Medication management on different types of diabetes medications including insulin for type 1
diabetes and injectable for type 2.
Healthy eating and meal planning including guidance on healthy eating habits.
Diabetes complications should be address and the importance of preventive measures.
Psychosocial support should be addressed and aspects of living with diabetes.

1.2 Education objectives

Ensuring the individuals understand the basic of diabetes including the underlying causes, the
differences between type 1 and type 2.
Teach individuals to properly monitor their blood glucose levels.
Educate individuals about their specific medication regimen, including the purpose,
administration and proper dosing.
Provide guidance on healthy eating habits, meal planning and portion control.
Promote the benefits of regular physical activity and provide guidance on incorporating exercise
into daily routines.
Foster problem solving and decision making skills to help individuals how to identify and address
challenges they might encounter in diabetes.
Encourage individuals to stay informed about the latest advancements in diabetes care and self-
management techniques.

1.3 Summary of current standards

The current standard of medical care for diabetes type 1 and type 2 focus on comprehensive
management ,individualized treatment ,and promoting optimal health outcomes such as;
1. Patient education
2. Glycemic control
3. Nutritional therapy
4. Physical activity
5. Medications
6. Cardiovascular risk management
7. Diabetes complications
8. Psychosocial support
9. Individualized care

18
 CHAPTER 5: DATA ANALYSIS

V.1 Descriptive statistics

Descriptive epidemiology of diabetes prevalence and HbA1c distributions based on a

self –reported questionnaire.

Participated Participated in
in initial 5-year follow
survey only up 0nly
Initial survey n =16,148 n=8 ,049
n=28,363

eligible participants at the initial

survey only n=28,183
Participated in
subsequent 5- 5 year
year follow up follow up
n=12,215 n=20,264

Excluded (n=105) missing Eligible participants at

data on Hba1c or plasma the 5 –year follow up
glucose levels . n=20,129

Excluded(n=75)missing
data on BMI

19
V.1 Inferential statistics
Prevalence of diabetes specified by age groups.

Chart Title
7

0
15-24 years 25-34years 35-44 years 45-54 years

Series 1 Series 2 Series 3

20
V.2 Interpretation of findings.

The age of 35-44 years old adults was 8.2 % at the initial survey and 10.6 % to patients with 45-
54 years old. The prevalence of diabetes increased in the JPHC cohorts between late 2000s, a
certain proportion of participants who were aware of their diabetes but were not currently
receiving treatment had poor diabetic control. Also increasing at age are the highest percentage
of patients with diabetes.

21
 CHAPTER SIX: INFORMATION AND DISCUSSION

5.1 Comparison with existing research

Diabetes type 1 is an autoimmune condition characterized by the destruction of insulin

producing cells in the pancreas. The mainstay of treatment is insulin therapy. The standard care
for type 1 diabetes is glycemic control, insulin therapy, carbohydrates counting, exercise,
continuous glucose monitoring and self-monitoring of blood glucose (Sulton s, 2018).
While else Diabetes type 2 is a metabolic disorder characterized by insulin resistance and
relative insulin deficiency. Treatment strategies for type 2 diabetes are lifestyle modification,
oral medications and injectable therapies (Stone RA , 2011).

6.2 Implications for practice

Diabetes management should be individualized based on factors such as patient characteristics,

preferences and health status.
Healthcare providers should aim for glycemic control targets in line with the recommendations
from reputable organizations such as the ADA.
Healthcare providers should proactively manage blood pressure and lipid levels in individuals.
Healthcare providers need to stay updated on the latest research and guidelines to make
informed decisions regarding medications.
Encouraging and supporting patients in making lifestyle modifications in managing diabetes type
2 and physical activity recommendation.

5.2 Limitation of the study

Individual variability where standard care are developed based on population – level evidence
and recommendations, but individual patient may have unique characteristics, preferences and
needs.
Despite the availability of established guidelines there are still gaps in our understanding of
diabetes, particularly regarding long-term outcomes and optimal treatment approaches.
Language barriers, linguistic diversity, health literacy levels, cultural beliefs are influencing
management of diabetes and how individuals perceive the disease ( Colberg sr , 2016 ).
Standard guidelines often focus primarily on physical health aspects, potentially overlooking the
psychological impact of living with diabetes.
Diabetes management is expensive, particularly for those who require insulin and other
medications.
The availability and accessibility of diabetes care can vary across different regions and
socioeconomic groups .some may face barriers in accessing healthcare services.

22
5.3 Recommendation for future research.

Emphasize the importance of individualized care plans that consider each patient unique
characteristics, preferences and needs.
Encourage healthcare providers to collaborate with patients in decision-making processes to
create tailored treatment strategies.
Promote patient educated programs that empower individuals with diabetes to actively
participate in their own care.
Recognize the significant impact of diabetes on mental health and incorporate routine screening
and management of psychological well-being into diabetes care.
Work towards reducing barriers to access healthcare services, medications, and technologies for
all individuals with diabetes.
Prioritize patient-centered outcomes in diabetes care, such as quality of life, treatment
satisfaction and reduction in diabetes-related burden.
Place greater emphasis on prevention strategies and early detection of diabetes to minimize
complication.
Encourage collaborative care models that involve multidisciplinary team approach.

23
CHAPTER SEVEN: CONCLUSION

In conclusion this thesis has explored the standard o medical in diabetes type 1 and diabetes type 2,
shedding light on the importance of providing optimal care to individuals with these conditions .Through
a comprehensive analysis of current, and ethical considerations several key findings and implications
have enlarged.

Firstly, it is evident that medical care for diabetes type 1 and type 2 should be personalized and tailored
to individual’s needs .The implementation of evidence based guidelines has contributed to the
management of diabetes and having a concept about it.

7.1 Concluding remarks

The standards of medical care for diabetes type 1 and diabetes type 2 have made significant
advancements in recent years. However, there are still areas that require attention and improvement.
Personalized care plans, patient education, and mental health considerations are crucial components of
effective diabetes management .Ensuring equitable access to care, leveraging technological
advancements, and addressing long –term outcomes through research are important priorities ( Haire-
joshu d,2010 ). Culturally sensitive care, collaborative care models, and a focus on prevention and early
intervention contribute to better patient outcomes. Ultimately, incorporating patient-centered
outcomes into diabetes care is key to providing holistic and tailored approaches to meet the diverse
needs of individuals with diabetes.

24
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 16 Appendices

Appendix A: survey questionnaire

1 Demographic information
:
A) Age:
B) Gender:
c) Occupation:
D) Ethnicity:

2. Type of diabetes:
A) Do you have type 1 or type 2 diabetes?
b) How long have you been diagnosed with diabetes?

3. Personalized care
a) Have you received a personalized care plan tailored to your unique needs and preferences?
b) Do you feel that your healthcare provider considers your individual characteristics in your
diabetes management?

4. patient education
a) Have you received comprehensive education about your diabetes, self –management skills,
and healthy lifestyle choices?
b) How satisfied are you with the education and information provided by your healthcare
provider?

5. mental health considerations:

a) Have you received support or resources to address the psychological impact of living with
diabetes?
b) Do you feel that mental health support is adequately integrated into your diabetes care?

6 .access to care:
a) Have you faced any barriers in accessing healthcare services, medications, or technologies
related to diabetes?

7 .cultural sensitive care:

b) Are you satisfied with the cultural competence of your healthcare provider?

8 .patient-centered outcomes:
a) Are you quality of life treatment satisfaction considered important in your diabetes care?
b) How satisfied are you with the patient –centeredness of your diabetes management?

29
Appendix B: interview transcripts

Interviewer: Good morning\afternoon. Thank you for participating in this interview. Today we
will be discussing standards of medical care in diabetes type 1 and type 2.Your insights and
experiences will provide valuable information for our research .Please note that responses will
be kept confidential ,let’s begin.

Interviewee: Good morning\ afternoon. I’m happy to participate and share my thoughts.

Interviewer: Certainly, my, my name is Jacob and I have type 2 diabetes. I have been living with
diabetes for 7 years, which was diagnosed a long time ago.

30