Exploring the Impact of Diabetes Mellitus: A Literature Review on Global Health Concern

Running head: LITERATURE REVIEW PAPER
Literature review paper
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LITERATURE REVIEW PAPER
Introduction:
The human health is deteriorating fast and it is deteriorating steadily, and it is
deteriorating every single day. There are a variety of different health care priorities that effect
the health of the society. However, among the range of health priorities that have gained
attention in recent years, diabetes mellitus has been recognised as a public health problem
that has been found to approach epidemic proportions on a global scale (Bommer et al.,
2017). This is a non-communicable diseases which currently affects close to 422 million
individuals on a global basis (Sturt et al., 2015). In the past few decades, the impact of the
disease has only expanded multiple folds, from being 108 million in the year of 1980 to 382
million in the 2013. Hence, needless to mention, the impact of this particular disease is
devastating on the world health scenario.
By definition, the world health organization discusses diabetes mellitus to be a
chronic disorder which is either inherited due to a genetic predisposition, or acquired through
deficiency in producing insulin in the pancreas or due to the ineffectiveness of the insulin
produced. The deficiency results in enhanced concentration of glucose in the blood stream,
which in turn can even damage many of the body parts and affect the system of the body such
as the blood vessels and the nerves. There are several subtypes of diabetes namely, type 1
diabetes, gestational diabetes, and type 2 diabetes (Gonder-Frederick et al., 2016). Type 1
diabetes is primarily characterized by conditions where the pancreatic cells are unable to
produce sufficient amount of insulin, which is vital for survival. Some major environmental
factors that lead to failure of the pancreas include proteins in gluten, gut microbiota, bacterial
infection and viral infections. In addition, an estimated 50 genes have also been associated
with type 1 diabetes. The second type is the type 2 diabetes that is associated with the
inability of human body to respond properly to the action of the insulin that the pancreas is
producing. According to the demographic data, type two diabetes is one of most common

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type of diabetes which effects the most of the target population. Although, it has to be
mentioned in this context that type 2 diabetes is also associated with a variety of related co-
morbidities such as obesity, coronary arterial complications and renal disorders. Similarly,
type two diabetes is also associated with a number of psychological issues as well, especially
due to the body image issues and the various physical restrictions that the disease is
associated with. As a result, there had been many instances where the impact or the burden of
living with diabetes deals a huge psychological and even societal blow on the target patient
population leading to a variety of disorders including depression, agitation, irritation and even
lack of self-worth (Jones et al., 2016). As a result, health care delivery planning people
suffering from diabetes has now started to incorporate psychosocial management and
interventions. There is mounting evidence for the fact that emotions are comparatively steady
over time, and establish the individual’s general viewpoint towards the circumstances, thus
confirming the personality. Nonetheless, it is conceivable that emotions change with the onset
of several chronic diseases (Fisher et al., 2018). Dysregulation of feelings and emotions have
been found to exert a noteworthy impact on the physical health of a person, by activating the
autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal axis, which in turn
creates major effects on the immune and metabolic functioning of the individual. Time and
again it has been postulated that variability in glycaemic index measures are directly
correlated with mood and emotion (trait anxiety, depression, and anger) that eventually
deteriorates the quality of life of the patients (Young-Hyman et al., 2016). Abnormal and
inconsistent glucose readings have also been meaningfully allied with poor health-related
quality of life (HRQOL), following adjustment for weight and age, and patients suffering
from diabetes mellitus, with increased trait anxiety or depression are at an increased
likelihood of demonstrating more glucose variability. Researchers provides evidence for the
fact that when an individual is diagnosed with the metabolic syndrome for the first time,

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he/she generally experience a plethora of psychological stages like bereavement, and
increased HbA1c levels are concomitant with fatigue, tension, denial, and displeasure
(Bermúdez-Millán et al., 2016). This literature review paper will attempt to explore, evaluate
and analyse the existing pieces of literature on psychosocial management of the emotions of
diabetic patients by taking the assistance of the literature framework.
Review framework and article selection:
This literature review is taking the assistance of a number of databases for collection
of the articles to review. First and foremost, Google scholar is going to be used for the
preliminary research on the topic and to understand the extent of evidence available on the
topic area that has been chosen for this review study. Based on the preliminary analysis of the
initial review, the chosen articles to be reviewed will be taken from three renowned databases
for nursing or health care research, PubMed, Cochrane library, and CINAHL. As CINAHL
has the highest collection of research journals on health care related topics, the most of the
articles will be taken from the CINAHL library. The article selection will be done based on
Smart search, using specialized search phrases linked with Boolean operators such as
“AND”, “OR”, and “NOT”.
CINAHL stands for Cumulative index to nursing & allied health literature, and it is
also one of the most coveted databases for research in health sciences. CINAHL database
provides indexes for at least more than 3000 journals and publications belonging to the
domain of nursing and allied health which are also written in English. The database also
contains more than 2.3 million records that are dating back to 1981. Specifically, the database
also has more than 400 nursing and allied health journals from all over the world. Hence, for
this review study we have chosen the CINAHL database for the review. In the first search, we
received 90 results as I had used a broad key phrase for the searching. In the next phase of the
research I had used a few limiters, such as “abstract available”, “peer reviewed”, “Full text

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available”, and “human subject research”. As a result, in each phase with one limiter used
reduced the number of search hits from 90 to 35 in the last hit. Although, the results had not
been as relevant and specific as required, due to which, I applied another limiter to obtain
articles that have been published 2013 onwards, which in turn helped me enhance the
currency of the research evidence, which narrowed down the result to 8 articles. The resultant
articles were reviewed using the framework of thematic analysis.
Summary and critique of the articles being reviewed:
The critical appraisal framework used for the review had been CASOP which helped
in identifying both the strengths and weaknesses, of each of the evidences that has been
incorporated in the paper. Criticizing the extent of the evidence base on the topic, the articles
found were mostly of high quality and addressed the actual research question effectively. The
evidence pyramid framework was used for determining the quality of evidence of the
scholarly articles as high, moderate, low and very low. Only one systematic review has been
used in the paper, which is level 1 evidence for secondary literature (Halcomb, 2018). The
rest of the articles reviewed had been mostly observational, cohort or quantitative survey
studies. There had not been any RCT study that could be incorporated to the study, which is
undoubtedly a notable con of the study.
When critically analysing the content of the article, it has to be mentioned that the
small sample size in most of the articles had been one of the most important contributing
factor to the lack of validity or transferability of the data findings, another notable criticism in
this context needs to be the lack of enough evidence to address each of the diverse
interrelated factors associated with psychosocial management of the emotional impacts of
diabetes mellitus. However, there lies a gap in the presence of inadequate evidence for the
emotional impacts of gestational diabetes, and the psychosocial interventions that have been
implemented to address those impacts.

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Findings:
The review framework that is going to be used in the literature review to present the
findings is the thematic analysis. The use of a review framework helps in presenting the
literature review in a concise and systematic manner and also helps the readers to identify the
exact message or verdict that the articles are providing.
What is diabetes mellitus and why psychosocial management is required:
The very first theme to be discussed in this context is what diabetes mellitus as a
disease is, and how it impacts the quality of life of the patients, and exactly why the patients
would require psychosocial management for the disease. As discussed by Strandberg et al.
(2015) people diagnosed with diabetes mellitus report instances where they face substantial
demands and stresses in preserving and showing adherence to a healthy lifestyle, while
showing compliance to their prescribed treatment regimen, in relation to the social and family
environment, in addition to the healthcare system. Diabetes‐associated emotional suffering is
seen to be allied with reduced glycaemic control in such persons. With the aim of examining
the association between such emotional distress and glycaemic control follow-up amid
patients with type 1 diabetes, the researchers subjected the patients to Diabetes Distress
Scale, and also took into consideration their socio-demographic information. Following
adjustment of confounding variables, the researchers established a significant correlation
between poor glycaemic control and emotional distress (fixed‐effect coefficient
0.40, P < 0.001). In addition, treatment regimen‐associated distress also demonstrated robust
relation with glycaemic control (fixed‐effect coefficient 0.47, P < 0.001). This helped in
establishing the fact that patients with raised baseline diabetes‐associated emotional agony
are at an increased likelihood of lengthy suboptimum glucose control. Thus, necessary
psychosocial management strategies must be implemented for alleviating their emotive
distress and enhancing their quality of life.