Introduction
Disease progression entails the process of an illness becoming more severe and spreading to other body parts. It’s mainly influenced by age and time, and people suffering from chronic illnesses like diabetes are prone to disease progression (Hawthorne et al., 2023). These illnesses result in mental health issues, poor quality of life, and loss of life in some severe cases. Hence, this creates the need for patients with progressive chronic illnesses to seek effective medical aid as the diseases also affect organ systems in the body. This paper discusses the disease progression of a diabetic patient and its negative impacts on the renal system.
Assessment
From the patient’s lab results and medical history, particular aspects have to be assessed before diagnosis. First, the patient’s blood sugar level is determined through the A1C test, which proved her sugar level was at 8.9%, suggesting her diabetes was progressing (Zhao et al., 2021). Secondly, her kidney’s functionality, using the Glomerular Filtration Rate (GFR) test, showed her GFR was 47%. According to Spencer et al. (2023), rates below 60% suggest that a patient has diabetic nephropathy that is associated with high blood pressure.
Pathophysiologic Disorders and Findings
The tests reveal that the renal system, especially the kidney, is adversely affected because high blood sugar levels damage blood vessels and nephrons (Akhtar et al., 2020). Hence, the vessels can’t transport enough blood to the kidney tissues for circulation. Additionally, bladder muscles used in urine excretion are also damaged by high sugar levels, causing urinary retention and making it difficult for someone to visit the bathroom (Akhtar et al., 2020). These findings are important as they help a patient and his doctor determine the most effective diabetes care plan to prevent kidney failure.
Pharmacological Approach and Contraindications
Diabetes nephropathy can be managed through different medical drugs. For high blood pressure, drugs like angiotensin-converting enzyme (ACE) inhibitors are prescribed to patients (Fried et al., 2021). In contrast, medicines for high blood sugar levels include traditional drugs like insulin and modern drugs like Metformin and glucagon-like peptide 1 (GLP-1) receptor agonists (Lv & Guyo, 2020). Finerenone is also prescribed to patients, aiming to reduce scarring in the kidney tissues (Singh et al., 2022). Despite treatment interventions, contraindications exist, including some patients experiencing allergic reactions to ACEs, making them not fit for the medication (Fried et al., 2021). At the same time, pregnant women are advised not to use ACEs because the medical drug can harm the growing fetus.
Client Education and Patient-centered Care Barriers
Patient education is important after diagnosis of an illness as it helps the patient know how to manage the condition with new information. In our case, the patient’s diabetes has progressed since childhood, suggesting the need for a new diabetes care plan. Thus, the patient can be advised to exercise more and change diet to control blood sugar levels and blood pressure (Shah et al., 2021). The patient who’s suffering from neuropathy should also be educated on modern ways to care for her feet and be recommended to have proper footwear. When offering patient care, the doctor may face socioeconomic barriers like food insecurity, as healthy foods may not be affordable for some patients. Additionally, cultural barriers, like some societies having carbohydrate-dominant meals, make diabetes management difficult and spiritual barriers make some patients believe diabetes is based on spiritual forces; hence, prayers will cure them.
Conclusion
In summary, age and time influence disease progression in patients with chronic illnesses like diabetes. These diseases cause mental health issues like depression because a lot of money is needed to cater to hospital bills. Moreover, diseases like diabetes affect distinct organ systems. In our case, the patient has diabetes, which damages blood vessels and nephrons in the kidney. An assessment revealed that the patient is suffering from diabetes nephropathy, which can be managed using medical drugs like ACEs. However, the medication is contraindicated since some people are allergic to it. The patient was further advised to change her diet and lifestyle to limit the progression of diabetes nephropathy into kidney failure.
References
Akhtar, M., Taha, N. M., Nauman, A., Mujeeb, I. B., & Al-Nabet, A. D. M. (2020). Diabetic kidney disease: Past and present. Advances in anatomic pathology, 27(2), 87-97.https://www.ingentaconnect.com/content/wk/adapa/2020/00000027/00000002/art00004
Fried, L. F., Petruski-Ivleva, N., Folkerts, K., Schmedt, N., Velentgas, P., & Kovesdy, C. P. (2021). ACE inhibitor or ARB treatment among patients with diabetes and chronic kidney disease. American Journal of Managed Care, 27. https://openurl.ebsco.com/EPDB%3Agcd%3A3%3A4974019/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A157543298&crl=c
Hawthorne, G., Lightfoot, C. J., Smith, A. C., Khunti, K., & Wilkinson, T. J. (2023). Multimorbidity prevalence and patterns in chronic kidney disease: findings from an observational multicentre UK cohort study. International Urology and Nephrology, 1-11. https://link.springer.com/article/10.1007/s11255-023-03516-1
Lv, Z., & Guo, Y. (2020). Metformin and its benefits for various diseases. Frontiers in endocrinology, 11, 191.https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.00191/full
Shah, S. Z., Karam, J. A., Zeb, A., Ullah, R., Shah, A., Haq, I. U., … & Chen, H. (2021). Movement is improvement: the therapeutic effects of exercise and general physical activity on glycemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetes Therapy, 12, 707-732.https://link.springer.com/article/10.1007/s13300-021-01005-1
Singh, A. K., Singh, A., Singh, R., & Misra, A. (2022). Finerenone in diabetic kidney disease: A systematic review and critical appraisal. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 16(10), 102638.https://www.sciencedirect.com/science/article/pii/S1871402122002521
Spencer, S., Desborough, R., & Bhandari, S. (2023). Should Cystatin C eGFR become routine clinical practice?. Biomolecules, 13(7), 1075.https://www.mdpi.com/2218-273X/13/7/1075
Zhao, M. J., Prentice, J. C., Mohr, D. C., & Conlin, P. R. (2021). Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus. BMJ Open Diabetes Research and Care, 9(1), e001797.https://drc.bmj.com/content/9/1/e001797.abstract
write