Diabetes mellitus is a chronic metabolic disorder characterised by elevated blood glucose levels with complications associated with micro- and macrovascular damage that has become a prevalent health concern worldwide. Nurses play a pivotal role in the prevention and management of this condition, providing both direct care and education. This article explores the fundamentals of diabetes care for registered nurses, highlighting the advancements and practical strategies in nursing practice in this area.
Prevalence
The prevalence of diabetes has increased globally, with significant implications for healthcare organisations. According to Diabetes UK, more than 5 million people in the UK are living with diabetes, a number projected to rise significantly in the coming years (Diabetes UK, 2023). This increase necessitates that all health professionals, regardless of their specialty, possess a fundamental understanding of diabetes management.
Types of diabetes
Diabetes is primarily classified into three types. Type 1 is an autoimmune condition that results in the destruction of insulin-producing beta cells in the pancreas. Insulin is a hormone that enables glucose to enter cells where it is used for energy. Patients with type 1 diabetes require immediate and lifelong insulin therapy. Ensuring timely and appropriate insulin administration is crucial to prevent life-threatening complications such as diabetic ketoacidosis (DKA) (National Institute for Health and Care Excellence (NICE), 2022).
Type 2 diabetes is the most common form, accounting for approximately 90% of cases. It is characterised by increased resistance and reduced cellular sensitivity to insulin alongside relative insulin deficiency due to deteriorating pancreatic function. Management includes lifestyle modifications, oral hypoglycaemic agents, and sometimes insulin. Nurses play a key role in educating patients about diet, exercise and medication adherence (ElSayed et al, 2023).
Gestational diabetes occurs during pregnancy and can increase the risk of developing type 2 diabetes later in life. Monitoring and controlling blood glucose levels are vital to prevent complications for both mother and child (World Health Organization (WHO), 2016).
Management
Education and empowerment are fundamental aspects of diabetes management. Nurses are instrumental in educating patients. This includes teaching the correct injection technique, glucose monitoring, and recognising the signs of hypo- and hyperglycaemia. Empowering patients through education can significantly improve self-management and outcomes (Healy, 2023). The advent of technologies such as continuous glucose monitors and insulin pumps have revolutionised diabetes care. Nurses need to stay abreast of these technologies to assist patients in their effective use. Collaborating with patients to understand their devices ensures better management and concordance (Healy, 2023).
Diabetes affects many aspects of a patient's life. One of the critical challenges is managing hypoglycaemia, a condition where blood glucose levels fall below 4 mmol/L. Symptoms can range from mild (sweating, trembling) to severe (confusion, unconsciousness). Repeated episodes of hypoglycaemia can diminish the individual's awareness of severe hypoglycaemia therefore prompt recognition and treatment, such as administering glucose tablets or glucagon, is essential (Healy, 2023).
Supporting patients to be meticulous in following their medication regimen is another aspect of nursing care in diabetes. Non-concordance can lead to poor glycaemic control and increased complications. Nurses can employ strategies such as motivational interviewing and regular follow-ups to enhance concordance (Polonsky and Henry, 2016). The COVID-19 pandemic disrupted routine care for many patients with diabetes, leading to worsened glycaemic control and delayed diagnoses. Nurses must be proactive in resuming regular screenings and addressing the backlog of care needs (Healy, 2023).
The nurse's role
Nurses must adopt a holistic approach, addressing not just the physical but also the psychological and social dimensions of diabetes. The complexity and burden of managing the condition can significantly impact emotional wellbeing, potentially leading to diabetes distress or major depressive disorders; people with diabetes are twice as likely to experience depression and are likely to be depressed more frequently and for longer than those without the condition (Gordon, 2022). Nurses must be aware of the interplay between diabetes and wellbeing and are well placed to provide emotional support, signposting to services and helping patients navigate the social challenges associated with their condition (Davies et al, 2022).
Ongoing education and training are crucial for nurses to stay updated with the latest advancements in diabetes care. Professional development opportunities, such as workshops and online courses, can enhance nurses' skills and knowledge, ensuring high-quality care (Nursing and Midwifery Council, 2021). Through education, technological proficiency, and holistic care, nurses can significantly improve patient outcomes.
Technological advancements have significantly impacted diabetes care. Continuous glucose monitoring (CGM) is now a standard care technology for all people with type 1 diabetes and for some living with type 2. CGM enables the user to quickly monitor glucose levels without frequent and painful finger pricking (Gordon, 2023). Appropriate user education on the functionality and maintenance of these devices ensures optimal usage and better glycaemic control (Healy, 2023). Nurses will increasingly encounter users of this technology meaning knowledge of CGM, the data generated, and support needed for people with type 1 diabetes will be a key element of ongoing diabetes care (Gordon, 2023).
The role of nurses in diabetes care extends beyond clinical duties. Nurses also serve as advocates for their patients, helping them navigate the complexities of the healthcare system and ensuring they receive the necessary support and resources. This advocacy role is particularly important for patients from underserved communities who may face barriers to accessing care (Davies et al, 2022).
Moreover, nurses play a vital role in diabetes prevention. Educating patients and the general public about the risk factors for diabetes, promoting healthy lifestyle choices, and supporting early detection initiatives are all crucial components of diabetes prevention efforts. By focusing on prevention, nurses can help reduce the incidence of diabetes and its associated complications (WHO, 2016).
Effective communication is a cornerstone of diabetes care. The language used by nurses can have a significant impact on how people living with diabetes experience their condition and feel about living with it day to day; poor communication can be stigmatising and hurtful, whereas good use of language can reduce anxiety, educate, build confidence and enhance self-care (NHS England, 2023). Nurses must communicate clearly and compassionately with patients, families and other healthcare providers using ‘person first’ language and explaining complex medical information in a way that is understandable to the individual. They must listen to patients' concerns, and collaborate with other members of the healthcare team to develop and implement comprehensive person-centred care plans (Healy, 2023).
In addition to patient education and support, nurses are involved in research and quality improvement initiatives related to diabetes care. Participating in research helps advance the understanding of diabetes and its management, leading to the development of evidence-based practices. Quality improvement projects, such as implementing best practices for diabetes management in clinical settings, can lead to better patient outcomes and more efficient healthcare delivery (Healy, 2023).
The role of nurses in diabetes care is multifaceted and essential. Nurses are at the forefront of patient education, medication management, lifestyle modification support, and the use of advanced technologies. They also play a crucial role in advocacy, prevention, communication, research, and quality improvement. By staying informed and proactive, nurses can continue to improve care quality and patient outcomes.
Continuous professional development and staying abreast of the latest advancements will equip nurses to meet the evolving challenges and fast pace of change across diabetes care. The future of diabetes care will likely see continued advancements in technology, new treatment modalities, and an increased emphasis on personalised healthcare. Nurses must be prepared to adapt to these changes and integrate new approaches into their practice. By doing so, they can ensure that they continue to provide the highest quality care to their patients.
Conclusion
Diabetes is a complex and challenging condition that requires a comprehensive and multifaceted approach to care. All nurses play a crucial role in this effort, providing education, support, and advocacy for their patients, it is no longer the preserve of the diabetes specialist nurse alone. By staying informed about the latest advancements in diabetes management, engaging in continuous professional development, and adopting a holistic approach to care, nurses can significantly improve patient outcomes and contribute to the overall effort to combat this global health challenge.
The implications of diabetes care extend beyond the individual patient to the broader healthcare system. Effective diabetes management can reduce hospital admissions, decrease healthcare costs, and improve the quality of life for millions of people living with diabetes by reducing morbidity and mortality. Nurses, with their unique blend of clinical expertise, compassion, and dedication, are at the heart of this effort, making a profound difference in the lives of their patients and their families.