Research Paper: Diabetic Mellitus Type I in Geriatric Patient

Research Paper: Diabetic Mellitus Type I in Geriatric Patient
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Research Paper: Diabetic Mellitus Type I in Geriatric Patient
Introduction
Diabetes Mellitus is one of the prevalent non-communicable diseases worldwide. This condition falls into two major categories: type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM), with T2DM being more prevalent than T1DM. This classification is etiological and separates diabetes mellitus into two primary types, type 1 and type 2, with type 2 diabetes contributing more than 85% of the total diabetes mellitus prevalence (Forouhi & Wareham 2019) and T1DM represents only about 10% of the diabetes cases worldwide (Paschou et al.,2018).   In 2015, 9.4% of the U.S population had diabetes, and an estimated value of 415 million people worldwide had diabetes in the same year (Xu et al., 2018). The author postulated a projected rise to 642 million people by the year 2040. These findings are shared by Forouhi & Wareham (2019), who presented the estimates showing a global prevalence of 425 million people, with diabetes in 2017, which is predicted to increase to approximately 629 million people by 2045. This data is worrying considering the immense morbidity and mortality associated with a cascade of diabetes complications. Diabetes has often been associated with increased cardiovascular diseases, cancer, renal disorders, neuropathy, and retinopathies. Besides morbidity and mortality, diabetes is a burden to healthcare and economy systems. Xu et al. (2018) indicate the disease's economic burden at approximately $245bn (£174bn; €199bn) in the U.S by 2012 and about $1.31tn worldwide in 2015. Such a significant prevalence and a sharp rise of diabetes are attributable to the global increase in obesity prevalence and unhealthy behaviors encompassing poor diets and physical inactivity (Forouhi & Wareham 2019).  These contributing factors are modified by wider societal determinants, including changes in nutrition within the global context. Irrespective of the type of diabetes, the burden caused by diabetes is substantial not only to healthcare and quality of life but also causes the loss of economic resources. This paper will focus on T1DM in a geriatric patient.
Presenting Case
The client, James, is a 66 older adult who presented to the emergency clinic with a complaint of extreme fatigue, frequent hunger, unexplained weight loss, and blurred vision. James reports that these complaints have persisted over three months and symptoms appear to worsen each time. He says an inability to recall events, persons, and where he has place items and inappropriate gait. He cited poor warning healing as a result of bruises and minor injuries and deteriorating hearing capacity. James also reported an incident in which he has fallen due to confusion increased incidence of urinary incontinence. The physician examined the patient. He appears sluggish, confused, and irritable. The physical finding showed dry feet, muscle atrophy, and small feet ulcerations. The past medical history reveals a history of being treated for hypertension and that he is on Lopressor HCT prescription. However, he does not have any other substantial history of hospitalization, existing commodities, and surgery. He reports that he is on Lopressor HCT prescription but reports no history of other significant hospitalization, existing commodities, or surgery. His vital signs included a blood pressure of 160/100, heart rate 92, SpO2 98, and an oral temperature of 98.8°F.His random blood sugar test was 220 mg/dl. The physician recommended admissions with a start of soluble insulin and intravenous fluids to stabilize sugars and be flowed by diagnostic tests including full hemogram, liver function tests, lipid profile, and glycated hemoglobin (A1C) test. Glycated hemoglobin (A1C) test was found to be 15%.
Etiology and Risk Factors
The diagnostics tests, including random blood sugars glycated hemoglobin (A1C) test, illustrates impaired sugar metabolism, which is suspected to be T1DM due to its acute onset. Type 1 diabetes mellitus (T1DM) is often described as autoimmune diabetes. It is characterized by insulin deficiency due to pancreatic β-cell loss. Insulin deficiency leads to hyperglycemia. Although symptomatic onset commonly occurs during childhood or adolescence, manifestation can appear later in life. The etiology of T1DM remains uncertain. However, the disease's pathogenesis is postulated to involve T cell-mediated destruction of β-cells (Katsarou et al., 2017).T1DM results from the autoimmune destruction of β cells in the endocrine pancreas. The pathogenesis of T1DM is different from that of T2DM, where T2DM entails both insulin resistance and reduced secretion of insulin by the β cells contribute to impaired glucose metabolism. According to Paschou et al. (2018), the autoimmune destruction of β-cells takes place in genetically susceptible individuals as an influence by one or more environmental factors: this process may progress over a period from months to years, during which period patients are usually asymptomatic and euglycemic, but show positive results for relevant autoantibodies. The manifestation of symptomatic hyperglycemia will occur post-latency period, and it reflects a situation where a large amount of β cells have already been destroyed.
Genetic factors play a role in the emergence of T1DM.T1DM may appear even in individuals without a family history. Only about 10–15% of the patients have a first or second-degree relative with diabetes (Paschou et al., 2018). However, the authors pointed out that the lifetime risk for developing T1DM increases in relatives of diabetic patients, as an estimated 6% of children, 5% of siblings, and 50% of monozygotic twins have the disease when compared to 0.4% prevalence of the general population.T1TM loci have been identified especially within the major histocompatibility complex (MHC), also called HLA (human leukocyte antigen), which is located on chromosome 6) (Paschou et al., 2018). Polymorphisms within the region of the insulin gene promoter, as located on the short arm of chromosome 11 and near the gene encoding for proinsulin, contribute to approximately 10% of the genetic predisposition for T1DM (Paschou et al., 2018). Other genetic factors to consider can include CTLA-4, PTPN22, AIRE, FoxP3, STAT3, IFIH1, HIP14, and ERBB3 (Paschou et al., 2018).
The enviroemental factors do contribute to the prevalence of T1DM. Exogenous factors may play a role in the development of type 1 diabetes. Multiple pathways can lead to the destruction of pancreatic beta-cells but it appears that it is an interaction of specific exposures, gene variants, and gene-environment factors that influence predisposition to T1DM (Rewers et al., 2018).There strong evidence from studies that exposure to environmental factors like include viruses including rubella, coxsackievirus B or enteroviruses and toxins and nutrients like cow’s milk, cereals may contribute to T1DM but the mechanism of causation remains uncertain Paschou et al., 2018). The authors noted that the role of diet and gut microbiota in the development of T1DM remains controversial though some have suggested that early introduction of cow’s milk into infants’ diet may lead to T1DM because the infant can form antibodies in response to insulin found in cow’s milk. Genetic factors and environmental factors could have played a role in Jame’s T1DM.James case can be viewed in the current context of COVID-19,which some scientist have hypothesize that coronavirus may be causing diabetes. This postulation relates with the immunological mechanisms that results in T1DM as a result of exposure to viral micro-organisms.
Pathogenesis
More often, T1DM leads to deranged sugar regulation in the body, which is marked by hyperglycemia. Hyperglycemia has a repertoire of adverse effects on body organs and tissues, which underpin its high prevalence of comorbidities and mortality. The pathogenesis of both types of diabetes leads to a cascade of events with deleterious effects with profound multisystem impact on cardiovascular, neural, renal, and urinary systems and visual systems. Among its primary complications include retinopathies, neuropathies, neuropathic foot, cardiovascular and encephalic complications (Fernandes Lima et al., 2016). These complications cause deterioration to the functional capacity, autonomy, and quality of life of the affected persons. The chronic metabolic dysregulation associated with T1DM includes patients at high risk for long-term macro and microvascular complications, and when it is not treated, it leads to hospitalization and high risk of cardiovascular diseases (de Melo et al., 2019). It has various adverse effects on the lower urinary tract due to being a systemic disease and the ability to cause pathologies at the microvascular level (Eskidemir et al., 2019). Diabetes leads to changes in the mass, compliance, and parenchyma composition of bladder tissue and its associated pathologies affect detrusor hyporeflexia and detrusor areflexia resulting in urge incontinence and stress urinary incontinence (Eskidemir et al., 2019). The urinary pathologies are often associated with previous surgeries linked to diabetic complications, being more than 55 years of age, being male, and having a diabetes-related complication.
Symptoms
The majority of geriatric syndromes may be due to diabetes. Diabetes, including T1DM, affects multiple systems in the body, and this results in a variety of manifestations. Clinical features among elderly diabetic patients are a bit different. Diabetes in elderly people is usually diagnosed with delay owing to atypical symptomatic features of dementia, urinary incontinence, and the phenomenon of primary postpra...