Policy Boundaries, Essay Example

Introduction

The prevalence of type 2 diabetes in the United States is significant and requires a comprehensive approach and strategy in order to reduce risk, promote prevention, and improve treatment outcomes for patients with this disease. In this country, type 2 diabetes is prevalent in every corner and in every city; therefore, it is a national epidemic that must be addressed on a national scale across multiple platforms. Political involvement in the type 2 diabetes debate has been important in stimulating conversation regarding this issue; however, there has not been sufficient discussion in this manner to date. National healthcare organizations, however, have been instrumental in moving guidelines, recommendations, research, and funding forward in order to improve outcomes related to the disease. Furthermore, behavioral modifications and weight loss are critical issues related to type 2 diabetes that are primary focus areas. Type 2 diabetes as an epidemic continues to wreak havoc on American society and requires further evaluation as national problem with very real and lasting consequences. The challenges associated with achieving an effective response to type 2 diabetes must incorporate social responsibility to address all demographic groups affected by the disease, including African Americans. This group, in particular, faces a very high risk and requires much consideration and evaluation in order to support widespread prevention and growth of the disease. The following discussion will address type 2 diabetes across a number of key areas, such as legislation regarding the fight against the disease, executive decisions that have been made to address the condition, any court decisions that have been made, current regulations, as well as ethical and legal considerations that govern the disease and its overall impact on health and wellbeing for adults throughout the United States. A conclusion will also be drawn regarding the impact of type 2 diabetes on current healthcare practice and the steps that are required to improve outcomes and to promote widespread preventative efforts to reduce the impact of the disease on many population groups, including African Americans.

Legislation

In late 2013, the Diabetes Advocacy Alliance (DAA) sought to expand the need for Congressional involvement in the diabetes epidemic by drafting a proposal to several ranking senators. This was an important step that the group took in order to consider the responsibility of legislative bodies in supporting the growth of resources designed to fight diabetes and to alleviate the danger of this epidemic throughout the United States (American Association of Clinical Endocrinologists, 2013). This was an important step towards the improvement of resources that specifically target the type 2 diabetes epidemic and how it continues to impact younger groups of people in significant ways (AACE, 2013). With the ever-increasing level of interest regarding type 2 diabetes, it is more important than ever to address the disease as a part of an overall health initiative to address chronic disease and how it impacts many members of society in different ways (AACE, 2013).

A number of legislative bills are already in process and have been sponsored by Congressional leaders, including the National Diabetes Clinical Care Commission Act (H.R. 1074/S. 539) to address the quality of diabetes care; The Medicare Diabetes Prevention Act of 2013 (H.R. 962/S. 452) to encourage seniors to seek enrollment in evidence-based diabetes prevention programs; Congressional funding that is earmarked to support the National Diabetes Prevention Program; the Gestational Diabetes Act (H.R. 1915/S. 907) to reduce the risk associated with gestational diabetes; the Access to Quality Diabetes Education Act (H.R. 1274/S.945) to enable credentialed diabetes educators to become Medicare providers for diabetes self-management training initiatives; and the Preventing Diabetes in Medicare Act (H.R. 1257) to enable Medicare recipients to receive coverage for services such as medical nutrition therapy for patients with prediabetes and who also face the risk of type 2 diabetes (AACE, 2013). Each of these legislative efforts sheds light on the ever-growing epidemic of type 2 diabetes and how it impacts both children and adults in many ways that could be supported by increased legislation in these areas (AACE, 2013). The Congressional Diabetes Caucus, chaired by Diana Degette and Ed Whitfield, support the aforementioned issues and continue to consider the epidemic and its impact on Americans (2014).

Executive Decisions

Type 2 diabetes is well represented in grant funding provided by the National Institutes of Health to conduct research regarding many areas of the disease in order to move forward with new perspectives and approaches to improve outcomes for many Americans (NIH, 2014). Many different types of studies have been funded or are currently funded in order to achieve the desired results that have a positive impact on current patients and on prevention mechanisms for the disease (NIH, 2014). Furthermore, research that is being conducted in local communities and in other areas presents an opportunity to explore the different dimensions of diabetes and how it impacts millions of Americans in communities small and large. In many of these communities, type 2 diabetes leads to many serious complications and therefore, requires further consideration and evaluation on many levels. This is an ongoing process that offers many benefits to users and also demonstrates the importance of improving outcomes through research and other directives designed to address diabetes as a condition that has serious and lasting complications for many Americans. By continuing to enforce the need for additional research in this area, advocates for research and programmatic efforts involving type 2 diabetes are instrumental in continuing to shape outcomes and future directions in improving disease prevention and management throughout the United States.

Court Decisions

Although type 2 diabetes and legal implications do not necessarily go hand in hand, there have been important and meaningful developments regarding the need to support patients with type 2 diabetes in more severe forms that may impact their ability to work and to be productive at an optimal level. For example, a number of cases were brought to federal courts in an effort to demonstrate that plaintiffs had a disability that required protection under the Americans with Disabilities Act; however, results have been mixed and have led to additional questions regarding the legal precedence for type 2 diabetes in the workplace environment (American Diabetes Association). In many of these cases, type 2 diabetes was not deemed a disability; therefore, these plaintiffs were not victorious (American Diabetes Association). However, there are considerations that must be made regarding the impact of type 2 diabetes and how it may prohibit optimal performance in some work-related settings, and these efforts must be taken into consideration as a means of addressing future outcomes for individuals (American Diabetes Association).

Regulations

The developments that have occurred throughout healthcare practice in recent years regarding type 2 diabetes represent an opportunity to explore the different dimensions of the disease and how community, state, and federal leaders have expanded attention and improved focus in this area. Furthermore, many decisions regarding the disease have occurred that provide a greater understanding of its widespread impact and focus on new directions in achieving favorable outcomes. Experts in healthcare have been instrumental in shaping how diabetes is treated and approached by the medical community; therefore, much research and many publications have been released as a means of improving disease management and focus on the condition (American Diabetes Association, 2014). For example, Clinical Practice Recommendations for 2014 were created by the ADA in order to evaluate existing evidence and develop directives that impact diabetes management and prevention (ADA, 2014). These recommendations include standards of care, nutrition therapy, and hyperglycemia management, among other areas, all of which demonstrate the importance of new perspectives that are designed to address type 2 diabetes directly and to make all possible efforts to aid in prevention and long-term success in treating the condition in order to minimize complications (ADA, 2014). These factors are critical to the success of type 2 diabetes and support the continued growth and development of new perspectives to manage the disease that have been proven effective through prior evidence (ADA, 2014). These ADA standards serve as the cornerstone for the development of new diabetes-based perspectives that are likely to have a significant impact on patient care outcomes and on developing new strategies to prevent the disease in larger groups of people (ADA, 2014).

From a community-based perspective, it is evident that additional work must be performed in order to accomplish primary goals and objectives, such as obesity prevention, accompanied by improved nutrition and exercise (Uusitupa et.al, 2011). These factors pose a serious risk to community members in that they limit the ability of individuals to prevent diabetes if they do not have proper knowledge of how their own behaviors may contribute to obesity and a higher risk of type 2 diabetes (Uusitupa et.al, 2011). For this reason, lifestyle modifications must be promoted on a larger scale and must provide a greater understanding of the need to address behaviors as part of the solution in preventing type 2 diabetes in many patients (Uusitupa et.al, 2011). Behavioral modifications may go a long way in supporting the development of new perspectives that are designed to encourage the growth of type 2 diabetes and related conditions (Uusitupa et.al, 2011). Other efforts to consider must include diabetes self-management, which is achieved through a variety of educational platforms that support the expansion of efforts to alleviate the risks and complications of type 2 diabetes over the long term (Funnell et.al, 2012). This strategy will support the growth of new perspectives that are designed to improve outcomes for patients through expanded self-management techniques that impact long-term objectives for these individuals who face the risks associated with type 2 diabetes on a daily basis (Funnell et.al, 2012).

Ethical and Legal Considerations

From an ethical perspective, type 2 diabetes introduces many complications and factors that pose a risk to individuals and communities. Therefore, issues may arise that impact type 2 diabetes prevention, diagnoses, care, and treatment in many areas. For example, genetic testing to screen for type 2 diabetes poses ethical challenges to medical experts because this may be viewed as an interference or infringement upon the natural progression of health that could be addressed in other ways (Haga, 2009). This type of “personalized medicine” poses a threat to routine methods and practices that are designed to address chronic disease and treatment for patients (Haga, 2009; Bunnik et.al, 2012). Other concerns may include cultural needs and expectations that distinguish one patient from the next and that have an impact on diabetes prevention and management (The Diabetes Educator, 2012). In this context, it is important to identify specific resources that may be effective in supporting the needs of patients with type 2 diabetes that embrace cultural sensitivity in order to achieve the desired outcomes for patients (The Diabetes Educator, 2012). There are many ethical factors to consider in working with patients from different cultures; therefore, these issues must be considered and supported by an understanding or an acknowledgement of these factors and how they influence individual beliefs regarding illness, an in particular, type 2 diabetes (The Diabetes Educator, 2012). These factors contribute to the development of new strategies that will encourage clinical experts to be more effective in communicating with patients across different cultures, including sensitivity to different policies and procedures that may impact outcomes for patients in a positive manner (The Diabetes Educator, 2012). These behaviors will further advance the type 2 diabetes agenda to improve outcomes and to facilitate positive self-management and focus on the condition as a whole (The Diabetes Educator, 2012).

Conclusion

Type 2 diabetes is a chronic disease with serious and lasting complications for millions of Americans. Research and programmatic efforts regarding the disease have come far; however, the disease continues to impact the quality of life of many people, from children to adults. Therefore, it is important to identify the resources that are required to ensure that patient care outcomes are achieved and that there are significant opportunities to achieve growth and development in disease prevention and management. The issues related to type 2 diabetes are complex and intricate; therefore, additional studies and funding must be allocated towards expanding research that will alleviate diabetes risk and improve outcomes for patients. Many policymaking agendas have been introduced to combat type 2 diabetes, but additional work in this area is required to ensure that all possible concepts are explored in a timely manner to ensure that all possible avenues are explored from the political, legal, ethical, and social perspectives to facilitate disease prevention and improved management of type 2 diabetes on a larger scale.

References

American Association of Clinical Endocrinologists (2013). Support letter for diabetes legislation. Retrieved from https://am.aace.com/files/views/103113-daa-support-letter-for-diabetes-legislation.pdf

American Diabetes Association (2014). Clinical Practice Recommendations 2014. Retrieved from http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=84160

American Diabetes Association (2014). The effect of Sutton v. United Air Lines on people with diabetes: selected federal court cases. Retrieved from http://web.diabetes.org/Advocacy/Employment/9EffectofSuttono.pdf

Bunnik, E.M., Schermer, MHN, & Janssens, AC (2012). The role of disease characteristics in the ethical debate on personal genome testing. BMC Medical Genomics, 5(4), retrieved from http://www.biomedcentral.com/1755-8794/5/4

Congressional Diabetes Caucus (2014). Diabetes Caucus legislation. Retrieved from http://www.house.gov/degette/diabetes/legislation.shtml

The Diabetes Educator (2012). Cultural sensitivity and diabetes education. The Diabetes Educator, 38(1), 137-141.

Funnell, M. M., Brown, T. L., Childs, B. P., Haas, L. B., Hosey, G. M., Jensen, B., … & Weiss, 108 A. (2012). National standards for diabetes self-management education. Diabetes care, 35(Supplement 1), S101-S108.

Haga, S.B. (2009). Ethical issues of predictive genetic testing for diabetes. Journal of Diabetes Science and Technology, 3(4), 781-788.

National Institutes of Health (2014). Diabetes, Type 2. Retrieved from http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=121

Uusitupa, M., Tuomilehto, J., & Puska, P. (2011). Are we really active in the prevention of obesity and type 2 diabetes at the community level?. Nutrition, Metabolism and Cardiovascular Diseases, 21(5), 380-389.