Diabetic Retinopathy in Type 2 Diabetes Mellitus: A Case Study of Anne Baptiste

This essay explores the case study of Anne Baptiste, a 32-year old Afro-Caribbean woman suffering from type-2 diabetes and diabetic retinopathy. It focuses on the process of developing PICO question and the search strategy, the underpinning pathophsiology centring the diabetic retinopathy in relation to the symptoms of Anne, and the patent-centred care approach towards improving the overall disease outcome via increasing the therapy adherence.

Running head: ESSAY
Essay
Name of the Student
Name of the University
Author Note

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ESSAY
Introduction
The following essay will be structured on scenario: 1 what highlights case of Anne
Baptiste, a 32-year old Afro-Caribbean woman suffering from type-2 diabetes and have
developed diabetic retinopathy. The essay has three parts. The first part of the essay will
focus on the process of developing PICO question and the search strategy. The second part of
the essay will highlight the underpinning pathophsiology centring the diabetic retinopathy in
relation to the symptoms of Anne. The third part of the essay will focus of the patent-centred
care approach towards improving the overall disease outcome via increasing the therapy
adherence.
Part 1
Introduction of the topic
Having high blood glucose level for a significant period of time results in the
generation of the marco and microvascular complications. This micro and macro vascular
complications of the diabetes results narrowing of the arteries and the blood vessels which
give rise of the development of cardiovascular complication, renal complications and visual
impairments (Murea, Ma and Freedman 2012). Visual impairment in diabetes is termed as
diabetic retinopathy. There are two types of diabetic retinopathy, non-proliferative and
proliferative diabetic retinopathy. Non-proliferative diabetic retinopathy (NPDR) is side-
effects of the patients suffering from high level of blood glucose. It is defined as a condition
where the retinal blood vessels are damaged and develop tiny leaks. The blood leaks from the
damaged retinal vessels and the leaked blood is deposited as exudates in the retina (Yau et al.
2012). The leakage of the blood vessels causes swelling of the retina and associated blood
vessels and this is the reason why Anne Baptiste has microaneurysms and "dot and blot

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haemorrhaging. Proliferative retinopathy is more advanced stage of diabetic retinopathy
where fragile blood vessels starts growing in the retina and inside the vitreous and a gel like
fluid fill the back side of the eye (Tarr et al. 2013). These fragile blood vessels at times can
leak blood into the vitreous resulting in the clouding of the vision as in case of Anne.
Proliferative retinopathy if not treated on time might give rise to bilateral neovascularisation
this hampers the overall visual activity as in case of Anne during July 2016. Gradually the
signs of maculopathy with neovascularisation start developing.
Why it is important to have focused question?
It is important to have a focused question because it helps to directly related with the
chosen or the selected group of population upon which the research is required to be
conducted. Moreover, having a focused question also helps to specifically compare the
disease condition or the severity of the disease upon application of two different
interventions. Focus question thus help to conduct the research in a structured manner
(Parahoo 2014).
Why focus is over qualitative study?
The main focus of the research which I will chooseis quality based on systematic
review. The reason behind this is, systematic review helps in the generation of evidence-
based practice. According to Parahoo (2014), evidence-based practice is preferred approach
in rendering services to the individuals with disabilities. One of the important ways of
developing evidence based practice is systematic review. Systematic review helps to analyse
the already published paper which are relevant, authentic and current in relation to the focus
topic. The accumulation of data through systematic review helps to structure the best possible
evidence-based practice that can be applicable over the target population (Melnyk et al.
2010).

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PICO Question
P Population Type 2 diabetic patient
I Intervention Support from family or closed peers
C Comparison No support from family
O Outcome Adherence to the therapy plan and overall
improvement of the diseased condition
How constant support from the closed peers or family members (I) helps in increasing the
therapy adherence (O) of diabetic patients (P) ?
Search strategy
The main search strategy which Iused for the search of the relevant literacy articles is
keyword search with the help of the Boolean operators in the university databases. Initially,
the main inclusion criteria selected was
Year: Last 10 years
Keywords used: Diabetes and family support (details
However, I found thatuse of this filter and keywords leads to the generation of
uncountable hits and majority of them are either redundant or out of the scope of the study.
Hence the inclusion criteria were revised further in order to limit the number of the search as
mentioned by the Parahoo (2014). Revised inclusion criteria include
Year: Last five years (2013 to 2018)
Keywords: Type 2 diabetes mellitus OR Insulin-independent diabetes mellitus AND
family centred care plan AND therapy adherence.

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Selection of the specific keywords and shortening of the time filter further helped in
the generation of refined search. Moreover, decreasing the time-frame will also help to select
papers which are based on current therapeutic interventions of diabetes. Here comes the
importance of systematic approach in qualitative research as it helps to highlight specific yet
relevant studies (Parahoo 2014).

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Part 2
The diseased scenario that will be referred in this case study include Type 2 Diabetes
Mellitus (T2DM). Anne Baptiste, a 32-year old Afrco-Caribbean woman is diagnosed with
T2DM (non-insulin dependent) in June 2008. The main problem which Anne experienced is
lack of proper control over her high blood glucose level. This caused prolong unmanaged
hyperglycemia that ultimately lead to the development of non-proliferative retinopathy. Her
negligence in abiding by the doctors therapy made the progression of non-proliferative
retinopathy even worse leading to decline in visual acuity.
The primary diseased condition of Anne is T2DM. Diabetes is a disease where the
blood glucose level of the body increases due to inability of the body to respond to the
secretion of the insulin hormone in the blood by the pancreatic B-cells. There are two types
of diabetes. Type 1 Diabetes (T1DM) is a physiological condition when the pancreatic B-
cells fail to produce adequate insulin for the uptake of glucose from the blood. T2DM, the
condition which Anne has developed results in the inability of the glucose molecule to
respond to the insulin secreted by the pancreases (American Diabetes Association, 2014).
This causes inability of the cells to uptake glucose from the blood and causing hyperglycemia
(high blood glucose level). This was the case of Anne. According to Murea, Ma and
Freedman (2012), T2DM is a lifestyle disease and results from unhealthy lifestyle habits. In
case of Anne, unhealthy lifestyle habit is lack of proper diet. T2DM can go undetected for
several years leading to long-term disease complications. Murea, Ma and Freedman (2012)
stated that it is more common among the Afro Caribbean population, making Anne's case
more predictable.
The signs or the quantitative aspect that will be focused in case of Anne who is
suffering from T2DM will be hyperglycemia. The symptoms or the qualitative aspect that

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will be focused in this diseased condition include constant stress in order to monitor her
blood glucose level, maintenance of healthy diet plan, looking after her daughter (Anne is a
single mother) and maintaining her balance in professional life. Murea, Ma and Freedman
(2012) stated that increase in the level of stress and anxiety is an important factor leading to
the development of T2DM, a lifestyle disease.
According to Tarr et al. (2013) the risk of developing and progression of diabetic
retinopathy is closely associated with the duration of diabetes. Other factors which lead to the
development of diabetic retinopathy are high blood pressure, high blood cholesterol and lipid.
However, Wang and Lo (2018), highlighted that chronic hyperglycemia is the reason behind
the progression of diabetic retinopathy. Tarr et al. (2013) are of the opinion that increase in
the blood glucose level for a prolong period of time leads to activation of polyol pathway for
the breakdown of glucose whose end product is fructose. The intermediate of the pathway of
sorbitol which cause osmotic damage of the retinal cells leading to cell death and diabetic
retinopathy and loss of vision. Non-enzymatic degradation of the unused glucose in the blood
lead to the production of advanced glycation end products which is toxic and gets
accumulated in retinal vessel leading to vision loss. High blood glucose level also caused
subclinial inflammation of the retinal cells leading to leukostatsis and development of
retinopathy. Diabetes retinopathy is of two types proliferative ad non-proliferative. Initially
non-proliferative retinopathy surfaces which later transforms to proliferative retinopathy
leading to drastic disease progression (Tarr et al., 2013).

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References
American Diabetes Association. (2014). Diagnosis and classification of diabetes
mellitus. Diabetes care, 37(Supplement 1), S81-S90.
Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B. and Williamson, K.M., 2010. Evidence-
based practice: step by step: the seven steps of evidence-based practice. AJN The American
Journal of Nursing, 110(1), pp.51-53.
Murea, M., Ma, L. and Freedman, B.I., 2012. Genetic and environmental factors associated
with type 2 diabetes and diabetic vascular complications. The review of diabetic studies:
RDS, 9(1), p.6.
Parahoo, K., 2014. Nursing research: principles, process and issues. Macmillan International
Higher Education.
Tarr, J.M., Kaul, K., Chopra, M., Kohner, E.M. and Chibber, R., 2013. Pathophysiology of
diabetic retinopathy. ISRN ophthalmology, 2013.
Wang, W., & Lo, A. (2018). Diabetic Retinopathy: Pathophysiology and
Treatments. International journal of molecular sciences, 19(6), 1816.
Yau, J.W., Rogers, S.L., Kawasaki, R., Lamoureux, E.L., Kowalski, J.W., Bek, T., Chen,
S.J., Dekker, J.M., Fletcher, A., Grauslund, J. and Haffner, S., 2012.Global prevalence and
major risk factors of diabetic retinopathy. Diabetes care, p.DC_111909.

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Appendix A
Keyword 1 Keyword 2 Keyword 3
Type 2 diabetes
mellitus OR Insulin-
independent diabetes
mellitus
family centred care
plan
Therapy adherence

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Appendix B
Type 2 diabetes mellitus Family centred care plan Therapy adherence
OR OR OR
Insulin-independent diabetes
mellitus
Family based approach Increase in disease outcome
OR OR
Diabetes Family support
HITS HITS HITS
105, 060 56,931 189, 324
Overall unique yet relevant hits (minus the redundant and irrelevant hits): 153