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Lifestyle factors
Weightloss, exercise and diet modification

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Evidence based research gathered from both Australia and countries around the world have all indicated that blood pressure lowering strategies such as lifestyle factors and pharmacological interventions have the most positive impact on T2DM and the co-morbidities associated with this disease. Although there is evidence that suggests that education plays a vital role in both prevention and detection of the disease, its impact on the comorbidities and disease itself does not have as much of an impact as blood pressure lowering strategies.

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Whilst education and accessibility are key components in having a positive impact on preventing co-morbidities and mortality in people with Type II Diabetes in Australia, the evidence ultimately suggests that blood pressure lowering strategies such as pharmacological and non-pharmacological interventions have the most positive impact on the prevention of co-morbidities and mortality in people with T2DM.

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National Heart Foundation of Australia (2010). Guide to management of hypertension 2008. Quick reference guide for health professionals. Updated December 2010. Retrieved from http://heartfoundation.org.au/images/uploads/publications/HypertensionGuidelines2008QRG2010Update.pdf

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National Heart Foundation of Australia (2010). Guide to management of hypertension 2008. Quick reference guide for health professionals. Updated December 2010. Retrieved from http://heartfoundation.org.au/images/uploads/publications/HypertensionGuidelines2008QRG2010Update.pdf

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National Heart Foundation of Australia (2010). Guide to management of hypertension 2008. Quick reference guide for health professionals. Updated December 2010. Retrieved from http://heartfoundation.org.au/images/uploads/publications/HypertensionGuidelines2008QRG2010Update.pdf

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National Heart Foundation of Australia (2010). Guide to management of hypertension 2008. Quick reference guide for health professionals. Updated December 2010. Retrieved from http://heartfoundation.org.au/images/uploads/publications/HypertensionGuidelines2008QRG2010Update.pdf

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AIHW National Hospital Morbidity Database & AIHW National Morality Database. (2004-2005). Hospitalisations with Diabetes and CHD, stroke or PVD, 2004-05 & Diabetes deaths also involving CHD, stroke or PVD, 2005. Updated 2008. Retrieved from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454991

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The following posters show the promotion of World Health Day 2016 from Diabetes Australia and ways it is targeted at different audiences.

"World Health Day 2016". Diabetesaustralia.com.au. N.p., 2016. Web. 24 Mar. 2016.

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Access to healthcare can affect those individuals who are living with type 2 diabetes in many different ways. It was reported that in 2012, 30% of the Australian population lived in regional and remote areas (Australian Government, 2014) with the study showing that the majority of those individuals tend to have higher levels of disease risk factors and illness then those in major cities.  The general population in these environments have a decline in employment opportunities resulting in low income, are isolated, have reduced access to transport and education all affecting their accessibility to obtaining health care (Azzopardi et al., 2012 & National Rural Health Alliance INC, 2013).

This can affect individuals, as they are not able to get the ongoing treatment they need. Without the appropriate interventions and resources, people living with type 2 diabetes in rural areas are not able to efficiently monitor their diabetes and from this could develop other lifestyle comorbidities, becoming detrimental in have an impact to their quality of life (Azzopardi et al., 2012).

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OTHER FACTORS THAT PLAY A CRUCIAL ROLE IN PREVENTING COMORBIDITY AND MORTALITY IN RELATION TO TYPE 2 DIABETES: 

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OTHER FACTORS THAT PLAY A CRUCIAL ROLE IN PREVENTING COMORBIDITY AND MORTALITY IN RELATION TO TYPE 2 DIABETES: 

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As previously discussed regular exercise has many health benefits however also has its risks in those with type 2 diabetes mellitus (T2DM).  The physical demands of exercise can be different in people and especially in those with T2DM. Nurses need to therefore ensure that all risks are minimised by referring patients to a doctor, diabetes educator or exercise specialist to undertake a health and fitness assessment (Thomas, 2013).

Before implementing any dietary changes, the individual should consult their doctor, from this a referral to allied health professionals such as a dietitian or diabetes educator may follow.  Because T2DM is such a serious and complex disease, all diet moderations should be tailored to the individuals needs in order to manage the disease and ultimately improve quality of life. The dietitian will put an individualised meal plan together, taking into account food preferences, cultural/religious needs, level of physical activity, lifestyle and other health conditions the individual may have (University of Maryland Medical Centre, 2016 & McCulloch, 2014) to ensure the most effective meal plan can be made. It is vital that the nurse and multidisciplinary team have a in-depth understanding of diabetes mellitus, signs and symptoms of hypoflycaemis and hyperglycaemia as well as the individuals limits in terms of BGLs. Depending on the individuals care plans, BSLs may need to be done bi-daily (BD) or even before each meal (QID).

Nurses play an important role in the management and prevention of type 2 diabetes in Australia. As previously discussed, weight reductions markedly delay the onset of type 2 diabetes (Adams, 2009).  In some cases weight loss can prevent it completely, for example, Adams (2009) notes that a 5-7% weight loss can reduce the incidence of type 2 diabetes. This accompanied by 30 mins extra of daily walking can lower the incidence by 58% (Adams, 2009). As a result, early detection, multifaceted professional intervention, patient education are all necessary interventions to improve the management or prevention of type 2 diabetes. Thus the main nursing implication involved in achieving weight loss in those individuals with type 2 diabetes is the application of appropriate intervention and the need to be adept at identifying those at risk.

Nurses play an important role in ensuring patients are educated on type 2 diabetes and have the correct information so they are able to enhance their quality of life with this disease (Australian Government, 2014). By allowing the patient the full knowledge and ways to manage the disease, the patient is able to make decisions on their educated decision on future choices (Australian Government, 2014).

Optimal medication adherence improves clinical outcomes and can even lower health care costs by reducing morbidity and decreasing health care use (Lin & Ciechanowski, 2008). It is the role of the patient, health care providers and health care systems to collaboratively play a role in achieving optimal diabetes management, particularly through medication adherence (Lin & Ciechanowski, 2008). Lin & Ciechanowski, 2008, recommend including the family, where possible, during patient education of medication adherence. It is critical nurses demonstrate empathy when assessing a patients previous medication adherence, and work with them to ensure optimal patient outcomes are attained (Lin & Ciechanowski, 2008). Furthermore, simplifying the medication-taking process by utilising Webster Pak's, and where possible, reducing the number of dosage's taken a day makes medication adherence easier to maintain (Lin & Ciechanowski, 2008). Communication between all health care professionals involved in the patient's care and education on medication adherence is essential education in the process of attaining ideal health outcomes (Lin & Ciechanowski, 2008).

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Type 2 Diabetes Mellitus (T2DM) is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas (Diabetes Australia, 2015). The cause of T2DM is unknown, however as Diabetes Australia (2015) identified there are both modifiable (lifestyle) and non-modifiable (genetics) risk factors. Lifestyles factors that greatly increase the risk of developing T2DM include high blood pressure, obesity or being overweight, sedentary life and poor diet (Diabetes Australia, 2015). Genetic risk factors include, family history of diabetes, old age and having an Aboriginal or Torres Strait Islander background (Diabetes Australia, 2015). Diabetes Australia (2015) also identified an increased risk of T2DM occurs in women who have given birth to a child over 4.5 kilograms, experienced gestational diabetes when pregnant, or have Polycystic Ovarian Syndrome. T2DM can be managed with regular physical activity, improved diet and weight reduction (Diabetes Australia, 2015); as T2DM is a progressive condition, Fonseca (2010) notes, that oral medications and/or insulin injections may be required in conjunction with such lifestyle changes.

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Medication
There are a variety of pharmacological and non-pharmacological strategies commonly used to reduce blood pressure (BP) in patients with, or at risk of suffering hypertension (National Heart Foundation of Australia, 2010). Proven non-pharmacological BP lowering strategies include regular physical activity, smoking cessation, dietary modification (limit salt intake <4mg/day), weight reduction (waist circumference < 94 cm (males); < 80 cm (females), BMI < 25 kg/m2) and limiting alcohol intake (National Heart Foundation of Australia, 2010). Pharmacological strategies include the use of a variety of antihypertensive medications either independently or together in combination therapy (National Heart Foundation of Australia, 2010; Cooper-Dehoff et al., 2010). Angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists, calcium channel blockers, thiazide diuretics and beta-blockers are the most common classes of antihypertensive medications used (National Heart Foundation of Australia, 2010). See Figures 3 and 4  for general guidelines on initial and maintenance drug treatment of hypertension (National Heart Foundation of Australia, 2010).

Individuals with type 2 Diabetes Mellitus (T2DM) are at an increased risk of developing cardiovascular disease including stroke, coronary heart disease, peripheral arterial disease and renovascular disease, compared with individuals who do not suffer T2DM, as illustrated in Figure 1 (National Heart Foundation of Australia, 2010; The Australian Government Department of Health, 2015). Furthermore, cardiovascular disease is the most common cause of death in people who suffer T2DM (Merlotti, Morabito & Pontiroli, 2014).

General clinical guidelines suggest maintaining a systolic BP of <130 in individuals with T2DM to reduce chance of experiencing cardiovascular events (Cooper-Dehoff et al., 2010; The ACCORD Study Group, 2010).

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Blood pressure lowering strategies have the most positive impact on preventing co-morbidity and mortality in people with Type II diabetes in Australia. Agree/Disagree. Discuss the nursing implications for your position utilising evidence based research. 

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Blood pressure lowering strategies have the most positive impact on preventing co-morbidity and mortality in people with Type II diabetes in Australia. Agree/Disagree. Discuss the nursing implications for your position utilising evidence based research. 