T2DM Management: Pharmacological and Non-Pharmacological Approaches

This essay delves into the multifaceted management of Type 2 Diabetes Mellitus (T2DM), a global health challenge. It begins by examining pharmacological interventions, such as Metformin and Thiazolidinediones, highlighting their efficacy in managing insulin resistance and blood glucose levels while also addressing their limitations, including potential side effects and the impact on gut microbiota. The essay then transitions to non-pharmacological interventions, emphasizing the importance of lifestyle modifications like diet, exercise, and behavioral changes such as smoking cessation and alcohol reduction. It discusses the impact of weight management and the role of personalized dietary plans, while also acknowledging the complexities of behavioral interventions and the need for comprehensive approaches that consider social determinants of health. The essay concludes by advocating for a combined approach, integrating both pharmacological and non-pharmacological strategies, and emphasizing the need for patient-centered communication and care models to improve outcomes in T2DM management.

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of the University
Author Note

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Introduction
Type 2 Diabetes Mellitus (T2DM) is a lifestyle disease that has reached its epidemic
proportions. At least 382 million people residing throughput the world is affected with T2DM
and what is alarming is half of them are undiagnosed. T2DM is complex disease and is
regarded as a heterogeneous metabolic disorder where there occurs interaction of the genetic
and environmental factors leading to the development of variable degrees of insulin
resistance (IR) along with dysfunction of the beta cells of the Islets of Langerhans. When beta
cells of Islet of Langerhans secrete adequate insulin to overcome IR, hyperglycemia initiation
of T2DM occurs. The micro and macrovascular complication associated with T2DM is the
major cause of mortality and morbidity in patients with T2DM (Powers et al., 2017).
Inzucchiet al. (2015) are of the opinion a amalgamation of the pharmacological and non-
pharmacological interventions will help in effective management of T2DM. The essay will
initiate with the pharmacological intervention associated with the effective management of
T2DM. This will be followed by the non-pharmacological intervention for the management
of T2DM. The essay will follow an argumentative pattern in order establish the effectiveness
of the pharmacological and non-pharmacological interventions in T2DM management while
highlighting the self-management skills of T2DM.
Discussion
Pharmacological management of T2DM
Altaf, Barnett and Tahrani (2015) are of the opinion that despite lifestyle interventions
and weight-loss are two of the principal cornerstone for the management of IR and T2DM.
On the other hand Stevens et al. (2015) stated that individuals with impaired fasting blood
glucose level of impaired level of glucose tolerance have an increased risk of T2DM. In such

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individuals, proper amalgamation of lifestyle intervention and pharmacological interventions
are important for decreasing the risk of severity of T2DM. However, implementation of the
lifestyle implementation leads to significant change in behaviour and this cannot be achieved
during a course of one week or month. However, for patients which high blood glucose level,
immediate interventions are important in order to prevent the chances of hyperglycemic
shocks. Such that, pharmacological interventions must be implemented in order to reduce
immediate risk of diabetes mellitus. Metformin and thiazolidinediones (TZ) are two most
widely used pharmacological agents for countering the effects of IT. Both the drug helps in
inhibiting hepatic glucose output while improving the insulin sensitivity. Inspite of the high
efficacy of metformin and TZ in improving IR and decreasing the level of glucose without
increasing the risks of hypoglycaemia and other favourable cardiovascular effects, these
medications fail to maintain the glycaemic measures within the target level for a long term.
The study conducted by Sanchez-Rangel and Inzucchi (2017) stated that metformin is one of
the popular oral glucose lowering medications and is regarded as an optimal approach for
T2DM management. However, there are certain controversy for behind the long term use of
metformin for the management of T2DM for example. Long term-use of metformin leads to
the modification of the gut microbiota. The metrformin-microbiota interactions in a gut
stimulator generate irreversible modification at the gene level of gut microbiota. The altered
expression of gut microbiota leads increases the severity of developing the gastro-intestinal
tract infection like food poisoning and thus hampering the quality of life of the patients (Wu
et al., 2017). Altaf, Barnett and Tahrani (2015) also highlighted in their review that
medications like metformin and TZ have significant side effects and thereby limiting the
long-term use. Thus Altaf, Barnett and Tahrani (2015) proposed that there is a need to
identify new treatment targets in order to improve the insulin sensitivity without increasing
the risk of developing hypoglycaemia and other threats of cardiovascular disease.

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Hausenblas, Schoulda and Smoliga (2015) conducted a systematic review in order to study
the efficacy of resveratrol, the red wine polyphenol for the effective treatment of T2DM. the
analysis of the six clinical trial highlighted that resveratrol supplementation is more effective
in comparison to no medication for the effective regulation of high systolic blood pressure,
high level of hemoglobin A1c and creatinine. However, the medication fail to provide any
significant effect towards modulating the fasting glucose level, homeostatic model for the
assessment of insulin resistance along with regulating the diastolic blood pressure and level
of cholesterol in blood. However, resveratrol is associated with limited side effects and thus
is now an important pharmacological target for the management of T2DM.
Non-pharmacological intervention for T2DM
Khuntiet al. (2018)reported that T2DM is a preventable disease and this can be done
by regulating modifiable factors leading to the disease development like diet, body weight,
smoking of tobacco and drinking of alcohol. These can be achieved by effective modification
of lifestyle habits.
Weight Management
The T2DM is an irreversible physiological condition where the body becomes
resistant to insulin and hence it is known as insulin independent diabetes. Thus,
implementation of the non-pharmacological interventions like lifestyle change is proved to be
helpful in reducing the severity and negative progression of T2DM. The majority of the
individuals with type 2 diabetes is obese or is over-weight. Obesity or high level of BMI
(basal metabolic index) worsens the metabolic and physiological abnormalities associated
with diabetes. Thus, effective management of obesity with the help of non-pharmacological
intervention will be helpful in reduction the severity of T2DM. The non-pharmacological
intervention for the diabetes management includes regular practice of mild to moderate

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physical exercise. Lean et al. (2018) reported that regular practice of the physical activity or
exercise under the supervision of the nursing professional and physiotherapists help to reduce
the BMI index and thereby helping to reduce the severity of diabetes mellitus. Reduction in
the BMI index is also effective for improving body image and thereby helping to fight against
poor self-esteem associated with T2DM and this in turn help to recover from depression
(Bădescu et al., 2016). Zomeret al. (2015) proposed that reduction in the body weight
associated with obesity help to reduce the cardiovascular threats associated with diabetes and
thus reducing the severity of micro and macrovascular effect of diabetes. However, the study
meta-analysis of the randomized control trial conducted by Franz, Boucher, Rutten-Ramos
and VanWormer (2015) reported that weight-loss interventions by the practice of physical
activity scoreless in the domain of significant reduction in the HbA1c, lipids and blood
pressure. The meta-analysis mainly proposed that physical exercise must be executed along
with proper regulation of the proper diet plan in order to reduce high BMI and obesity. The
diet plan that must be followed by diabetes management will include anti-diabetic diet that
must be low on cholesterol, carbohydrate and glucose content. The physical activity plus
proper diet plan is thus regarded as suitable primary intervention for improved glycemic
control. Feinmanet al. (2015) further stated that intake of the energy per day must be
designed as per the body weight mass, age, height, gender and sex and degree of physical
activity executed per day. Thus framing of the diet plan must be done under the active
supervision of trained nutritionist. Feinman et al. (2015) also highlighted that as per the
evidence-based practice, low carbohydrate diet is the first approach for effective management
of diabetes mellitus.
Behavioural change for prevention of smoking and drinking
The non-pharmacological interventions for T2DM management include change in the
behaviour along with bringing change in the public health determinants. The behavioural

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change for the effective management of T2DM include Pan, Wang, Talaei, Hu andWu (2015)
stated that cigarette smoking and cessation of alcohol is one of the leading yet avoidable
cause of reduction of the disease burden of T2DM, The reduction in the smoking and
drinking is associated with behavioral change intervention for the management of T2DM.
The behavioral change interventions deal with education of the client about the disease
progression and harmful effect of T2DM. Hu et al. (2018) stated that education is not
comprehensive for the effective management of T2DM, as per the evidence-based practice,
the change in the behavior can be done by improvement of the social determinants of health.
For example, people who belong to poor social determinists of health like lack of proper
employment and lack of proper disease education are more likely to become victim of
smoking and drinking addiction and thus giving rise of T2DM. Stead and Lancaster (2017)
conducted a systematic review in order to evaluate whether individual counseling by a
smoking cessation specialist is helpful to quit smoking. The review of the randomized control
trial and quasi-experimental studies highlighted that individually given intervention for
smoking cessation counseling can help the smokers to quit smoking. The review only found
moderate quality evidence of a smaller benefit when the counseling is done in addition to the
pharmacotherapy. The study conducted by Hu et al. (2018) however highlighted different
results. It showed that smoking cessation leads to substantial weight gain and leading to
short-term increase in the risk of type 2 diabetes mellitus. Thus, smoking cessation must be
accompanied with proper diet chart. Pan, Wang, Talaei, Hu andWu (2015) stated that similar
individualized counseling help in the cessation of the tendency towards consumption of
alcohol and thus is regarded as an important non-pharmacological intervention for the
reducing alcohol intake and improving the quality of the life of T2DM patients and reducing
the severity of the disease. The conducted by Brown et al. (2016) revealed a completely
different perspective. The study showed that in comparison to the non-pharmacological

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intervention of alcohol cessation in order to reduce the blood glucose level and body weight
is less effective than pharmacological intervention. The use of the community based
pharmacological intervention delivered by the nursing professional is more effective in
comparison to the non-pharmacological intervention for effective management of alcohol
cessation. Moreover, cessation of alcohol with pharmacological intervention also helps to
reduce body weight and alcohol withdrawal symptoms.
Comprehensive implementation of pharmacological and non-pharmacological
intervention
According to American Diabetes Association (2016) in order to improve the provision
of the effective management of T2DM, both pharmacological and non-pharmacological
interventions must be implemented at an optimal rate. However, for the optimal
implementation of both the interventions require effective patient centred communication
style that included patient preferences, assessment of the patient health related literacy and
numeracy along with the cultural barriers. American Diabetes Association (2016) also
highlights that the care should be aligned with the components of the Chronic Care Model
(CCM) in order to ensure that there is a productive interaction between a nursing professional
and healthcare service user. This pro-active interaction between the nursing educator and
healthcare service user help to promote disease literacy and at the same time increase the
provision for designing of patient-centered care and thereby helping to improve the outcome
care. In order to make the diabetes care plan more feasible, the care system must be supported
with team-based care along with community involvement, decision-making support tools in
order to satisfy the exact needs of the patients.

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Conclusion
Thus from the above discussion, it can be concluded that type 2 diabetes mellitus
(T2DM) is preventable. However, the prevention programs is required to be systematically
identify the people who are at risk of developing the disease and addressing the
pathophysiological, public-health determinants and behavioural determinants of the diabetes
development. As per the evidence-based recommendation proper amalgamation of the
pharmacological and non-pharmacological interventions is effective for the proper
management of T2DM. Among the pharmacological intervention, the use of metformin for
effective regulation of insulin find prominence behind the reducing the severity of high blood
glucose level. However, long-term use of anti-diabetic medication is associated with
numerous side-effects and thus non-pharmacological interventions must also be used. The
non-pharmacological intervention for the management of T2DM include increase physical
activity and healthy diet (high fibre, low amount of saturated fat and low carbohydrate) is two
of the most popular interventions for non-pharmacological management of diabetes.
Decreased calorie intake will help to reduce the high blood glucose level and thus helping to
manage diabetes. Evidence based strategies also support behavioural change like reduction of
intake of alcohol and smoking of cigarette for effective management of diabetes. However,
behavioural change can only be done by improving the social determinates of health.

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